Cost-effective

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Immunisation is one of the most cost-effective ways to save lives, improve health and ensure long-term prosperity

Public health's 'best buy'

Immunising children is one of public health's "best buys". Vaccines are relatively easy to deliver and, in most cases, provide lifelong protection. In return, they boost development through direct medical savings and indirect economic benefits such as cognitive development, educational attainment, labour productivity, income, savings and investment.

According to the State of the World's Vaccines and Immunization 2009 report, "Immunization - even with the addition of the new, more costly vaccines - remains one of the most cost-effective health interventions." 
 

In 2005, Harvard University scientists calculated that spending on Gavi's programme to expand vaccine coverage in eligible countries would deliver a rate of return of 18% by 20201 - higher than most other health interventions, and similar to primary education.
 

Although new vaccines supported by Gavi cost more than other vaccines that have long been included in national immunisation programmes, they remain cost-effective compared with many other interventions:

Cost-effectiveness and DALYs

In low-income countries, life expectancy is shorter and more lifetime is spent in poor health. To measure the lost value of a healthy life year free of illness and disability, public health refers to disability-adjusted life years or DALY's.  DALY's combine the years of life lost due to premature death (mortality) and loss of full health due to illness and disability (morbidity).

WHO's Commission on Marcroeconomics and Health has classified interventions that gain a year of healthy life (ie, a DALY averted) at a cost that is less than GDP per capita as very cost-effective.8 Those averting each DALY at a cost between one and three times the GDP per capita are cost effective.

A 2006 study estimated the cost per DALY averted with the traditional EPI vaccines ranges from US$ 7 to US$ 438 The cost per death averted ranges from US$ 205 in South Asia and Sub-Saharan Africa to US$ 3,540 in Europe and Central Asia.9 

Hepatitis B

A review of economic evaluations found that universal immunisation against hepatitis B in intermediate and high-endemic countries is cost-effective or even cost-saving in comparison to no vaccination.2 

Hib and pneumococcal

The majority of economic evaluations of Haemophilus influenzae type b vaccines conclude that the vaccine is a cost-effective intervention.3 A 2007 study estimated that at a price of US$ 5 per dose, pneumococcal vaccines are a very cost-effective intervention in 68 of the poorest countries.4 

Rotavirus

According to a 2009 study, at an initial price of US$ 7 per dose, which gradually decreases over time to US$ 1.25 per dose by 2017, vaccination with rotavirus vaccines would be very cost-effective in all Gavi-eligible countries.5 

Vaccine affordability

The cost-effectiveness of immunisation has made vaccines increasingly affordable for low-income countries. Tellingly, the percentage of low-income countries dedicating a separate line item for vaccines within their national budgets rose from 64% in 2000 to 75% in 2006.6 

All low-income countries are largely dependent on external support to finance vaccination, but a recent analysis found that on average the share of government financing of routine immunisation in low-income countries has increased from 35% to 39% between 2000 and 2008.7 This should be seen in the context of a significant increase in the overall cost of vaccines.

Vaccines boost economic growth in poorest countries

'Value of Vaccination' study, which argues long-term benefits of immunisation should be measured in economic terms not only lives saved, estimates an 18% rate of return on Gavi investments by 2020.

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WHO/Alejandro Costa

1 Harvard School of Public Health study 2005, http://www.hsph.harvard.edu/news/press-releases/archives/2005-releases/press10142005.html 

2 Tu HT, Woerdenbag HJ, Kane S, Riewpaiboon A, van Hulst M, Postma MJ. Economic evaluations of hepatitis B vaccination for developing countries. Expert Rev Vaccines. 2009 Jul; 8(7):907-20.

3 Griffiths UK, Miners A. Economic evaluations of Haemophilus influenzae type b vaccine: systematic review of the literature. Expert Review Pharmacoecon Outcomes Res. 2009 Aug; 9(4):333-46

4 Sinha A, Levine O, Knoll MD, Muhib F, Lieu TA. Cost-effectiveness of pneumococcal conjugate vaccination in the prevention of child mortality: an international economic analysis. Lancet. 2007 Feb 3; 369(9559):389-96.

5 Atherly D, Dreibelbis R, Parashar UD, Levin C, Wecker J, Rheingans RD. Rotavirus vaccination: cost-effectiveness and impact on child mortality in developing countries. J Infect Dis. 2009 Nov 1; 200(Supp 1):S28-38.

6 Lydon P, Beyai Pl, Chaudhri I, Cakmak N, Satoulou A, Dumolard L. Government financing for health and specific national budget lines: the case of vaccines and immunization. Vaccine. 2008 Dec 2; 26(51):6727-34.

7 Ibid.

8 Walker DG, Hutubessy R, Beutels P. WHO guide for standardisation of economic evaluations of immunizations programmes. Vaccine. 2010 Mar 8; 28(11):2356-9. Epub 2009 Jun 28.

9 Brenzel L, Wolfson LJ, Fox-Rushby J, Miller M, Halsey NA. Vaccine-Preventable Disease. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, et al, editors. Disease Control Priorities in Developing Countries. 2nd edition. New York: Oxford University Press; 2006. P. 389-412.

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