Incremental system costs of introducing combined DTwP-hepatitis B-Hib vaccine into national immunization services in Ethiopia
Incremental system costs of introducing combined DTwP-hepatitis B-Hib vaccine into national immunization services in Ethiopia
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DOI：
10.1016/j.vaccine.2008.12.037
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发表时间：
2009-02-25
期刊：
影响因子：
5.5
通讯作者：
Yigzaw, Asnakew
中科院分区：
文献类型：
--
作者：
Griffiths, Ulla K.;Korczak, Viola S.;Yigzaw, Asnakew
目的：在全球疫苗免疫联盟（GAVI Alliance）的支持下，2007年3月，一种单剂量瓶装的全液体型百白破 - 乙肝 - b型流感嗜血杆菌联合疫苗（五价疫苗）被引入埃塞俄比亚的常规免疫服务中。这种疫苗取代了10剂量瓶装的百白破疫苗。我们旨在估算提供五价疫苗所增加的系统成本。
方法：作为新疫苗引入后评估的一部分，在两周时间内收集了埃塞俄比亚四个地区有关冷藏设施扩建以及疫苗运输频率增加的数据。对卫生系统各级人员进行了访谈。有关促进疫苗引入的培训和宣传成本信息是从亚的斯亚贝巴的卫生部、联合国儿童基金会和世界卫生组织收集的。
结果：从10剂量的百白破疫苗转换为单剂量的五价疫苗后，在国家和地区层面，每个完成免疫接种儿童所需的冷藏储存量增加了106%，在疫苗配送的三个较低层级增加了71%。各级都购买了冷藏设备，许多地方的疫苗收集频率增加了一倍多。冷藏设备、培训和宣传的新增资本成本达480万美元，即2007年出生队列中每个儿童1.53美元。将资本成本按年计算并加上经常性成本后，2007年出生队列中每个儿童的系统成本为0.80美元。在疫苗接种覆盖率为78%的情况下，这相当于每个完成免疫接种的儿童1.13美元。最重要的系统成本项目是冷藏，在出生队列中每个儿童为0.62美元，每增加1立方厘米冷藏空间为0.03美元。
结论：在埃塞俄比亚，引入五价疫苗需要在额外的冷藏设备上进行大量投资，并增加疫苗运输频率。全球疫苗免疫联盟为出生队列中每个儿童提供0.30美元的引入补助，大约可覆盖为促进引入所进行的资本投资的20%。（C）2008爱思唯尔有限公司。保留所有权利。
Objective: With support from the GAVI Alliance a fully liquid combined DTwP-HepB-Hib (pentavalent) vaccine in a single dose vial was introduced into Ethiopia's routine immunization services in March 2007. This vaccine was substituted with DTwP in a 10-dose vial. We aimed to estimate the incremental system costs of pentavalent vaccine delivery.Methods: Data on cold storage expansion and increased vaccine transport frequency were collected in four regions of Ethiopia over a 2-week period, as part of a Post-introduction Evaluation of the new vaccine. Interviews were conducted with individuals at all levels of the health system. Information on the costs of training and communication to facilitate the introduction was collected from the Ministry of Health, UNICEF and WHO in Addis Ababa.Results: The switch from a 10-dose DTwP to a single dose pentavalent vaccine increased refrigeration storage volume per fully vaccinated child by 106% at national and regional levels and by 71% at the three lower levels of vaccine distribution. Cold storage equipments were purchased at all levels and the frequency of vaccine collection more than doubled in many places. Incremental capital costs of cold storage equipment, training and communication amounted to US$ 4.8 million, or US$ 1.53 per child in the 2007 birth cohort. After annualizing capital costs and adding recurrent costs, system costs came to US$ 0.80 per child in the 2007 birth cohort. With a vaccination coverage rate of 78% this is equivalent to US$ 1.13 per fully vaccinated child. The most important system cost item is cold storage, amounting to US$ 0.62 per child in the birth cohort and US$ 0.03 per additional cm(3) of cold storage.Conclusion: In Ethiopia introduction of pentavalent vaccine necessitated considerable investments in additional cold storage equipment as well as an increase in vaccine transport frequency. A GAVI Alliance introduction grant of US$ 0.30 per child in the birth cohort would cover approximately 20% of the capital investments undertaken to facilitate introduction. (C) 2008 Elsevier Ltd. All rights reserved.