Scoping Review of Current Costing Literature on Interventions to Reach Zero-Dose Children in Low- and Middle-Income Countries.

A limited number of studies focus on estimating the costs of interventions to increase childhood immunization coverage in low- and middle-income countries (LMICs). Existing reviews often compare estimated costs but lack information on the methods used. The objective of this review is to summarize the methods used in costing studies that assessed interventions to reach zero-dose (ZD) children. We conducted a review of existing studies that estimate the costs of increasing childhood vaccination and reducing prevalence of ZD children in LMICs. We conducted searches of PubMed using terms including "immunization", "cost", "coverage increase", "zero-dose", and "LMIC", and further extended our search to bibliographies and gray literature from organizations working to reach ZD children. We only included articles that estimated the cost of interventions to increase childhood vaccination and/or reach ZD children and not articles about introducing new vaccines or other age groups. We categorized each article according to their costing methods, cost components, types of costs calculated, and presence of uncertainty analysis. Eleven articles met our inclusion criteria. Interventions costs varied from USD 0.08 per additional dose for SMS reminders in Kenya to USD 67 per dose for cash transfers in Nicaragua. Most of the studies were from South Asia: India (4), Pakistan (2), and Bangladesh (1). The rest were from Africa (3) and Latin America (1). Most articles did not include a description of their costing methods. Only three described their methods in detail. Few studies have estimated the costs of increasing childhood vaccination coverage and reducing the number of ZD children in LMICs. The wide variation in intervention costs underscores the need for standardized costing methodologies to enhance comparability across studies. Only three studies detailed their costing methods, making comparisons challenging. Establishing research principles for costing ZD interventions could strengthen future evidence for policymaking.