Abstract
Background: Most health economic evaluations of childhood vaccination only capture the health and short-term economic benefits. Measuring broader, long-term effects of vaccination on productivity and externalities could provide a more complete picture of the value of vaccines. Method. MEDLINE, EconLit and NHS-EED databases were searched for articles published between January 1990 and July 2011, which captured broader economic benefits of vaccines in low and middle income countries. Studies were included if they captured at least one of the following categories on broader economic impact: outcome-related productivity gains, behaviour-related productivity gains, ecological externalities, equity gains, financial sustainability gains or macroeconomic benefits. Results: Twenty-six relevant studies were found, including observational studies, economic models and contingent valuation studies. Of the identified broader impacts, outcome-related productivity gains and ecological externalities were most commonly accounted for. No studies captured behaviour-related productivity gains or macroeconomic effects. There was some evidence to show that vaccinated children 8-14 years of age benefit from increased cognitive ability. Productivity loss due to morbidity and mortality was generally measured using the human capital approach. When included, herd immunity effects were functions of coverage rates or based on reduction in disease outcomes. External effects of vaccines were observed in terms of equitable health outcomes and contribution towards synergistic and financially sustainable healthcare programs. Conclusion: Despite substantial variation in the methods of measurement and outcomes used, the inclusion of broader economic impact was found to improve the attractiveness of vaccination. Further research is needed on how different tools and techniques can be used in combination to capture the broader impact of vaccination in a way that is consistent with other health economic evaluations. In addition, more country level evidence is needed from low and middle income countries to justify future investments in vaccines and immunization programs. Finally, the proposed broader economic impact framework may contribute towards better communication of the economic arguments surrounding vaccine uptake, leading to investments in immunization by stakeholders outside of the traditional health care sector such as ministries of finance and national treasuries.
| Original language | English |
|---|---|
| Article number | 878 |
| Journal | BMC Public Health |
| Volume | 12 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 2012 |
Bibliographical note
Funding Information:We would like to thank the following participants of a WHO consultation on the broader economy impact of vaccination in Toronto, Canada, 13–14 July 2011 for helpful discussions: Arnab Acharya, Til Bärnighausen, Ricardo Brandao, Anaïs Colombini, Dagna Constenla, Adrienne Goebbels, Mira Johri, Ann Levin, Arindam Nandi, Jennifer O’Brien, Maarten Postma, Baudouin Standaert, Aparnaa Somanathan, Stéphane Verguet and Damian Walker. We also thank Sachiko Ozawa for helpful comments. Finally, we would like to thank the GAVI Alliance for their financial support. RH is a staff member of the World Health Organization. The views expressed are that of the author and do not necessarily represent the views of the World Health Organization.
Keywords
- Cost-effectiveness analysis
- Developing countries
- Economic evaluations
- Externalities
- Immunization
- Low and middle income countries
- Vaccines
