Cost-effectiveness and budget impact analyses of strategies to improve measles vaccination coverage in Kenya

Measles control efforts have been implemented over the years. However, elimination of the disease is yet to be realized. Additionally, global measles vaccination coverage has stagnated over the past decade, leading to outbreaks. We assessed the cost-effectiveness and budget impact of scaling-up vaccination coverage in Kenya, towards the measles elimination goal. A cost-effectiveness analysis was conducted using a Markov model from a health system's perspective over a 10-year time frame, incorporating a new birth cohort annually. Two vaccination scenarios were examined 1) a constant coverage improvement scenario, assuming current funding is maintained resulting in annual increases of 0.3% and 2% in the first and second-dose measles vaccine coverage, respectively, alongside supplementary immunization activities(SIAs) and 2) an intensified investment scenario, assuming achievement of 95% coverage for both vaccine doses in addition to SIAs. The later assumed increased investments to reach hard-to-reach populations. A threshold of USD 1,280 per disability adjusted life year (DALY) averted was applied. A budget impact analysis was also conducted. Over a 10-year time horizon, the constant coverage improvement scenario led to 6% fewer deaths (213 (161-276)) and was cost-effective (incremental cost-effectiveness ratio, ICER = USD 1,269 ($1,205-$1,333) per DALY averted) compared to the base scenario. Increasing coverage in the intensified investment scenario, further reduced deaths by 25% (879(626--1,284)) and was more cost effective, ICER 1,093 (1,029 -1,157) per DALY averted, compared to the constant improvement scenario. The constant improvement scenario had a moderate budget impact while the intensified improvement scenario had a very high budget impact, when assessed against Kenya's health expenditure. Our findings suggest that accelerating measles coverage through intensified investments towards measles elimination is cost-effective but has a high budget impact. Therefore, policy makers should consider market shaping interventions and strategies to mobilize and allocate sufficient resources to increase vaccination coverage and ensure sustained health gains.