The risks, costs, and benefits of possible future global policies for managing polioviruses.
OBJECTIVE
We assessed the costs, risks, and benefits of possible future major policy decisions on vaccination, surveillance, response plans, and containment following global eradication of wild polioviruses.


METHODS
We developed a decision analytic model to estimate the incremental cost-effectiveness ratios and net benefits of risk management options for polio for the 20-year period and stratified the world according to income level to capture important variability between nations.


RESULTS
For low-, lower-middle-, and upper-middle-income groups currently using oral poliovirus vaccine (OPV), we found that after successful eradication of wild polioviruses, OPV cessation would save both costs and lives when compared with continued use of OPV without supplemental immunization activities. We found cost-effectiveness ratios for switching from OPV to inactivated poliovirus vaccine to be higher (i.e., less desirable) than other health investment opportunities, depending on the actual inactivated poliovirus vaccine costs and assumptions about whether supplemental immunization activities with OPV would continue.


CONCLUSIONS
Eradication promises billions of dollars of net benefits, although global health policy leaders face difficult choices about future policies. Until successful eradication and coordination of posteradication policies, health authorities should continue routine polio vaccination and supplemental immunization activities.
Kids Risk Project, Harvard School of Public Health, 677 Huntington Ave, Third Floor, Boston, MA 02115, USA. kimt@hsph.harvard.edu
Kimberly M
KM
Thompson
Radboud J Duintjer
RJ
Tebbens
Mark A
MA
Pallansch
Olen M
OM
Kew
Roland W
RW
Sutter
R Bruce
RB
Aylward
Margaret
M
Watkins
Howard E
HE
Gary
James
J
Alexander
Hamid
H
Jafari
Stephen L
SL
Cochi
D002648:Child; D003362:Cost-Benefit Analysis; D004196:Disease Outbreaks / Q000517:prevention & control; D014943:Global Health; D006291:Health Policy; D006801:Humans; D017589:Immunization Programs / Q000191:economics* / Q000639:trends*; D018803:Models, Economic; D011051:Poliomyelitis / Q000517:prevention & control*; D011054:Poliovirus Vaccine, Inactivated / Q000191:economics; D011055:Poliovirus Vaccine, Oral / Q000191:economics; D023321:Poliovirus Vaccines / Q000191:economics* / Q000627:therapeutic use; D011634:Public Health; D015203:Reproducibility of Results; D012308:Risk Management / Q000191:economics* / Q000379:methods / Q000458:organization & administration
D011054:Poliovirus Vaccine, Inactivated; D011055:Poliovirus Vaccine, Oral; D023321:Poliovirus Vaccines