A Systematic Review of the Incremental Costs of Implementing a NewVaccine in the Expanded Program of Immunization in Sub-SaharanAfrica

摘要

The World Health Organization is planning a pilotintroduction of a new malaria vaccine in three sub-Saharan African countries. Toinform considerations about including a new vaccine in the vaccination programof those and other countries, estimates from the scientific literature of theincremental costs of doing so are important. A systematicreview of scientific studies reporting the costs of recent vaccine programs insub-Saharan countries was performed. The focus was to obtain from each study anestimate of the cost per dose of vaccine administered excluding the acquisitioncost of the vaccine and wastage. Studies published between 2000 and 2018 andindexed on PubMed could be included and results were standardized to 2015 USdollars (US$). After successive screening of 2119 titles,and 941 abstracts, 58 studies with 80 data points (combinations of country,vaccine type, and vaccination approach–routine v. campaign) were retained. Moststudies used the so-called ingredients approach as costing method combiningfield data collection with documented unit prices per cost item. Thecategorization of cost items and the extent of detailed reporting varied widely.Across the studies, the mean and median cost per dose administered was US$1.68and US$0.88 with an interquartile range of US$0.54 to US$2.31. Routinevaccination was more costly than campaigns, with mean cost per dose of US$1.99and US$0.88, respectively. Across the studies, therewas huge variation in the cost per dose delivered, between and within countries,even in studies using consistent data collection tools and analysis methods, andincluding many health facilities. For planning purposes, the interquartile rangeof US$0.54 to US$2.31 may be a sufficiently precise estimate.