Harvard T.H. Chan School of Public Health, Center for Health Decision Science, 718 Huntington Avenue 2nd Floor, Boston, MA, 02115, USA.
Thinkwell, Washington, DC, USA.
Pharmacoeconomics. 2020 Sep;38(9):995-1005. doi: 10.1007/s40273-020-00930-6.
To plan for the financial sustainability of immunization programs and make informed decisions to improve immunization coverage and equity, decision-makers need to know how much these programs cost beyond the cost of the vaccine. Non-vaccine delivery cost estimates can significantly influence the cost-effectiveness estimates used to allocate resources at the country level. However, many low- and middle-income countries (LMICs) do not have immunization delivery unit cost estimates available, or have estimates that are uncertain, unreliable, or old. We undertook a Bayesian evidence synthesis to generate country-level estimates of immunization delivery unit costs for LMICs.
From a database of empirical immunization costing studies, we extracted estimates of the delivery cost per dose for routine childhood immunization services, excluding vaccine costs. A Bayesian meta-regression model was used to regress delivery cost per dose estimates, stratified by cost category, against a set of predictor variables including country-level [gross domestic product per capita, reported diphtheria-tetanus-pertussis third dose coverage (DTP3), population, and number of doses in the routine vaccination schedule] and study-level (study year, single antigen or programmatic cost per dose, and financial or economic cost) predictors. The fitted prediction model was used to generate standardized estimates of the routine immunization delivery cost per dose for each LMIC for 2009-2018. Alternative regression models were specified in sensitivity analyses.
We estimated the prediction model using the results from 29 individual studies, covering 24 countries. The predicted economic cost per dose for routine delivery of childhood vaccines (2018 US dollars), not including the price of the vaccine, was $1.87 (95% uncertainty interval $0.64-4.38) across all LMICs. By individual cost category, the programmatic economic cost per dose for routine delivery of childhood vaccines was $0.74 ($0.26-1.70) for labor, $0.26 ($0.08-0.67) for supply chain, $0.22 ($0.06-0.57) for capital, and $0.65 ($0.20-1.66) for other service delivery costs.
Accurate immunization delivery costs are necessary for assessing the cost-effectiveness and strategic planning needs of immunization programs. The cost estimates from this analysis provide a broad indication of immunization delivery costs that may be useful when accurate local data are unavailable.
为了规划免疫规划的财务可持续性，并做出明智的决策以提高免疫覆盖率和公平性，决策者需要了解这些规划的疫苗以外的成本。非疫苗接种成本估算可能会极大地影响用于在国家层面分配资源的成本效益估算。然而，许多低收入和中等收入国家（LMICs）没有免疫接种交付单位成本估算，或者估算结果不确定、不可靠或陈旧。我们进行了贝叶斯证据综合分析，以生成 LMIC 免疫接种交付单位成本的国家估算。
我们从免疫成本研究数据库中提取了常规儿童免疫服务每剂量接种成本的估算值，不包括疫苗成本。使用贝叶斯荟萃回归模型，根据成本类别对每剂量接种成本估算值进行回归，预测变量包括国家层面的（人均国内生产总值、报告的白喉-破伤风-百日咳三联疫苗第三剂覆盖率（DTP3）、人口和常规免疫接种计划中的剂量数）和研究层面的（研究年份、单抗原或方案成本每剂量和财务或经济成本）。使用拟合的预测模型，为 2009-2018 年的每个 LMIC 生成常规免疫接种交付成本的标准化估算值。在敏感性分析中指定了替代回归模型。
我们使用 29 项个别研究的结果来估计预测模型，涵盖 24 个国家。包括疫苗价格在内，常规儿童疫苗接种的预测经济接种成本（2018 年美元）为所有 LMIC 每剂量 1.87 美元（95%不确定性区间 0.64-4.38 美元）。按个别成本类别计算，常规儿童疫苗接种的程序性经济接种成本为每剂量 0.74 美元（0.26-1.70 美元）用于劳动力，0.26 美元（0.08-0.67 美元）用于供应链，0.22 美元（0.06-0.57 美元）用于资本，0.65 美元（0.20-1.66 美元）用于其他服务交付成本。
准确的免疫接种交付成本是评估免疫规划成本效益和战略规划需求的必要条件。本分析中的成本估算提供了免疫接种交付成本的广泛指示，在无法获得准确的本地数据时可能有用。
