Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205 USA.
Centre for Equity & Health Systems, icddr,b, 68 Shahed Tajuddin Ahmed, Sarani, Mohakhali, Dhaka 1212, Bangladesh.
Vaccine. 2014 Apr 25;32(20):2294-9. doi: 10.1016/j.vaccine.2014.02.075. Epub 2014 Mar 12.
To estimate the incremental economic costs and explore satisfaction with a highly effective intervention for improving immunization coverage among slum populations in Dhaka, Bangladesh. A package of interventions based on extended clinic hours, vaccinator training, active surveillance, and community participation was piloted in two slum areas of Dhaka, and resulted in an increase in valid fully immunized children (FIC) from 43% pre-intervention to 99% post-intervention.
Cost data and stakeholder perspectives were collected January-February 2010 via document review and 10 key stakeholders interviews to estimate the financial and opportunity costs of the intervention, including uncompensated time, training and supervision costs.
The total economic cost of the 1-year intervention was $18,300, comprised of external management and supervision (73%), training (11%), coordination costs (1%), uncompensated staff time and clinic costs (2%), and communications, supplies and other costs (13%). An estimated 874 additional children were correctly and fully immunized due to the intervention, at an average cost of $20.95 per valid FIC. Key stakeholders ranked extended clinic hours and vaccinator training as the most important components of the intervention. External supervision was viewed as the most important factor for the intervention's success but also the costliest. All stakeholders would like to reinstate the intervention because it was effective, but additional funding would be needed to make the intervention sustainable.
Targeting slum populations with an intensive immunization intervention was highly effective but would nearly triple the amount spent on immunization per FIC in slum areas. Those committed to increasing vaccination coverage for hard-to-reach children need to be prepared for substantially higher costs to achieve results.
估算为提高孟加拉国达卡贫民窟人群的免疫覆盖率而采取高效干预措施的额外经济成本，并探讨相关满意度。在达卡的两个贫民窟地区试点了一套干预措施，包括延长诊所工作时间、对防疫员进行培训、开展主动监测和社区参与，结果使合格完全免疫儿童（FIC）的比例从干预前的 43%增加到干预后的 99%。
2010 年 1 月至 2 月，通过文件审查和对 10 名利益攸关方进行访谈收集成本数据和利益攸关方观点，以估算干预措施的财务和机会成本，包括无偿时间、培训和监督成本。
为期 1 年的干预措施总成本为 18300 美元，包括外部管理和监督（73%）、培训（11%）、协调费用（1%）、无偿员工时间和诊所费用（2%）以及通信、供应品和其他费用（13%）。由于该干预措施，估计有 874 名额外儿童得到正确和完全免疫，每名合格 FIC 的平均成本为 20.95 美元。利益攸关方将延长诊所工作时间和培训防疫员列为干预措施的最重要组成部分。外部监督被视为干预成功的最重要因素，但也是最昂贵的因素。所有利益攸关方都希望恢复该干预措施，因为它是有效的，但需要额外资金使干预措施可持续。
针对贫民窟人群开展强化免疫干预措施非常有效，但会使贫民窟地区每名 FIC 的免疫支出增加近两倍。那些致力于提高难以接触到的儿童疫苗接种覆盖率的人需要为实现目标做好准备，因为这需要付出更高的成本。
