title: Incremental system costs of introducing combined DTwP-hepatitis B-Hib vaccine into national immunization services in Ethiopia.
abstract: 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 equipment 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Hib Initiative, Health Policy Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. ulla.griffiths@lshtm.ac.uk
authors.forename: Ulla K
authors.initials: UK
authors.lastname: Griffiths
authors.forename: Viola S
authors.initials: VS
authors.lastname: Korczak
authors.forename: Dereje
authors.initials: D
authors.lastname: Ayalew
authors.forename: Asnakew
authors.initials: A
authors.lastname: Yigzaw
mesh_terms: D002648:Child; D003365:Costs and Cost Analysis; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000191:economics*; D004356:Drug Storage / Q000191:economics; D005002:Ethiopia; D018073:Haemophilus Vaccines / Q000191:economics*; D017325:Hepatitis B Vaccines / Q000191:economics*; D006801:Humans; D017589:Immunization Programs / Q000191:economics; D014186:Transportation / Q000191:economics
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine; C524361:DtwP-HepB-Hib vaccine; D018073:Haemophilus Vaccines; D017325:Hepatitis B Vaccines