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Pegurri, E., Fox-Rushby, J. A., & Damian, W. (2005). The effects and costs of expanding the coverage of immunization services in developing countries: a systematic literature review
Main Findings
The authors review and synthesise the results from 60 studies corresponding to 49 interventions carried out in different developing countries in Africa, Southeast Asia and Central/South America. Forty-four of these interventions were evaluated for effectiveness, 10 for costs and three for cost-effectiveness. The authors found the following:
With exception of one study, all interventions aimed at improving immunisation coverage had a positive impact leading on average to a 27 per cent increase in the proportion of fully vaccinated children (SD: 19%, CI: -1%; 72%) compared to the mean baseline coverage.
Involvement of community health workers and channelling (door-to-door canvassing) were most effective at increasing vaccination coverage.
The average cost per dose of vaccine delivered varied considerably (US$ 7 to 222) for the same type of intervention within and across settings.
Within countries, average incremental costs are higher for outreach teams than for mass campaigns, both of which are higher than the average total costs of routine services.
Across countries, peer-training and channelling appear to be most cost-effective.
The authors highlight the need to improve the methodological quality of future studies and propose that future evaluations of interventions to improve immunisation coverage include a cost-analysis. The authors further suggest expanding the review by searching unpublished literature and increasing the sample of included studies.