VoICE Immunization Evidence: Cost of treating illness
Cost of treating illness
Introduction of new vaccines and/or strengthening existing immunization programs provide opportunities for significant reductions in disease burden with resultant economic benefits.
In 41 Gavi-eligible countries, it is estimated that without any rotavirus vaccine (RVV) coverage, an estimated 2.2 million Catastrophic Health Costs (CHC) cases and 600,000 Medical Impoverishment (MI) cases would occur due to rotavirus gastroenteritis. Unfortunately these figures would not significantly decrease under the current immunization forecasts because very few countries have introduced the RVV. However, with the introduction of RVV the number of CHC cases would drop to 1.3 million and MI cases to 400,000, representing a 40% reduction.
Expanding vaccine coverage would improve household financial well-being by increasing disposable income that could further improve living conditions
It is estimated that under current vaccine coverage trends in 41 Gavi-eligible countries, enhanced Gavi funding would help to avoid out-of-pocket health expenditures in an amount that surpasses US$4.5 billion attributable to measles, US$168 million attributable to severe pneumococcal disease, and US$200 million attributable to severe rotavirus.
Immunization can offer some financial protection against significant illness treatment costs among the poor.
A study looking at the impact of pneumococcal vaccine introduction and scaling up pneumonia treatment in Ethiopia found that 30-40% of all deaths averted by these interventions would be expected to occur in the poorest wealth quintile. The greatest resulting financial risk protection would also be concentrated among the bottom income quintile.
In a financial risk model analysis of 41 Gavi-eligible countries, the burden of Catastrophic Health Costs (CHC) and Medical Impoverishment (MI) would be greatest in the lowest income populations. With expanded vaccine coverage, the share of prevented cases of measles, pneumococcal disease, and rotavirus, in relation to the total number of cases prevented, would be larger in the lowest income populations thereby providing a larger financial risk protection (FRP) to these populations.
Illness episodes can cause catastrophic health expenditures to a household, both medical and non-medical out-of-pocket expenditures.
A study in Bangladesh found that families are heavily borrowing or losing assets to be able to bear the cost of pneumonia in their children <5 years of age.
Costs for treatment for rotavirus at a large urban hospital in Malaysia led one third of families to experience catastrophic health expenditures (CHC). When direct and indirect costs of treating rotavirus were considered, almost 9 in 10 families spent more than 10% of their monthly household income on treating rotavirus. In addition, 6% of families were pushed into poverty after paying for treatment.
Children with rotavirus experience longer hospital stays than children with non-rotavirus diarrhea. In a study looking at the direct and indirect costs of treating rotavirus in Malaysia, rotavirus hospitalizations cost families 26% of their average total monthly household income, which was significantly higher than the cost for non-rotavirus diarrhea hospitalizations.
In a 2002 study from Cambodia, households with a dengue patient had to borrow money at high interest rates and lose productive assets (land) to repay debts linked to healthcare costs. Public healthcare cost significantly less than private healthcare but was either not present where people lived or did not have a good reputation.
In 41 Gavi-eligible countries it is estimated that, in the absence of any measles vaccine use, approximately 18.9 million households would have Catastrophic Health Costs (CHC) attributable to measles. The number of CHC decreases to 3.4 million households in these countries if the current vaccine coverage forecasts is unchanged and decreases to 2.6 million cases if coverage was enhanced with Gavi support. Overall, optimizing vaccine coverage for measles can reduce by approximately 90% the incidence of CHC due to measles disease.
Families and caretakers may experience acute or lasting loss of wages associated with caring for a child ill with, or permanently disabled by, a vaccine-preventable disease.
Among families participating in a study in Western Cape, South Africa, 35% of mothers who were previously employed stopped working to care for children who had survived tuberculosis meningitis with permanent disabilities. 19% of families reported experiencing financial loss as a result of caring for these disabled children.
Treatment of vaccine-preventable disease carries a heavy financial toll for health systems and for families.
In a study in The Gambia – a setting where healthcare is free of charge to patients – pneumococcal disease nonetheless placed a heavy financial burden on families seeking treatment before arrival at the hospital, with families paying for transportation costs, drugs, diagnostic tests and even burial in the case of death. 50-80% of the cost of treating an episode of pneumococcal disease was born by the health system, which still left families to cover a cost up to 10 times their average daily household budget. In addition the estimated treatment cost for inpatient pneumonia of US$109 is nearly 4 times the annual per capita expenditure for health in The Gambia.
In Malawi, in 17% of cases where children were admitted to the hospital, and in 9% of cases where children were treated as outpatients for diarrhea, household costs associated with treating that episode, exceeded monthly income in a significant number of cases. The costs were significant enough to push families from each income level below the national poverty line for the month in which the illness occurred.
Researchers estimate that vaccinating against 10 diseases in the world’s 94 poorest countries between 2011-2020 will avert US$586 billion in costs of illness (including treatment costs, transportation costs, lost caretaker wages and productivity losses due to death and disability). The 73 Gavi-supported countries account for US$544 billion of the treatment costs averted.