Friday, 24th of June 2011 Print


Global Eradication of Measles: An Epidemiologic and Economic Evaluation

  1. 1.   Ann Levin1,
  2. 2.   Colleen Burgess2,
  3. 3.   Louis P. Garrison Jr.3,
  4. 4.   Chris Bauch4,
  5. 5.   Joseph Babigumira3,
  6. 6.   Emily Simons5 and
  7. 7.   Alya Dabbagh5 

+ Author Affiliations

  1. 1.    1Independent Consultant, Bethesda, Maryland
  2. 2.    2MathEcology, Phoenix, Arizona
  3. 3.    3Department of Pharmacy, University of Washington, Seattle
  4. 4.    4Department of Mathematics and Statistics, University of Guelph, Ontario, Canada
  5. 5.    5World Health Organization, Geneva, Switzerland
  6. Correspondence: Ann Levin, PhD, 6414 Hollins Dr, Bethesda, MD 20817 (annlevin@verizon.net).


Background. Measles remains an important  cause of morbidity and mortality in children in developing countries. Due to the success of the measles mortality reduction and elimination efforts thus far, the WHO has raised the question of whether global eradication of measles is economically feasible.

Methods. The cost-effectiveness of various  measles mortality reduction and eradication scenarios was evaluated vis-à-vis the current mortality reduction goal in six countries and globally. Data collection on costs of measles vaccination were conducted in six countries in four regions: Bangladesh, Brazil, Colombia, Ethiopia, Tajikistan, and Uganda. The number of measles cases and deaths were projected from 2010 to 2050 using a dynamic, age-structured compartmental model. The incremental cost-effectiveness ratios were then calculated for each scenario vis a vis the baseline.

Results. Measles eradication by 2020 was the  found to be the most cost-effective scenario, both in the six countries and globally. Eradicating measles by 2020 is projected to cost an additional discounted $7.8 billion and avert a discounted 346 million DALYs between 2010 and 2050.

Conclusions. In conclusion, the study found  that, compared to the baseline, reaching measles eradication by 2020 would be the most cost-effective measles mortality reduction scenario, both for the six countries and on a global basis.





The Cost-Effectiveness of Supplementary Immunization Activities for Measles: A Stochastic Model for Uganda

  1. 1.   David Bishai1,
  2. 2.   Benjamin Johns2,
  3. 3.   Divya Nair1,
  4. 4.   Juliet Nabyonga-Orem3,
  5. 5.   Braka Fiona-Makmot4,
  6. 6.   Emily Simons5 and
  7. 7.   Alya Dabbagh5 

+ Author Affiliations

  1. 1.    1Department of Population, Family, and Reproductive Health
  2. 2.    2Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  3. 3.    3Health Systems and Services Cluster, World Health Organization (WHO) Uganda Office, Kampala, Uganda
  4. 4.    4Immunization Program, WHO Ethiopia Office, Addis Ababa, Ethiopia
  5. 5.    5Department of Immunization, Vaccines and Biologicals, WHO Geneva Office, Geneva, Switzerland
  6. Correspondence: David Bishai, MD, MPH, PhD, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Room E4622, 615 N Wolfe St, Baltimore, MD 21205 (dbishai@jhsph.edu).


Supplemental Immunization Activities (SIAs) have become an important adjunct to measles control efforts in countries that endeavor to achieve higher levels of population immunity than can be achieved in a growing routine immunization system. Because SIAs are often supported with funds that have alternative uses, decision makers need to know how cost-effective they are compared with other options. This study integrated a dynamic stochastic model of measles transmission in Uganda (2010–2050) with a cost model to compare a strategy of maintaining Uganda's current (2008) levels of the first dose of routine measles-containing vaccine (MCV1) coverage at 68% with SIAs with a strategy using the same levels of MCV1 coverage without SIAs. The stochastic model was fitted with parameters drawn from district-level measles case reports from Uganda, and the cost model was fitted to administrative data from the Ugandan Expanded Program on Immunization and from the literature. A discount rate of 0.03, time horizon of 2010–2050, and a societal perspective on costs were assumed. Costs expressed in US dollars (2010) included vaccination costs, disease treatment costs including lost productivity of mothers, as well as costs of outbreaks and surveillance. The model estimated that adding on triennial SIAs that covered 95% of children aged 12–59 months to a system that achieved routine coverage rates of 68% would have an incremental cost-effectiveness ratio (ICER) of $1.50 ($US 2010) per disability-adjusted life year averted. The ICER was somewhat higher if the discount rate was set at either 0 or 0.06. The addition of SIAs was found to make outbreaks less frequent and lower in magnitude. The benefit was reduced if routine coverage rates were higher. This cost-effectiveness ratio compares favorably to that of other commonly accepted public health interventions in sub-Saharan Africa.




