VoICE Immunization Evidence: Return on investment
Return on investment
The greatest cost savings to be had by introducing new vaccines and increasing immunization coverage would occur in countries and regions with high disease burden and/or large populations
Key Evidence: The first study of the cost-effectiveness of typhoid conjugate vaccines found that routinely immunizing infants at 9 months of age would actually save costs in 2 settings (Delhi, India and a rural area of Vietnam), due to high incidence or high hospitalization rates, and would be cost-effective in the study’s 3 other sites (in India and Kenya). Adding a one-time catch-up campaign for various older age groups would still save costs in the Delhi and Vietnam, and increase the cost-effectiveness in the others, making it economically justifiable.
From the VoICE Editors: The study incorporated herd effects into its model, looked only at the perspective of healthcare payers and assumed the use of a single dose vaccine at 1 international dollar.
Key Evidence: In a modeled analysis of the economic impact of vaccine use in the world’s 72 poorest countries, for countries included in the analyses from the African region, scaling up coverage of the Rotavirus (RVV) vaccine to 90% was projected to result in more than US$900 million in treatment costs averted.
The interruption of disease outbreaks through vaccination can yield a significant return on investment.
Key Evidence: Considering both the direct and indirect costs, researchers in the Netherlands estimated that the preventative immunization of Dutch healthcare workers (HCW) against pertussis (to reduce exposure and transmission contributing to outbreaks) results in a return on investment of 4 Euros to every 1 euro invested. This projection assumes an outbreak of pertussis once every 10 years.
Key Evidence: In a study of a 2003 outbreak of pertussis in the US, including 17 cases among healthcare workers, researchers estimated that vaccinating healthcare workers would result in a 2.4-fold return on investment for hospitals.
Vaccination programs such as those for Rotavirus have shown a significant short-term return on investment.
Key Evidence: A series of studies in the U.S. estimated that the average savings in direct healthcare costs from rotavirus and acute gastroenteritis were between $121 million and $231 million per year once rotavirus vaccines were introduced.
Key Evidence: Vaccinating children against rotavirus in Bangladesh would prevent more than 50,000 outpatient visits and 40,000 hospitalizations in children under five each year, and reduce treatment costs by $5.8 million over 2 years — nearly all (96%) from fewer hospitalizations. Since this study didn’t take herd effects into account, the actual impact would likely be greater.
Key Evidence: In a UK cost-effectiveness analysis, which takes into account herd effect, the budget impact analysis demonstrated that the introduction of a rotavirus vaccine (RVV) program could pay back between 58-96% of the cost outlay for the program within the first 4 years.
Key Evidence: In an economic evaluation of vaccination against rotavirus conducted in Italy, it was shown that as early as the second year after rotavirus vaccine introduction, the vaccine cost would be more than offset by savings from prevention of disease cases and hospitalizations.
Investing in immunization programs in the world’s poorest countries yields a return significantly greater than the initial investment.
Key Evidence: A recent study estimated that, during the decade from 2011-2020, every US$1 invested in immunization programs in the world’s 73 poorest countries would yield a US$16 return on investment. Using an approach accounting for additional societal benefits of vaccination (the “full income approach”, which quantifies the value that people place on living longer and healthier lives), researchers estimated the return could be as high as US$44 per US$1 invested.
Key Evidence: Vaccination of children in the Philippines against 6 diseases was found to significantly increase IQ and language scores (compared to children receiving no vaccinations) and was estimated to have a 21% rate of return.