Costs and financing of routine immunization: Approach and selected findings of a multi-country study (EPIC)
Introduction
Vaccines are one of the best buys in public health [1], [2] and a good candidate for government financing [3]. Historically, the cost per fully immunized child (FIC) with measles, polio, DTP, and BCG vaccines ranges from less than $3 to $22, with variation between countries by facility type and ownership, volume of vaccines administered, wastage rates, type of delivery strategy, and input prices [4], [5], [6], [7], [8], [9], [10], [11]1. Unit costs generally decline as output increases, but there is scant evidence on whether unit costs will rise as coverage increases beyond 80% [1], [12], [13].
Currently, all GAVI-eligible countries have introduced pentavalent vaccine into their routine immunization (RI) programs2. Rotavirus, pneumococcal, and HPV vaccine introductions also are on the rise worldwide [14]. Total and unit costs of RI have increased with the introduction of new vaccines [15], [16], [17] but many of these studies have relied on secondary estimates of costs and financing. Secondary sources have been shown to underestimate the cost of national immunization programs [11] and reliability of secondary sources has been questioned [18].
Facility-based costing surveys have the potential to more fully capture the costs and financing of immunization through more detailed analysis of input use. Given the pace and breadth of new vaccine introduction and universal coverage goals highlighted in the Global Vaccine Action Plan [19], as well as the emphasis by the global community on Universal Health Coverage (UHC), there is a critical need for updated cost and financing estimates for RI and new vaccine introduction. Understanding the costs of existing coverage levels is a first step toward adequate planning and budgeting for GVAP and UHC goals. Potential cost variation at the facility level merits further exploration, as such analyses can identify areas of program efficiency and value for money.
Section snippets
Objective and scope of the EPIC studies
This paper describes the methods, selected findings and policy focus the EPI Costing and Financing (EPIC) studies conducted between 2012 and 2013 in Benin, Ghana, Honduras, Moldova, Uganda and Zambia, supported by the Bill & Melinda Gates Foundation (BMGF). The purpose of the EPIC studies was to provide countries and the global community with updated and detailed cost estimates of RI programs with pentavalent vaccine in the schedule, as well as the incremental costs of other new vaccines.
The
Methods and common approach
Because EPIC studies were carried out by different organizations, a Common Approach was developed to harmonize and standardize methods for cost and financing estimation [23].
Selected findings of the EPIC studies
We report some of the findings from the EPIC studies across countries to illustrate trends. Additional detail and analysis can be found in other manuscripts in this Supplement. First, there is a wide range of total facility immunization economic costs within the country samples, with nearly 200-fold differences in Moldova and 60-fold differences in Uganda. Benin had the smallest range between high and low cost facilities. Second, differences in total facility cost between countries are related
Policy conclusions and lessons learned
The EPIC studies provide a unique set of high quality data on RI program costs, updating the evidence-base to include pentavalent vaccines in the immunization schedule. The studies reveal that governments are financing a larger total amount and share of RI than previously estimated [17]. The major cost drivers continue to be labor, followed by vaccines.
The EPIC studies also showed a wide range in facility-level total costs within countries, as well as variation in unit costs between countries.
Conflict of interest statement
The authors declare no conflict of interest. The EPIC studies and preparation of this manuscript were supported by the Bill & Melinda Gates Foundation. However, the views expressed represent those of the authors only.
Acknowledgements
We would like to thank all of the members of the study teams who provided inputs into the development of the methods and approaches used for the EPIC studies. The contributions of Steering Committee members, most notably Carol Levin and Ulla Griffiths, were critical to the successful outcome of the EPIC studies. Finally, we appreciate the comments of two independent reviewers.
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