Cost-effectiveness of the expanded programme on immunization in the Ivory Coast: a preliminary assessment

A preliminary calculation was made of the cost-effectiveness of the measles component of the Expanded Programme on Immunization (EPI) in the Ivory Coast. The calculation is based on existing data (program budgets, coverage surveys, counts of vaccinations provided and subjective estimates) and applies to the first three demonstration and training zones (Abidjan, Abengourou and Korhogo) with a combined population of 1.75 million people. The average annual cost of the measles program (assumed to be 75% of all EPI costs, including supplies, personnel and equipment) in these three zones was $527,000 at 1980 prices. Having achieved an average coverage rate of 61%, the cost per vaccine was moderately high, $12. Yet, vaccinees are a sufficiently small part of the population that the cost per capita is only $0.30. The program is estimated to prevent 38,000 cases of measles and 1100 deaths per year in these three zones. Thus, the cost per measles case averted is $14, and the cost per death averted is $479. This means that the measles component of the EPI Program is highly effective in preventing deaths for the sums expended compared to many alternative health programs in developing countries.