Elsevier

Vaccine

Volume 20, Issues 27–28, 10 September 2002, Pages 3332-3341
Vaccine

Cost-effectiveness of measles elimination in Latin America and the Caribbean: a prospective analysis

https://doi.org/10.1016/S0264-410X(02)00296-7Get rights and content

Abstract

Background: In 1994, the Americas set a goal of interrupting indigenous measles transmission from the Western Hemisphere by 2000. To accomplish this goal, the Pan American Health Organization (PAHO) developed an enhanced measles vaccination strategy. Methods: Cost data was collected at PAHO for Latin American and Caribbean (LAC) countries covering 96% of the region’s population on components of the routine programs, and the ‘follow-up’ activities from member countries. In order to interpret our findings we have compared the present scenario regarding measles with one that would have ensued if past trends continued. Results: For the entire LAC population, estimated cost of elimination program will be US$ 571 million in present value terms. Interpretation: The vaccination strategy toward achieving elimination of measles costs US$ 244 million, incremental from the cost of vaccination before the elimination program. Within 2000–2020, the current program will have prevented the occurrence of 3.2 million cases of measles and 16,000 deaths. Thus, vaccination strategy prevents a single case of measles at the cost of US$ 71.75 and prevents a death due to measles at the cost of US$ 15,000. The case fatality rate depends on a well functioning treatment program for measles cases. The vaccination strategy saves a total of US$ 208 million in treatments costs due to reduced incidence of measles.

Section snippets

Background

In 1994, the Americas set a goal of interrupting indigenous measles transmission in the Western Hemisphere by 2000 with the purpose of eventual elimination of measles in this region. Elimination activity had actually started as early as 1990 (see Fig. 1).

The Pan American Health Organization (PAHO) has developed an enhanced measles elimination strategy, which is built upon the poliomyelitis elimination strategy that resulted in the elimination of polio in the Americas and is currently being

Methods

PAHO’s measles elimination policy has three essential vaccination components [2], [6], [7], [8]. First, a one time only national ‘catch-up’ campaign targeting all children 1–14 years, irrespective of previous disease or vaccination history. Second, efforts are made to strengthen routine vaccination services to reach at least 95% of infants in each successive birth cohort. This effort is called the ‘keep-up’ effort and is the intensification of the measles part of the extended program for

Findings

In present value terms the cost of the elimination campaign is US$ 548 million, for the available data. Extrapolated to the entire LAC region, it is US$ 571 million. This cost should be understood as a cost that is dependent upon the present infrastructure set up for vaccination and as such it is an incremental cost. A detailed account of cost and effectiveness follows.

Interpretation

When all costs are discounted, a case was prevented at the cost of US$ 71.75 (US$ 102 with discounted effectiveness). That is for extra US$ 244 million spent in measles coverage 3.2 million cases are prevented. This reduction in measles cases induced 16,000 fewer deaths and occurred because US$ 244 million more was spent on vaccination. Each death was prevented at the cost of US$ 15,203 (US$ 20,525 with discounted effectiveness).

Conclusions

A report regarding the cost-effectiveness of polio in LAC region compared the extra cost incurred due to the elimination effort—consisting of EPI and periodic campaigns—and the cost savings that would ensue from having no polio cases to be treated [30]. That study relied on the assumption that the elimination of polio would be achieved in 5 years in LAC with routine polio vaccination in place thereafter. The cost of treatment for polio is significant and lifetime cost of support for paralyzed

Acknowledgements

The Authors are grateful to Dr. Jean Marc Olivé for his comments during the development of the protocol for this study and to Dr. Matilde Pinto for her insightful review of the economical analysis on the final draft of the paper.

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