A cost-benefit analysis of typhoid fever immunization programmes in an Indian urban slum community
Poulos, C.; Bahl, R.; Whittington, D.; Bhan, M.K.; Clemens, J.D.; Acosta, C.J.
Journal of Health Population and Nutrition 22(3): 311-321
2004
ISSN/ISBN: 1606-0997 PMID: 15609784 Document Number: 238420
Many economic analyses of immunization programmes focus on the benefits in terms of public sector cost savings, but do not incorporate estimates of the private cost savings that individuals receive from vaccination. This paper considers the implications of Bahl et al.'s cost-of-illness estimates for typhoid immunization policy by examining how community-level incidence estimates and information on distribution of costs of illness among patients and the public health sector can be used in the economic analysis of vaccination programme options in Kalkaji, New Delhi, Delhi, India. The findings illustrate why typhoid vaccination programmes may often appear to be unattractive to public health officials who adopt a public budgetary perspective. Under many plausible sets of assumptions, public sector expenditure on typhoid vaccination does not yield comparable public sector cost savings. If public health officials adopt a societal perspective on the economic benefits of vaccination, there are many situations in which different vaccination programmes will make economic sense. The findings show that this is especially true when public decision makers recognize that (1) the incidence of typhoid fever is underestimated by blood culture-positive cases, and (2) avoided costs of illness represent a significant underestimate of the actual economic benefits to individuals of vaccination.