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

Author:

Clarke-Deelder Emma123ORCID,Suharlim Christian45,Chatterjee Susmita67ORCID,Portnoy Allison48ORCID,Brenzel Logan9,Ray Arindam10,Cohen Jessica L1,Menzies Nicolas A14ORCID,Resch Stephen C4

Affiliation:

1. Department of Global Health and Population, Harvard T. H. Chan School of Public Health , Boston, MA 02115, United States

2. Department of Epidemiology and Public Health, Swiss Tropical & Public Health Institute , Allschwil 4123, Switzerland

3. University of Basel , Basel 4001, Switzerland

4. Center for Health Decision Science, Harvard T. H. Chan School of Public Health , Boston, MA 02115, United States

5. Management Sciences for Health , Medford, MA 02155, United States

6. Research Department, George Institute for Global Health , New Delhi, Delhi 110025, India

7. Department of Medicine, University of New South Wales , New South Wales 2052, Australia

8. Department of Global Health, Boston University School of Public Health , Boston, MA 02118, United States

9. Bill & Melinda Gates Foundation , Seattle, WA 98109, United States

10. Bill & Melinda Gates Foundation , New Delhi, Delhi 110067, India

Abstract

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.

Funder

Bill & Melinda Gates Foundation, Grant

Publisher

Oxford University Press (OUP)

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