title: Cost-effectiveness and economic benefits of vaccines in low- and middle-income countries: a systematic review.
abstract: BACKGROUND
  Public health interventions that prevent mortality and morbidity have greatly increased over the past decade. Immunization is one of these preventive interventions, with a potential to bring economic benefits beyond just health benefits. While vaccines are considered to be a cost-effective public health intervention, implementation has become increasingly challenging. As vaccine costs rise and competing priorities increase, economic evidence is likely to play an increasingly important role in vaccination decisions.
  
  
  METHODS
  To assist policy decisions today and potential investments in the future, we provide a systematic review of the literature on the cost-effectiveness and economic benefits of vaccines in low- and middle-income countries from 2000 to 2010. The review identified 108 relevant articles from 51 countries spanning 23 vaccines from three major electronic databases (Pubmed, Embase and Econlit).
  
  
  RESULTS
  Among the 44 articles that reported costs per disability-adjusted life year (DALY) averted, vaccines cost less than or equal to $100 per DALY averted in 23 articles (52%). Vaccines cost less than $500 per DALY averted in 34 articles (77%), and less than $1000 per DALY averted in 38 articles (86%) in one of the scenarios. 24 articles (22%) examined broad level economic benefits of vaccines such as greater future wage-earning capacity and cost savings from averting disease outbreaks. 60 articles (56%) gathered data from a primary source. There were little data on long-term and societal economic benefits such as morbidity-related productivity gains, averting catastrophic health expenditures, growth in gross domestic product (GDP), and economic implications of demographic changes resulting from vaccination.
  
  
  CONCLUSIONS
  This review documents the available evidence and shows that vaccination in low- and middle-income countries brings important economic benefits. The cost-effectiveness studies reviewed suggest to policy makers that vaccines are an efficient investment. This review further highlights key gaps in the available literature that would benefit from additional research, especially in the area of evaluating the broader economic benefits of vaccination in the developing world.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States. sozawa@jhsph.edu
authors.forename: Sachiko
authors.initials: S
authors.lastname: Ozawa
authors.forename: Andrew
authors.initials: A
authors.lastname: Mirelman
authors.forename: Meghan L
authors.initials: ML
authors.lastname: Stack
authors.forename: Damian G
authors.initials: DG
authors.lastname: Walker
authors.forename: Orin S
authors.initials: OS
authors.lastname: Levine
mesh_terms: D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000191:economics; D006801:Humans; D019057:Quality-Adjusted Life Years; D014611:Vaccination / Q000191:economics*