An outreach strategy in Kenya to vaccinate children against measles in hard-to-reach areas (e.g., beyond 5 km from a vaccination post) would be highly cost-effective, despite the higher cost per child to reach these children. The estimated cost per DALY averted ranged from US$122 (if 50% of these children receive the first dose and one-half of them the second dose) to US$274 (if 100% receive the first dose) — considerably less than the country’s GDP per capita of US$1,865 used as the threshold of cost-effectiveness.
Economics & Return on Investment
A measles outbreak can be costly for national governments
A measles outbreak in the Federated States of Micronesia (FSM) in 2014, causing nearly 400 confirmed cases, cost nearly US$4 million (around US$10,000 per case), 88% of which was for a mass vaccination campaign, outbreak investigations, and other containment costs. While the U.S. government covered 2/3 of the costs, the economic burden to FSM — in labor and other costs of containing the outbreak, the direct costs of illness, and productivity losses — were the equivalent of the country’s entire education budget for one year.
Rotavirus hospitalizations cause significant economic burden due to work and school absenteeism
Children hospitalized with rotavirus in Norway were absent from daycare for 6.3 days, on average, and 73% of their parents missed work — for a mean of almost 6 days. These data, which can be used in economic evaluations of rotavirus vaccination, show that work absenteeism resulting from having a child hospitalized with rotavirus poses a considerable economic burden on society.
Vaccination of infants against pneumonia greatly reduces hospitalizations, saving millions in healthcare costs
In a study using actual data on hospitalizations and costs before and after PCV-10 vaccine was introduced in Brazil, an estimated 463,000 hospitalizations from all causes of pneumonia were prevented in persons less than 65 years of age over 5 years following introduction of the vaccine — saving an estimated US$147 million in hospitalization costs. Half of the costs averted were due to fewer hospitalizations in children under five, who were targeted for the vaccine, while the remaining half were due to fewer hospitalizations in persons 5-49 years of age, as a result of herd protection.
Vaccinating infants with PCV also reduced disease and hospitalizations in older individuals
The cost-effectiveness of vaccinating infants with PCV-13 in China was estimated to be 21 times greater when the indirect effects of vaccination in reducing invasive pneumococcal disease and hospitalized cases of pneumonia in older (unvaccinated) individuals was taken into account — with costs per quality of life-year gained (QALY) of around US$564 (Y3,777) vs. $11,836 (Y79,204) when only the direct impact on vaccinated children is considered.
Immunizing children against rotavirus saves money and prevents hospitalizations and outpatient visits
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 US$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.
Travel distance can become a barrier to vaccine access for women seeking neonatal care
An study using GIS to quantify the percent of pregnant women in Mozambique without access to tetanus toxoid (TT) vaccine at varying distances from health facilities estimated that if women cannot travel more than 5 km to a TT immunization site there will be almost 18,000 neonatal tetanus cases each year that could be prevented, costing the country more than US$362 million in treatment costs and lost productivity. Covering 99% of women with TT will currently require people to travel up to 35 km to obtain an immunization.
Immunizing infants and older age groups against typhoid can save costs and be economically justifiable
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 Delhi and Vietnam, and increase the cost-effectiveness in the others, making it economically justifiable.
Immunization against rotavirus and gastroenteritis saves millions of dollars in healthcare costs each year
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.
Rotavirus vaccination prevents hospitalizations, ER visits, and outpatient visits, saving millions of dollars in healthcare costs nationally
A study of insurance claims in the U.S. for children under five estimated that, from 2007 to 2011, rotavirus vaccination prevented more than 176,000 hospitalizations, 242,000 emergency room visits and more than 1.1 million outpatient visits due to diarrhea — saving an estimated $924 million in direct health care costs over four years.