Federici Carlo, Verykiou Maria, Cavazza Marianna, Olomi Willyhelmina, Irakiza Piero, Kayumba Kizito, Rodriguez Edith, Castillo Mendoza Luis Enrique, Malvolti Stefano, Hugo Claire, Ntinginya Nyanda Elias, Camara Souleymane, Sabi Issa, Sano Nagnouma, Sibomana Hassan, Condo Jeanine, Torbica Aleksandra, Jommi Claudio, Mantel Carsten, Mangiaterra Viviana
Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Via Sarfatti 10, Milano, 20136, Italy.
NIMR Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania.
J Med Internet Res. 2025 Aug 18;27:e62746. doi: 10.2196/62746.
Digital health interventions, such as electronic immunization registries (eIRs) and electronic logistic management information systems (eLMIS), have the potential to significantly improve immunization data management and vaccine logistics in low- and middle-income countries (LMICs). Despite their growing adoption, there is limited evidence of the financial and economic costs associated with their implementation compared to traditional paper-based systems.
We aimed to measure the costs of implementing eIR and eLMIS systems in LMICs and to estimate their economic costs as compared to the previous paper-based registries.
The study was conducted across four countries-Guinea, Honduras, Rwanda, and Tanzania-which implemented the tools in 2018, 2012, 2019, and 2014, respectively. A combination of primary and secondary data sources was used for the analysis. Retrospective cost data regarding the design, development, and implementation of the tools were directly obtained from implementers and National Immunization Program offices in all countries. Primary survey data were collected to gauge the operational expenses of immunization information systems, both with and without electronic tools, using an activity-based costing approach in 275 facilities. The annual cost of the immunization information system at the national level was then extrapolated and compared to national spending on immunization as a measure of affordability. Costs were reported in 2023 international dollars (I$).
The total costs of designing, developing, and deploying eIR, eLMIS, or both were I$ 2.2, 6.4, 6.8, and 44.3 million in Guinea, Honduras, Rwanda, and Tanzania, respectively. Design costs were greatly affected by the degree of customization of the tool, whereas rollout costs were mostly driven by the costs of purchasing hardware and training health workers. Overall, the implementation of the electronic systems was associated with higher costs in Honduras (I$626 per facility, 95% CI 516-821) and Rwanda (I$399, 95% CI I$108-I$691), a cost reduction in Tanzania (-I$2539, 95% CI -I$4290 to -I$789) and no significant cost difference in Guinea. The percentage weight of the cost of managing data with the electronic systems over the total national immunization budgets was estimated at 0.7%, 7.7%, 3.3%, and 4.8% for Guinea, Honduras, Rwanda, and Tanzania, respectively.
Digital health interventions such as eIR and eLMIS can potentially reduce costs and improve the efficiency of immunization data management and vaccine logistics in LMICs. However, the extent of cost savings depends on how effectively these digital systems replace traditional paper-based methods and the extent of their use in decision-making, especially at the facility level. Careful planning and investment are essential to unlocking the full economic potential of digital health in LMICs.
数字健康干预措施，如电子免疫登记系统（eIRs）和电子物流管理信息系统（eLMIS），有潜力显著改善低收入和中等收入国家（LMICs）的免疫数据管理和疫苗物流。尽管它们的采用率不断提高，但与传统纸质系统相比，关于其实施相关的财务和经济成本的证据有限。
我们旨在衡量在低收入和中等收入国家实施电子免疫登记系统和电子物流管理信息系统的成本，并估计与之前的纸质登记系统相比它们的经济成本。
该研究在四个国家开展——几内亚、洪都拉斯、卢旺达和坦桑尼亚，这四个国家分别于2018年、2012年、2019年和2014年实施了这些工具。分析使用了主要和次要数据源的组合。关于这些工具设计、开发和实施的回顾性成本数据直接从所有国家的实施者和国家免疫规划办公室获取。使用基于活动的成本核算方法，在275个设施中收集主要调查数据，以衡量有无电子工具情况下免疫信息系统的运营费用。然后推断国家层面免疫信息系统的年度成本，并与国家免疫支出进行比较，以此作为可承受性的衡量标准。成本以2023年国际美元（I$）报告。
在几内亚、洪都拉斯、卢旺达和坦桑尼亚，设计、开发和部署电子免疫登记系统、电子物流管理信息系统或两者的总成本分别为220万、640万、680万和4430万国际美元。设计成本受工具定制程度的影响很大，而推广成本主要由购买硬件和培训卫生工作者的成本驱动。总体而言，电子系统的实施在洪都拉斯（每个设施626国际美元，95%CI 516 - 821）和卢旺达（399国际美元，95%CI 108 - 691国际美元）带来了更高的成本，在坦桑尼亚成本降低（-2539国际美元，95%CI -4290至-789国际美元），在几内亚没有显著的成本差异。对于几内亚、洪都拉斯、卢旺达和坦桑尼亚，使用电子系统管理数据的成本在国家免疫总预算中的占比分别估计为0.7%、7.7%、3.3%和4.8%。
诸如电子免疫登记系统和电子物流管理信息系统等数字健康干预措施有潜力降低成本，并提高低收入和中等收入国家免疫数据管理和疫苗物流的效率。然而，成本节约的程度取决于这些数字系统有效取代传统纸质方法的程度以及它们在决策中，特别是在设施层面的使用程度。精心规划和投资对于释放低收入和中等收入国家数字健康的全部经济潜力至关重要。
