Elsevier

Vaccine

Volume 33, Supplement 1, 7 May 2015, Pages A60-A65
Vaccine

Costs of routine immunization services in Moldova: Findings of a facility-based costing study

https://doi.org/10.1016/j.vaccine.2014.12.034Get rights and content

Highlights

  • The cost of a fully immunizing a child is higher than previous estimates.

  • Good understanding of the major cost drivers is helpful for managing EPI costs.

  • Knowledge of costs helps achieve adequate coverage in a sustainable manner.

Abstract

Objective

Available estimates on how much it costs to provide routine immunization services are out-dated. This study attempts to address gaps in evidence by evaluating the total economic and unit costs of delivering routine immunization (RI) services in Moldova as part of a multi-country study on the costs and financing of routine immunization (EPIC).

Methods

This cross-sectional study is based on a multistage stratified random sample of fifty primary health care facilities. Data on inputs, prices, and outputs were collected retrospectively for 2011 and analyzed using an ingredient-based costing approach in Excel and SPSS®.

Results

The average total annual facility cost for RI was $11,943 ranging from $565 to $112,548 and labor cost was the main driver of routine immunization costs contributing 65%, followed by capital costs – 16.3% and the cost of vaccines and injection supplies accounting for 9%.

The average cost per dose was $18.3, the cost per child was $316.6 and the cost per fully immunized child was $332.3. The results show considerable variation in the costs of routine immunization services across facility type and depending on a facility scale i.e. annual doses administered.

Conclusions

The study shows that the cost of fully immunizing a child in a middle-income country is much higher than previous estimates. These results will be used by the government for better planning and financing of routine immunization services, leading to greater sustainability.

Introduction

Vaccination against childhood communicable diseases through the Expanded Program on Immunization (EPI) is one of the most cost-effective public health interventions [1]. By reducing mortality and morbidity, vaccination can substantially contribute toward achieving the Millennium Development Goal of reducing under-five mortality among children by two-thirds between 1990 and 2015 [2].

The costs and financing of national immunization programs have been evaluated since the 1980s as part of the Universal Childhood Immunization Initiative [3]. However, currently available information is out-dated and new knowledge on the full economic costs of routine immunization programs is important to inform both global and national policies and practice.

Our study evaluates the total economic and unit costs of the immunization program in the Republic of Moldova as part of a multi-country study supported by the Bill and Melinda Gates Foundation and aimed at evaluating the costs of routine immunization programs and new vaccine introduction. It is expected that our study results will contribute to building a new evidence-base that will provide valuable inputs into the development of national and global policies, as well as contribute to better planning and management of the national immunization program in Moldova.

Section snippets

The national immunization program in Moldova

The current plan for the national immunization program in Moldova covers the period 2011–2015 and guarantees free immunization against ten infectious diseases: poliomyelitis, diphtheria, tetanus, pertussis, hepatitis B, measles, mumps, rubella, tuberculosis, and Haemophilus influenza type B. Based on this program Moldova plans to increase DTP 3 coverage up to 94% and 95% in 2014 and 2015 respectively, although country already reports high DPT3 coverage rate that is above 90% [4], [5].

Routine

Materials and methods

This is a cross-sectional facility-based costing study, which examines total and unit costs of routine immunization and describes cost drivers and cost variation across facilities in Moldova.

Total facility costs and observed cost variation

The total facility level immunization costs in the sample varied from $565 to $112,548, with a mean of $11,943 and median $US3822. Log transformed variables reveal a positive linear correlation between total facility level costs and total doses delivered (r = 0.95, p < 0.01).

Fig. 1 shows that total facility cost varies by facility type, with costs increasing with facility size (HOs to FMCs). Variation within facility type is not large with the exception of FMCs where costs range from $28,335 to

Discussion

The study helped estimate average unit cost per dose delivered in 2011 ($18.3) and cost per FIC ($316.6). These figures are higher than what has been previously reported in the literature [9], [14], [15], [16] and also higher than the figures used in the cMYP–191 $US per FIC [8]. Though cMYP underestimated shared costs by 32% and capital costs by 61%, but recurrent costs were overestimated by almost 44% [12].

Our study shows that the labor inputs are significant contributor to a unit cost and

Conclusions

Our findings could inform policy discussions within Moldova around increasing immunization coverage rates while running the program more efficiently and sustainably. At the same time increasing coverage rates through sustainable financing is a global concern, well beyond Moldova. Our study noted variations in total immunization costs and unit costs at the facility level and variation in the facility performance measured by DTP3 coverage rate. The analysis allows hypothesizing that

Conflict of interest statement

None declared.

Acknowledgements

This study would have not been possible without the continuous support of the Ministry of Health of the Republic of Moldova, EPI manager, directors of District Public Health Centers and health care providers who gave their time as well as allowed access to facilities and facility records. Therefore, we would like to acknowledge their invaluable support in carrying out this work. We would like to thank Bill & Melinda Gates Foundation for providing financial support. And in particular, we would

References (25)

  • D. Walker et al.

    Allowing for differential timing in cost analyses: discounting and annualization

    (2002)
  • G. Gotsadze et al.

    Analyses of the costs and financing of routine immunization program and new vaccine introduction in Moldova technical report

    (2014)
  • Cited by (20)

    • Estimators Used in Multisite Healthcare Costing Studies in Low- and Middle-Income Countries: A Systematic Review and Simulation Study

      2019, Value in Health
      Citation Excerpt :

      A Centers for Disease Control–supported costing study of HIV treatment in programs supported by the United States President's Emergency Plan for AIDS (PEPFAR) used the median to create country-specific estimates using cost data from 43 sites across 5 countries.3 Researchers reporting the results of the EPI costing & financing project, a study of routine infant immunization costs across 319 sites and 6 countries, used a variety of methods to summarize results, including both simple and volume-weighted means.8-13 Estimation techniques differ in terms of the quality of inference they provide.

    • Assessing the operational costs of routine immunization activities at the sub-center level in Myanmar: What matters for increasing national immunization coverage?

      2018, Vaccine
      Citation Excerpt :

      The budget breakdown should allocate funds according to geographical conditions, security concerns, and other relevant factors. The operational costs for routine immunizations, including transportation costs, are covered by governments in many countries [30–34]. In Myanmar, the transportation costs for routine immunizations were partially supported by international non-governmental organizations in selected areas, [1] such as the rural delta and coastal areas.

    • The drivers of facility-based immunization performance and costs. An application to Moldova

      2015, Vaccine
      Citation Excerpt :

      Ordinary least square (OLS) method was applied to a traditional cost function structure, recognizing a multivariate influence of different factors on Moldovan immunization costs, where production variables as well as population and health system characteristics participate in the definition of total costs, at the facility, district and national levels. Out of 1318 health care facilities delivering immunization services in Moldova across 37 districts, the research team sampled 50 institutions, combining districts with urban and rural locations, as well as capturing diversity of health service providers, more details on sampling are described elsewhere [13]. Details about costs and cost elements are also available from the full study report [14].

    View all citing articles on Scopus
    View full text