Brenzel Logan
Bill & Melinda Gates Foundation, Vaccine Delivery, 4929 Chevy Chase Blvd, Chevy Chase, MD 20815, United States.
Vaccine. 2015 May 7;33 Suppl 1:A93-8. doi: 10.1016/j.vaccine.2014.12.076.
Immunization is one of the most cost-effective health interventions, but as countries introduce new vaccines and scale-up immunization coverage, costs will likely increase. This paper updates estimates of immunization costs and financing based on information from comprehensive multi-year plans (cMYPs) from GAVI-eligible countries during a period when countries planned to introduce a range of new vaccines (2008-2016).
The analysis database included information from baseline and 5-year projection years for each country cMYP, resulting in a total sample size of 243 observations. Two-thirds were from African countries. Cost data included personnel, vaccine, injection, transport, training, maintenance, cold chain and other capital investments. Financing from government and external sources was evaluated. All estimates were converted to 2010 US Dollars. Statistical analysis was performed using STATA, and results were population-weighted.
Results pertain to country planning estimates. Average annual routine immunization cost was $62 million. Vaccines continued to be the major cost driver (51%) followed by immunization-specific personnel costs (22%). Non-vaccine delivery costs accounted for almost half of routine program costs (44%). Routine delivery cost per dose averaged $0.61 and the delivery cost per infant was $10. The cost per DTP3 vaccinated child was $27. Routine program costs increased with each new vaccine introduced. Costs accounted for 5% of government health expenditures. Governments accounted for 67% of financing.
Total and average costs of routine immunization programs are rising as coverage rates increase and new vaccines are introduced. The cost of delivering vaccines is nearly equivalent to the cost of vaccines. Governments are financing greater proportions of the immunization program but there may be limits in resource scarce countries. Price reductions for new vaccines will help reduce costs and the burden of financing. Strategies to improve efficiency in service delivery should be pursued.
免疫接种是最具成本效益的卫生干预措施之一，但随着各国引入新疫苗并扩大免疫接种覆盖范围，成本可能会增加。本文根据全球疫苗免疫联盟（GAVI）合格国家在计划引入一系列新疫苗的时期（2008 - 2016年）的综合多年计划（cMYP）中的信息，更新了免疫接种成本和融资的估计。
分析数据库包括每个国家cMYP基线和5年预测年的信息，总样本量为243个观测值。三分之二来自非洲国家。成本数据包括人员、疫苗、注射、运输、培训、维护、冷链和其他资本投资。评估了政府和外部来源的融资情况。所有估计值均换算为2010年美元。使用STATA进行统计分析，结果进行了人口加权。
结果涉及国家规划估计。常规免疫接种的年均成本为6200万美元。疫苗仍然是主要成本驱动因素（51%），其次是免疫接种特定人员成本（22%）。非疫苗交付成本占常规计划成本的近一半（44%）。每剂常规交付成本平均为0.61美元，每名婴儿的交付成本为10美元。每剂三联疫苗（DTP3）接种儿童的成本为27美元。随着每一种新疫苗的引入，常规计划成本都会增加。成本占政府卫生支出的5%。政府占融资的67%。
随着覆盖率的提高和新疫苗的引入，常规免疫接种计划的总成本和平均成本都在上升。疫苗交付成本几乎与疫苗成本相当。政府为免疫接种计划提供了更大比例的资金，但在资源稀缺的国家可能存在限制。新疫苗降价将有助于降低成本和融资负担。应推行提高服务交付效率的策略。
