Supplementary immunization activities (SIAs) in South Africa: comprehensive economic evaluation of an integrated child health delivery platform.

Tuesday, 29th of October 2013

[source]Global Health Action[|source]

In many low- and middle-income countries, where the second dose is not routinely delivered through primary health care services, the second opportunity is offered during supplementary immunization activities (SIAs) that take place either nationally or sub-nationally. The SIAs delivery mechanism for the second measles dose was first successfully used by the Pan American Health Organization. Since 2000, the strategy has been exported to sub-Saharan Africa and is credited for the recent reduction in measles mortality.

In this article, the authors analyzed and present the cost-effectiveness of the full SIA delivery platform, which they termed the child health campaign platform. The authors report that cost-effectiveness varied by region and therefore imply that it could vary from country to country. In addition, they present evidence that integrating additional interventions with measles during SIAs makes it morre cost-effective. More details are available at:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3587392/

 

Abstract

BACKGROUND: Supplementary immunization activity (SIA) campaigns provide children with an additional dose of measles vaccine and deliver other interventions, including vitamin A supplements, deworming medications, and oral polio vaccines.

OBJECTIVE: To assess the cost-effectiveness of the full SIA delivery platform in South Africa (SA).

DESIGN: We used an epidemiologic cost model to estimate the cost-effectiveness of the 2010 SIA campaign. We used province-level campaign data sourced from the District Health Information System, SA, and from planning records of provincial coordinators of the Expanded Programme on Immunization. The data included the number of children immunized with measles and polio vaccines, the number of children given vitamin A supplements and Albendazole tablets, and costs.

RESULTS: The campaign cost $37 million and averted a total of 1,150 deaths (95% uncertainty range: 990-1,360). This ranged from 380 deaths averted in KwaZulu-Natal to 20 deaths averted in the Northern Cape. Vitamin A supplementation alone averted 820 deaths (95% UR: 670-1,040);measles vaccination alone averted 330 deaths (95% UR: 280-370). Incremental cost-effectiveness was $27,100 (95% UR: $18,500-34,400) per death averted nationally, ranging from $11,300 per death averted in the Free State to $91,300 per death averted in the Eastern Cape.

CONCLUSIONS: Cost-effectiveness of the SIA child health delivery platform varies substantially across SA provinces, and it is substantially more cost-effective when vitamin A supplementation is included in the interventions administered. Cost-effectiveness assessments should consider health system delivery platforms that integrate multiple interventions, and they should be conducted at the sub-national level.