Costs of routine immunization services in Moldova: Findings of a facility-based costing study
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
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The drivers of facility-based immunization performance and costs. An application to Moldova
2015, VaccineCitation 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].