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

Autor:	Clarke-Deelder E; Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA 02115, United States.; Department of Epidemiology and Public Health, Swiss Tropical & Public Health Institute, Allschwil 4123, Switzerland.; University of Basel, Basel 4001, Switzerland., Suharlim C; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, MA 02115, United States.; Management Sciences for Health, Medford, MA 02155, United States., Chatterjee S; Research Department, George Institute for Global Health, New Delhi, Delhi 110025, India.; Department of Medicine, University of New South Wales, New South Wales 2052, Australia., Portnoy A; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, MA 02115, United States.; Department of Global Health, Boston University School of Public Health, Boston, MA 02118, United States., Brenzel L; Bill & Melinda Gates Foundation, Seattle, WA 98109, United States., Ray A; Bill & Melinda Gates Foundation, New Delhi, Delhi 110067, India., Cohen JL; Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA 02115, United States., Menzies NA; Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA 02115, United States.; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, MA 02115, United States., Resch SC; Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, MA 02115, United States.
Jazyk:	angličtina
Zdroj:	Health policy and planning [Health Policy Plan] 2024 Jun 03; Vol. 39 (6), pp. 583-592.
DOI:	10.1093/heapol/czae024
Abstrakt:	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. (© The Author(s) 2024. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu