IMPACT OF THE INTRODUCTION OF NEW VACCINES AND VACCINE WASTAGE RATE ON THE COST-EFFECTIVENESS OF ROUTINE EPI: LESSONS FROM A DESCRIPTIVE STUDY IN A CAMEROONIAN HEALTH DISTRICT

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Vaccines are costly and from many studies constitute a major burden for every immunization program. With the introduction of the Global Immunization, Vision and Strategy (GIVS), immunization coverage objectives have been raised to reach more children (equity) and to cover more diseases. This involves the introduction of new vaccines and combinations which are generally more expensive.

 In this report, the authors assess the impact of the introduction of 2-dose lyophilized DPT-HB+Hib and of vaccine wastage rate on the cost-effectiveness of EPI in  Ngong health district of Cameroon. The report documents that a) the efficiency of EPI is lower with the outreach strategy, b) there is 5-time variation in cost per FIC amongst health centers, and c) excess vaccine wastage has a high cost when expensive vaccines are used, especially if the open vial policy cannot be applied as with lyophilized Hib vaccine. Report concluded by recommending the a presentation with liquid Hib where the open vial policy could apply. More details are accessible at:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3123280/

 ABSTRACT

The Expanded Program of Immunization (EPI) offers services to the population free of charge but these activities are costly with the greatest part being the cost of vaccines. In spite of the growing international solidarity towards funding for immunization, the growing objectives continue to outweigh the available resources. It is therefore crucial for any immunization system to seek greater efficiency so as to optimize the use of available means in a bid to ensure sustainability. It is in this light that we carried out this study which aims to assess the productive efficiency of routine EPI for children aged 0 - 11 months with respect to the fixed and outreach vaccine delivery strategies in Ngong health district. The study is descriptive and cross-sectional. Data were collected retrospectively for all 16 health centers of the district that offered EPI services during the period February - May 2009.

The results show that:

• Only 62% of planned outreach immunization sessions were effectively carried out mainly due to limited funds for transportation and staff availability. Consequently vaccine coverage was low (BCG: 70.1%, DPT-HB-Hib 3: 55.5%) and less resources (43%) were used for this strategy which served 52% of the target population - a major blow to equity.
• The average cost per Fully Immunized Child (FIC) was 9,571 FCFA (19.22 USD) for the fixed strategy; 12,751 FCFA (25.61 USD) for the outreach and 10,718 FCFA (21.53 USD) with both strategies combined. These figures are high than those observed in many other African health districts. However, DPT-HB-Hib and yellow fever vaccines contributed to the increase as vaccines occupied 57% of the total cost. With DPT in lieu of DPT-HB-Hib the cost/FIC would be 6,046 FCFA (12.14 USD). Dropout rates too were high (28.1% for the fixed, 29.7% for outreach).
• The cost of vaccines wasted in excess of the national norm at the level of health centers was 595,532 FCFA (1,196.15 USD), an amount that could cover the vaccine cost for 122 FIC (7.6% of the FIC during the period). This was accounted for as follows: BCG 1.1%, OPV 1.4%, DPT-HB-Hib 72.7%, measles 5.3%, yellow fever 19.5%
• Therefore we suggest improved communication for EPI, the introduction of DPT-HB-Hib with liquid Hib and the effective implementation of planned outreach sessions.