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Systematic review of the costs and effectiveness of interventions to increase infant vaccination coverage in low- and middle-income countries
BACKGROUND: In recent years, several large studies have assessed the costs of national infant immunization programs, and the results of these studies are used to support planning and budgeting in low- and middle-income countries. However, few studies have addressed the costs and cost-effectiveness o...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6806517/ https://www.ncbi.nlm.nih.gov/pubmed/31640687 http://dx.doi.org/10.1186/s12913-019-4468-4 |
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author | Munk, Cristina Portnoy, Allison Suharlim, Christian Clarke-Deelder, Emma Brenzel, Logan Resch, Stephen C. Menzies, Nicolas A. |
author_facet | Munk, Cristina Portnoy, Allison Suharlim, Christian Clarke-Deelder, Emma Brenzel, Logan Resch, Stephen C. Menzies, Nicolas A. |
author_sort | Munk, Cristina |
collection | PubMed |
description | BACKGROUND: In recent years, several large studies have assessed the costs of national infant immunization programs, and the results of these studies are used to support planning and budgeting in low- and middle-income countries. However, few studies have addressed the costs and cost-effectiveness of interventions to improve immunization coverage, despite this being a major focus of policy attention. Without this information, countries and international stakeholders have little objective evidence on the efficiency of competing interventions for improving coverage. METHODS: We conducted a systematic literature review on the costs and cost-effectiveness of interventions to improve immunization coverage in low- and middle-income countries, including both published and unpublished reports. We evaluated the quality of included studies and extracted data on costs and incremental coverage. Where possible, we calculated incremental cost-effectiveness ratios (ICERs) to describe the efficiency of each intervention in increasing coverage. RESULTS: A total of 14 out of 41 full text articles reviewed met criteria for inclusion in the final review. Interventions for increasing immunization coverage included demand generation, modified delivery approaches, cash transfer programs, health systems strengthening, and novel technology usage. We observed substantial heterogeneity in costing methods and incompleteness of cost and coverage reporting. Most studies reported increases in coverage following the interventions, with coverage increasing by an average of 23 percentage points post-intervention across studies. ICERs ranged from $0.66 to $161.95 per child vaccinated in 2017 USD. We did not conduct a meta-analysis given the small number of estimates and variety of interventions included. CONCLUSIONS: There is little quantitative evidence on the costs and cost-effectiveness of interventions for improving immunization coverage, despite this being a major objective for national immunization programs. Efforts to improve the level of costing evidence—such as by integrating cost analysis within implementation studies and trials of immunization scale up—could allow programs to better allocate resources for coverage improvement. Greater adoption of standardized cost reporting methods would also enable the synthesis and use of cost data. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-019-4468-4) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6806517 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-68065172019-10-28 Systematic review of the costs and effectiveness of interventions to increase infant vaccination coverage in low- and middle-income countries Munk, Cristina Portnoy, Allison Suharlim, Christian Clarke-Deelder, Emma Brenzel, Logan Resch, Stephen C. Menzies, Nicolas A. BMC Health Serv Res Research Article BACKGROUND: In recent years, several large studies have assessed the costs of national infant immunization programs, and the results of these studies are used to support planning and budgeting in low- and middle-income countries. However, few studies have addressed the costs and cost-effectiveness of interventions to improve immunization coverage, despite this being a major focus of policy attention. Without this information, countries and international stakeholders have little objective evidence on the efficiency of competing interventions for improving coverage. METHODS: We conducted a systematic literature review on the costs and cost-effectiveness of interventions to improve immunization coverage in low- and middle-income countries, including both published and unpublished reports. We evaluated the quality of included studies and extracted data on costs and incremental coverage. Where possible, we calculated incremental cost-effectiveness ratios (ICERs) to describe the efficiency of each intervention in increasing coverage. RESULTS: A total of 14 out of 41 full text articles reviewed met criteria for inclusion in the final review. Interventions for increasing immunization coverage included demand generation, modified delivery approaches, cash transfer programs, health systems strengthening, and novel technology usage. We observed substantial heterogeneity in costing methods and incompleteness of cost and coverage reporting. Most studies reported increases in coverage following the interventions, with coverage increasing by an average of 23 percentage points post-intervention across studies. ICERs ranged from $0.66 to $161.95 per child vaccinated in 2017 USD. We did not conduct a meta-analysis given the small number of estimates and variety of interventions included. CONCLUSIONS: There is little quantitative evidence on the costs and cost-effectiveness of interventions for improving immunization coverage, despite this being a major objective for national immunization programs. Efforts to improve the level of costing evidence—such as by integrating cost analysis within implementation studies and trials of immunization scale up—could allow programs to better allocate resources for coverage improvement. Greater adoption of standardized cost reporting methods would also enable the synthesis and use of cost data. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-019-4468-4) contains supplementary material, which is available to authorized users. BioMed Central 2019-10-22 /pmc/articles/PMC6806517/ /pubmed/31640687 http://dx.doi.org/10.1186/s12913-019-4468-4 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Munk, Cristina Portnoy, Allison Suharlim, Christian Clarke-Deelder, Emma Brenzel, Logan Resch, Stephen C. Menzies, Nicolas A. Systematic review of the costs and effectiveness of interventions to increase infant vaccination coverage in low- and middle-income countries |
title | Systematic review of the costs and effectiveness of interventions to increase infant vaccination coverage in low- and middle-income countries |
title_full | Systematic review of the costs and effectiveness of interventions to increase infant vaccination coverage in low- and middle-income countries |
title_fullStr | Systematic review of the costs and effectiveness of interventions to increase infant vaccination coverage in low- and middle-income countries |
title_full_unstemmed | Systematic review of the costs and effectiveness of interventions to increase infant vaccination coverage in low- and middle-income countries |
title_short | Systematic review of the costs and effectiveness of interventions to increase infant vaccination coverage in low- and middle-income countries |
title_sort | systematic review of the costs and effectiveness of interventions to increase infant vaccination coverage in low- and middle-income countries |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6806517/ https://www.ncbi.nlm.nih.gov/pubmed/31640687 http://dx.doi.org/10.1186/s12913-019-4468-4 |
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