COST-EFFECTIVENESS OF SUPPLEMENTARY IMMUNIZATION FOR MEASLES IN INDIA.

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One of the key activities for improving measles immunization coverage rates is Supplemental Immunization Activity (SIA), in low coverage states or countries. In the past, countries in the Americas have adopted the use of SIA campaigns and in turn led to improvements in measles vaccination coverage, as surveillance systems also evolved. In India, this strategy has been successfully used in pulse immunizations for Polio, outbreak control and crisis management in areas to rapidly raise immunization coverage. But is SIA the best of the options available in raising immunization coverage?

In this study, the authors present a cost-effectiveness analysis from the providers perspective. The report provides decision-makers with evidence to make a case for conducting supplemental immunization activities for measles in low coverage states/districts in India. Detailed full text analysis and results are accessible at: http://www.indianpediatrics.net/nov2009/957.pdf

ABSTRACT

OBJECTIVE: This study aims to estimate the incremental cost effectiveness of a supplementary immunization activity (SIA) for measles in a district of India with measles vaccine coverage equivalent to the National average.

DESIGN: A state transition model is used to estimate the effect of routine vaccination with measles vaccine as well as with measles vaccine during the SIA. The model follows each sub-cohort in the target population at respective age (1-5 years) to five years of age, using age specific incidence rate and vaccination rate to determine the number of cases of measles. Using age specific incidence rates and complication rates for measles; deaths and disability adjusted life year (DALY) averted is estimated.

RESULTS: Using base-case assumptions, an estimated 65479 cases of measles and 1637 deaths due to measles will be prevented in a span of four years from a single supplementary immunization activity in a pediatric population (1-5 years of age) of size 839,473. The cost per measles vaccine dose delivered is INR 30. Using base case analysis the cost to avert a death is INR 15381 and the cost per disability adjusted life year (DALY) averted is INR 430.

CONCLUSIONS: Supplementary immunization activity for measles is cost-effective. However, this cannot be considered superior to a second dose of measles in routine immunization.