ThinkWell, Geneva, Switzerland.
ThinkWell, Washington, D.C., USA.
BMC Health Serv Res. 2024 Nov 1;24(1):1334. doi: 10.1186/s12913-024-11809-z.
To improve the efficient use of scarce resources, low- and middle-income countries and development partners are increasingly encouraged to deliver multiple vaccines and other interventions in a single integrated campaign. However, little is known regarding the cost of delivering vaccines through integrated campaigns, and the extent to which efficiencies are achieved. To fill this evidence gap, we estimated the cost of integrated immunization campaigns in Nigeria and Sierra Leone, and the potential savings from integration.
We conducted a retrospective ingredients-based costing study from a payer perspective of a campaign held in 2019 in Sierra Leone with measles-rubella vaccine and oral polio vaccine, during which nutrition supplements were also offered in part of the country, and yellow fever campaigns held in three states in Nigeria in 2019 and 2020, where in one state (Anambra) meningococcal A vaccines were co-delivered. We collected data from 108 health facilities, all relevant administrative levels, and implementing partners. We estimated the full financial and economic cost of each campaign, the average unit cost of delivery, as well as the cost by activity and resource type. We also estimated the cost savings from integration in Anambra state by modelling out the cost of the alternative of two standalone campaigns.
The average financial delivery cost was $0.34 per dose in Sierra Leone, and the economic cost was $0.73 per dose. In Nigeria, the financial cost per dose was $0.29-$0.35 across the three states, and the economic cost per dose was $0.62-$0.85. Facilities and wards delivering more doses achieved a lower financial and economic unit cost of delivery, demonstrating evidence of economies of scale. We estimated that Anambra may have saved at least $1,204,133 in financial resources by integrating yellow fever and meningitis A vaccine delivery, amounting to $0.17 per dose delivered. When including opportunity costs, the economic cost saving was estimated at $0.34 per dose delivered.
The study offers evidence on what it costs to deliver integrated campaigns, and shows that integrated delivery is likely to result in significant cost savings. Where high delivery volumes can be achieved, integrated campaigns can benefit from economies of scale. The findings can be used to inform planning and budgeting for immunization campaigns in low- and middle-income countries.
为了提高稀缺资源的使用效率，中低收入国家和发展伙伴越来越多地被鼓励在一次综合活动中提供多种疫苗和其他干预措施。然而，对于通过综合运动来提供疫苗的成本，以及实现效率的程度，人们知之甚少。为了填补这一证据空白，我们估算了尼日利亚和塞拉利昂综合免疫运动的成本，以及整合带来的潜在节省。
我们从付款人的角度对 2019 年在塞拉利昂举行的一场运动进行了回顾性成本核算研究，该运动提供了麻疹-风疹疫苗和口服脊髓灰质炎疫苗，期间该国部分地区还提供了营养补充剂，以及 2019 年和 2020 年在尼日利亚三个州举行的黄热病运动，其中在一个州（阿南布拉）同时提供了脑膜炎 A 疫苗。我们从 108 个卫生机构、所有相关行政级别和实施伙伴那里收集了数据。我们估算了每个运动的全部财务和经济成本、平均单位交付成本，以及按活动和资源类型计算的成本。我们还通过模拟两个独立运动的替代方案的成本，估算了阿南布拉州整合带来的成本节约。
塞拉利昂每剂疫苗的平均财务交付成本为 0.34 美元，经济成本为 0.73 美元。在尼日利亚，三个州的每剂疫苗的财务成本为 0.29-0.35 美元，经济成本为 0.62-0.85 美元。提供更多剂量的设施和病房实现了更低的财务和经济单位交付成本，证明了规模经济的存在。我们估计，阿南布拉州通过整合黄热病和脑膜炎 A 疫苗接种，至少可以节省 1204133 美元的财务资源，相当于每剂 0.17 美元。当包括机会成本时，预计每剂节省的经济成本为 0.34 美元。
该研究提供了关于综合运动提供成本的证据，并表明综合交付可能会带来显著的成本节约。在能够实现高交付量的地方，综合运动可以受益于规模经济。研究结果可用于为中低收入国家的免疫运动提供规划和预算编制参考。
