Cost-effectiveness and economic benefits of vaccines in low- and middle-income countries: A systematic review
Highlights
► Reviews the economic benefits of adult and childhood vaccines in developing countries. ► Identified 108 articles from 51 countries covering 23 vaccines. ► 44 articles reported cost per disability-adjusted life years (DALY) averted. ► Vaccines cost less than $100 ($500) per DALY averted in 52% (77%) of articles. ► Few studies measure the long-term and societal economic benefits from vaccination.
Introduction
While vaccines are considered to be a cost-effective public health intervention, introduction and scale-up have become increasingly challenging. Governments in low- and middle-income countries and the international donor community face growing pressures on how to allocate their scarce resources and choose among many competing priorities. As the scope and costs of new vaccines continue to grow, economic evidence is likely to play an increasingly important role in decisions to introduce and sustain vaccination.
Vaccines may bring economic benefits beyond just health gains and there may be various pathways for these benefits to accrue. Unlike other health interventions, studies find that vaccines avert illness both directly through immunization and indirectly through herd immunity [1]. Both types of prevention can lead to a healthier, more productive population that can contribute more toward a country's economic development [2]. For example, by averting illness directly, households with vaccinated children can save medical costs and parents may take fewer days off of work to care for sick children [3]. By averting disabilities, some vaccines may prevent delays in cognitive development and may also improve school enrollment and attainment [4]. By averting deaths, vaccines may even alter fertility decisions due to greater child survival [3], [5]. While all such changes can have an immense impact on a country's economy, it is difficult to get a full picture of the economic impact resulting from immunization. Understanding the full economic benefits of vaccines is vital to policy makers whose decisions to introduce new vaccines not only impact the health of a society, but also its economy. Evidence on such economic benefits is therefore critical in assessing the full return on investment in vaccines.
For example, with the US$10 billion commitment and call to action by the Bill and Melinda Gates Foundation to increase access to life-saving vaccines during the “Decade of Vaccines” [6], there is greater need for evidence on vaccines’ return on investment, particularly at the country level. To assist both future investment and policy decisions today, we provide a review of the literature on the economic benefits of adult and childhood vaccines in low- and middle-income countries from 2000 to 2010. This systematic review addresses four research questions: How cost-effective are vaccines? How much are people willing to pay for vaccines? How frequently do economic benefit models use primary data? What narrow and broad economic benefits from vaccination have been reported?
Section snippets
Materials and methods
We conducted a systematic search in three major electronic databases [Pubmed (MEDLINE), Embase and Econlit (EBSCOhost)] to locate peer-reviewed articles on the economic benefit of vaccines in low- and middle-income countries. Specifically, we searched for articles that tried to quantify this benefit. The search, performed in February 2011, used variations of the following three keywords: “economic benefit” AND “vaccine” AND “low- and middle-income country”. Relevant MESH terms were selected and
Results
Pubmed search yielded 1225 articles. The search in Econlit yielded 44 articles where two unique articles were included. The Embase search produced 537 articles with nine unique studies. 14 additional articles were identified through reference list review and expert consultation. The initial screening resulted in 205 articles, of which 39 were duplicates. We read full-length versions of the 166 articles of which 58 articles were further excluded based on our criteria. This resulted in 108
Discussion
This review documents the available evidence showing that vaccination in low- and middle-income countries brings economic benefits beyond just health gains. The majority of studies illustrate that vaccines are cost-effective at less than $1000 per DALY averted, and many less than $100 per DALY averted. This suggests to policy makers that vaccines tend to be an efficient investment. Just as importantly, this review highlights key gaps in the available literature that need additional research,
Conclusions
This review identified more than 100 papers that illustrate the cost-effectiveness and economic benefits of vaccination in low- and middle-income countries. However, it also shows that most studies take a narrow perspective of the economic benefits of vaccination, and that a number of key gaps in evidence remain unfilled. To better represent the full economic benefits of vaccines in low- and middle-income country settings, the published literature would greatly benefit from approaches that
Acknowledgements
We thank Rohan Deogaonkar, Raymond Hutubessy and Mark Jit for their valuable comments. This study was performed with financial support from the Bill & Melinda Gates Foundation. The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Bill & Melinda Gates Foundation.
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