Assessing the Cost-Effectiveness of Measles Elimination in Uganda: Local Impact of a Global Eradication Program

  1. 1.   Joseph B. Babigumira1,
  2. 2.   Ann Levin2,
  3. 3.   Colleen Burgess3,
  4. 4.   Louis P. Garrison Jr.1,
  5. 5.   Chris T. Bauch4,
  6. 6.   Fiona Braka5,
  7. 7.   William B. Mbabazi6,
  8. 8.   Juliet O. Nabyonga6,
  9. 9.   Emily Simons1,a and

10. Alya Dabbagh1,a 

+ Author Affiliations

  1. 1.    1Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle
  2. 2.    2Independent Consultant, Bethesda, Maryland
  3. 3.    3MathEcology LLC, Phoenix, Arizona
  4. 4.    4Department of Mathematics and Statistics, University of Guelph, Ontario, Canada
  5. 5.    5World Health Organization, Ethiopia Country Office, Addis Ababa
  6. 6.    6World Health Organization, Country Office, Kampala
  7. 7.    7World Health Organization, Geneva, Switzerland
  8. Correspondence: Joseph B. Babigumira, MBChB, MS, PhD, Pharmaceutical Outcomes Research and Policy Program, Dept of Pharmacy, University of Washington, Box 357630, Seattle, WA 98195-7630 (babijo@uw.edu).


Background.  Measles control has succeeded  worldwide, and many countries have substantially reduced incidence and mortality. This has led to consideration of the feasibility of measles elimination in Uganda within the context of global eradication. Before an elimination program is initiated, it is important to consider its potential economic impact, including its cost-effectiveness.

Methods. Incremental cost-effectiveness  ratios (ICERs) were estimated for measles mortality reduction and measles elimination in Uganda. A dynamic age-structured compartmental model of measles transmission was used to simulate scenarios and estimate health outcomes and costs. The main outcome measures were costs, measles cases, measles deaths, disability-adjusted life-years (DALYs), and ICERs measured as cost per DALY averted through either the year 2030 or 2050.

Results. Measles elimination by 2020 averted  130,232 measles cases, 3520 measles deaths, and 106,330 DALYs through the year 2030, compared with the next best scenario (95% mortality reduction by 2015), and it was the most cost-effective strategy, with ICERs of $556 per DALY averted (2030 time horizon) and $284 per DALY averted (2050 time horizon).

Conclusions. Measles elimination in Uganda,  as part of a global eradication program, is projected to be highly cost-effective and should be considered among the available policy options for dealing with the disease.




Using Cost-Effectiveness Analysis to Support Research and Development Portfolio Prioritization for Product Innovations in Measles Vaccination

  1. 1.   Louis P. Garrison Jr1,
  2. 2.   Chris T. Bauch2,
  3. 3.   Brian W. Bresnahan1,
  4. 4.   Tom K. Hazlet1,
  5. 5.   Srikanth Kadiyala1 and
  6. 6.   David L. Veenstra1 

+ Author Affiliations

  1. 1.    1Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle
  2. 2.    2Department of Mathematics and Statistics, University of Guelph, Ontario, Canada
  3. Correspondence: Louis P. Garrison, PhD, Pharmaceutical Outcomes Research and Policy Program, University of Washington, 1959 NE Pacific St, Box 357630, Seattle, WA 98195 (lgarrisn@uw.edu).


Background. Several potential measles  vaccine innovations are in development to address the shortcomings of the current vaccine. Funders need to prioritize their scarce research and development resources. This article demonstrates the usefulness of cost-effectiveness analysis to support these decisions.

Methods. This study had 4 major components:  (1) identifying potential innovations, (2) developing transmission models to assess mortality and morbidity impacts, (3) estimating the unit cost impacts, and (4) assessing aggregate cost-effectiveness in United Nations Children’s Fund countries through 2049.

Results. Four promising technologies were  evaluated: aerosol delivery, needle-free injection, inhalable dry powder, and early administration DNA vaccine. They are projected to have a small absolute impact in terms of reducing the number of measles cases in most scenarios because of already improving vaccine coverage. Three are projected to reduce unit cost per dose by $0.024 to $0.170 and would improve overall cost-effectiveness. Each will require additional investments to reach the market. Over the next 40 years, the aggregate cost savings could be substantial, ranging from $98.4 million to $689.4 million.

Conclusions. Cost-effectiveness analysis can  help to inform research and development portfolio prioritization decisions. Three new measles vaccination technologies under development hold promise to be cost-saving from a global perspective over the long-term, even after considering additional investment costs.


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