Health impact and cost-effectiveness of expanding routine immunization coverage in India through Intensified Mission Indradhanush.

IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Emma Clarke-Deelder, Christian Suharlim, Susmita Chatterjee, Allison Portnoy, Logan Brenzel, Arindam Ray, Jessica L Cohen, Nicolas A Menzies, Stephen C Resch
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引用次数: 0

Abstract

Many children do not receive a full schedule of childhood vaccines, yet there is limited evidence on the cost-effectiveness of strategies for improving vaccination coverage. Evidence is even scarcer on the cost-effectiveness of strategies for reaching 'zero-dose children', who have not received any routine vaccines. We evaluated the cost-effectiveness of periodic intensification of routine immunization (PIRI), a widely applied strategy for increasing vaccination coverage. We focused on Intensified Mission Indradhanush (IMI), a large-scale PIRI intervention implemented in India in 2017-2018. In 40 sampled districts, we measured the incremental economic cost of IMI using primary data, and used controlled interrupted time-series regression to estimate the incremental vaccination doses delivered. We estimated deaths and disability-adjusted life years (DALYs) averted using the Lives Saved Tool and reported cost-effectiveness from immunization programme and societal perspectives. We found that, in sampled districts, IMI had an estimated incremental cost of 2021US$13.7 (95% uncertainty interval: 10.6 to 17.4) million from an immunization programme perspective and increased vaccine delivery by an estimated 2.2 (-0.5 to 4.8) million doses over a 12-month period, averting an estimated 1413 (-350 to 3129) deaths. The incremental cost from a programme perspective was $6.21 per dose ($2.80 to dominated), $82.99 per zero-dose child reached ($39.85 to dominated), $327.63 ($147.65 to dominated) per DALY averted, $360.72 ($162.56 to dominated) per life-year saved and $9701.35 ($4372.01 to dominated) per under-5 death averted. At a cost-effectiveness threshold of 1× per-capita GDP per DALY averted, IMI was estimated to be cost-effective with 90% probability. This evidence suggests IMI was both impactful and cost-effective for improving vaccination coverage, though there is a high degree of uncertainty in the results. As vaccination programmes expand coverage, unit costs may increase due to the higher costs of reaching currently unvaccinated children.

印度通过 Indradhanush 强化使命扩大常规免疫覆盖面的健康影响和成本效益。
许多儿童没有接种完整的儿童疫苗,但有关提高疫苗接种覆盖率策略的成本效益的证据却很有限。关于为未接种过任何常规疫苗的 "零剂量儿童 "提供接种策略的成本效益的证据更是少之又少。我们评估了定期加强常规免疫接种 (PIRI) 的成本效益,这是一种广泛应用于提高疫苗接种覆盖率的策略。我们重点关注了印度 2017-2018 年实施的大规模 PIRI 干预项目 Intensified Mission Indradhanush(IMI)。在 40 个抽样地区,我们使用原始数据测算了 IMI 的增量经济成本,并使用受控间断时间序列回归估算了增量疫苗接种剂量。我们使用 "挽救生命工具 "估算了避免的死亡人数和残疾调整生命年数,并从免疫规划和社会角度报告了成本效益。我们发现,在抽样地区,从免疫接种项目的角度来看,IMI 的增量成本估计为 2021 万美元(95% 不确定区间:1060 万至 1740 万美元),在 12 个月期间,疫苗接种量估计增加了 220 万剂(-50 万至 480 万剂),估计避免了 1413 例(-350 至 3129 例)死亡。从项目角度看,每剂疫苗的增量成本为 6.21 美元(2.80 美元为主),每名零剂量儿童的成本为 82.99 美元(39.85 美元为主),每避免一个残疾调整寿命年的成本为 327.63 美元(147.65 美元为主),每挽救一个生命年的成本为 360.72 美元(162.56 美元为主),每避免一个五岁以下儿童死亡的成本为 9701.35 美元(4372.01 美元为主)。在每避免 1x 人均国内生产总值 DALY 的成本效益阈值下,估计 IMI 具有 90% 的成本效益概率。这些证据表明,IMI 对提高疫苗接种覆盖率既有影响又有成本效益,尽管结果存在很大的不确定性。随着疫苗接种计划覆盖范围的扩大,单位成本可能会增加,因为为目前未接种疫苗的儿童接种疫苗的成本较高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Health policy and planning
Health policy and planning 医学-卫生保健
CiteScore
6.00
自引率
3.10%
发文量
98
审稿时长
6 months
期刊介绍: Health Policy and Planning publishes health policy and systems research focusing on low- and middle-income countries. Our journal provides an international forum for publishing original and high-quality research that addresses questions pertinent to policy-makers, public health researchers and practitioners. Health Policy and Planning is published 10 times a year.
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