@article{6cb3dfbff3ae41e88e537ac6b518fed0,
title = "Costs of Immunization Programs for 10 Vaccines in 94 Low- and Middle-Income Countries From 2011 to 2030",
abstract = "Objectives: Understanding the level of investment needed for the 2021-2030 decade is important as the global community faces the next strategic period for vaccines and immunization programs. To assist with this goal, we estimated the aggregate costs of immunization programs for ten vaccines in 94 low- and middle-income countries from 2011 to 2030. Method: We calculated vaccine, immunization delivery and stockpile costs for 94 low- and middle-income countries leveraging the latest available data sources. We conducted scenario analyses to vary assumptions about the relationship between delivery cost and coverage as well as vaccine prices for fully self-financing countries. Results: The total aggregate cost of immunization programs in 94 countries for 10 vaccines from 2011 to 2030 is $70.8 billion (confidence interval: $56.6-$93.3) under the base case scenario and $84.1 billion ($72.8-$102.7) under an incremental delivery cost scenario, with an increasing trend over two decades. The relative proportion of vaccine and delivery costs for pneumococcal conjugate, human papillomavirus, and rotavirus vaccines increase as more countries introduce these vaccines. Nine countries in accelerated transition phase bear the highest burden of the costs in the next decade, and uncertainty with vaccine prices for the 17 fully self-financing countries could lead to total costs that are 1.3-13.1 times higher than the base case scenario. Conclusion: Resource mobilization efforts at the global and country levels will be needed to reach the level of investment needed for the coming decade. Global-level initiatives and targeted strategies for transitioning countries will help ensure the sustainability of immunization programs.",
keywords = "health financing, investment, low- and middle-income countries",
author = "Sim, {So Yoon} and Elizabeth Watts and Dagna Constenla and Shuoning Huang and Logan Brenzel and Patenaude, {Bryan N.}",
note = "Funding Information: Funding/Support: This study was funded by the Bill & Melinda Gates Foundation ( OPP1128214 ) as part of Multi Project Grant (MPG). Funding Information: Author Contributions: Concept and design: Sim, Constenla, Brenzel, Patenaude, Acquisition of data: Sim, Huang, Brenzel, Analysis and interpretation of data: Sim, Watts, Constenla, Huang, Brenzel, Patenaude, Drafting of the manuscript: Sim, Watts, Critical revision of the paper for important intellectual content: Sim, Watts, Constenla, Brenzel, Patenaude, Statistical analysis: Sim, Watts, Patenaude, Obtaining funding: Constenla, Brenzel, Patenaude, Administrative, technical, or logistic support: Sim, Huang, Supervision: Constenla, Brenzel, Patenaude, Conflict of Interest Disclosures: Dr Constenla is employed by GSK Biologicals. No other disclosures were reported. Funding/Support: This study was funded by the Bill & Melinda Gates Foundation (OPP1128214) as part of Multi Project Grant. Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Acknowledgment: We are grateful of the contributions from the costing subgroup of the Decade of Vaccines Economics Core Advisory Groups for their support in collecting data inputs, technical guidance on methodology and validation of data sources, and review of preliminary results. The costing subgroup includes Anais Colombini (Gavi, the Vaccine Alliance; Geneva, Switzerland), Tewodaj Mengistu (Gavi, the Vaccine Alliance; Geneva, Switzerland), Joe Dieleman (Institute for Health Metrics and Evaluation; Seattle, USA), Xiao Xian Huang (World Health Organization; Geneva, Switzerland), Raymond Hutubessy (World Health Organization; Geneva, Switzerland), Claudio Politi (World Health Organization; Geneva, Switzerland), and Ulla Griffiths (UNICEF, New York City, USA). We thank Samya Mandal (Gavi, the Vaccine Alliance; Geneva, Switzerland), Kim Woodruff (Imperial College London), Xiang Li (Imperial College London), Steven Kuo (University College London), and Kelsey Vaughan (ThinkWell, The Netherlands) for model inputs and guidance on data use. We thank Alice Ma (Gavi, the Vaccine Alliance) for guidance on policy implications of the results. We also thank Salin Sriudomporn (Johns Hopkins School of Public Health) for assistance with scenario analysis. This work builds on prior research at the International Vaccine Access Center by Sachiko Ozawa (University of North Carolina), Allison Portnoy (Harvard T.H. Chan School of Public Health), and Simrun Grewal (University of Washington). So Yoon Sim was employed by the Department of International Health, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland, when this work was performed. The contents of this article are solely the responsibility of the authors and do not represent the official views of WHO. Publisher Copyright: {\textcopyright} 2020 ISPOR–The Professional Society for Health Economics and Outcomes Research",
year = "2021",
month = jan,
doi = "10.1016/j.jval.2020.07.010",
language = "English (US)",
volume = "24",
pages = "70--77",
journal = "Value in Health",
issn = "1098-3015",
publisher = "Elsevier Limited",
number = "1",
}