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Incremental system costs of introducing combined DTwP-hepatitis B-Hib vaccine into national immunization services in
Ulla K Griffiths1, Viola S Korczak, Dereje Ayalew
1Hib Initiative, Health Policy Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. ulla.griffiths@lshtm.ac.uk
Insights
Introducing the pentavalent vaccine in Ethiopia significantly increased cold storage needs and transport frequency. The system costs were estimated at US$1.13 per fully vaccinated child, with cold storage being the primary expense.
Area of Science:
- Public Health
- Vaccine Delivery Systems
- Health Economics
Background:
- Ethiopia introduced a fully liquid combined DTwP-HepB-Hib (pentavalent) vaccine in single-dose vials in March 2007, replacing the 10-dose vial DTwP vaccine.
- This transition was supported by the GAVI Alliance as part of routine immunization services.
Purpose of the Study:
- To estimate the incremental system costs associated with delivering the new pentavalent vaccine in Ethiopia.
- To assess the impact of the vaccine switch on cold chain infrastructure and logistics.
Main Methods:
- Data collection on cold storage and vaccine transport frequency occurred over two weeks in four Ethiopian regions.
- Interviews were conducted across all health system levels, and cost data for training and communication were gathered from national and international health organizations.
Main Results:
- The shift to single-dose pentavalent vaccine vials increased refrigeration storage volume by 71-106% and more than doubled vaccine transport frequency.
- Incremental capital costs for cold storage, training, and communication were US$4.8 million (US$1.53 per child in the 2007 birth cohort).
- Total system costs, including annualized capital and recurrent costs, were US$1.13 per fully vaccinated child, with cold storage accounting for the largest share (US$0.62 per child).
Conclusions:
- The introduction of the pentavalent vaccine in Ethiopia required substantial investment in cold storage infrastructure and increased vaccine transport.
- A GAVI Alliance introduction grant of US$0.30 per child would cover approximately 20% of the capital investments made for vaccine introduction.
Objective:
With support from the GAVI Alliance a fully liquid combined DTwP-HepB-Hib (pentavalent) vaccine in a single dose vial was introduced into Ethiopia's routine immunization services in March 2007. This vaccine was substituted with DTwP in a 10-dose vial. We aimed to estimate the incremental system costs of pentavalent vaccine delivery.
Methods:
Data on cold storage expansion and increased vaccine transport frequency were collected in four regions of Ethiopia over a 2-week period, as part of a Post-Introduction Evaluation of the new vaccine. Interviews were conducted with individuals at all levels of the health system. Information on the costs of training and communication to facilitate the introduction was collected from the Ministry of Health, UNICEF and WHO in Addis Ababa.
Results:
The switch from a 10-dose DTwP to a single dose pentavalent vaccine increased refrigeration storage volume per fully vaccinated child by 106% at national and regional levels and by 71% at the three lower levels of vaccine distribution. Cold storage equipment were purchased at all levels and the frequency of vaccine collection more than doubled in many places. Incremental capital costs of cold storage equipment, training and communication amounted to US$ 4.8 million, or US$ 1.53 per child in the 2007 birth cohort. After annualizing capital costs and adding recurrent costs, system costs came to US$ 0.80 per child in the 2007 birth cohort. With a vaccination coverage rate of 78% this is equivalent to US$ 1.13 per fully vaccinated child. The most important system cost item is cold storage, amounting to US$ 0.62 per child in the birth cohort and US$ 0.03 per additional cm(3) of cold storage.
Conclusion:
In Ethiopia introduction of pentavalent vaccine necessitated considerable investments in additional cold storage equipment as well as an increase in vaccine transport frequency. A GAVI Alliance introduction grant of US$ 0.30 per child in the birth cohort would cover approximately 20% of the capital investments undertaken to facilitate introduction.
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