title: Supplementary immunization activities (SIAs) in South Africa: comprehensive economic evaluation of an integrated child health delivery platform.
abstract: BACKGROUND
  Supplementary immunization activity (SIA) campaigns provide children with an additional dose of measles vaccine and deliver other interventions, including vitamin A supplements, deworming medications, and oral polio vaccines.
  
  
  OBJECTIVE
  To assess the cost-effectiveness of the full SIA delivery platform in South Africa (SA).
  
  
  METHODS
  We used an epidemiologic cost model to estimate the cost-effectiveness of the 2010 SIA campaign. We used province-level campaign data sourced from the District Health Information System, SA, and from planning records of provincial coordinators of the Expanded Programme on Immunization. The data included the number of children immunized with measles and polio vaccines, the number of children given vitamin A supplements and Albendazole tablets, and costs.
  
  
  RESULTS
  The campaign cost $37 million and averted a total of 1,150 deaths (95% uncertainty range: 990-1,360). This ranged from 380 deaths averted in KwaZulu-Natal to 20 deaths averted in the Northern Cape. Vitamin A supplementation alone averted 820 deaths (95% UR: 670-1,040); measles vaccination alone averted 330 deaths (95% UR: 280-370). Incremental cost-effectiveness was $27,100 (95% UR: $18,500-34,400) per death averted nationally, ranging from $11,300 per death averted in the Free State to $91,300 per death averted in the Eastern Cape.
  
  
  CONCLUSIONS
  Cost-effectiveness of the SIA child health delivery platform varies substantially across SA provinces, and it is substantially more cost-effective when vitamin A supplementation is included in the interventions administered. Cost-effectiveness assessments should consider health system delivery platforms that integrate multiple interventions, and they should be conducted at the sub-national level.
authors: Department of Global Health, University of Washington, Seattle, WA 98104, USA. verguet@uw.edu
authors: Stéphane
authors: S
authors: Verguet
authors: Waasila
authors: W
authors: Jassat
authors: Melanie Y
authors: MY
authors: Bertram
authors: Stephen M
authors: SM
authors: Tollman
authors: Christopher J L
authors: CJ
authors: Murray
authors: Dean T
authors: DT
authors: Jamison
authors: Karen J
authors: KJ
authors: Hofman
mesh_terms: D000871:Anthelmintics / Q000191:economics / Q000627:therapeutic use; D002648:Child; D002662:Child Health Services / Q000191:economics*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics*; D006293:Health Promotion / Q000191:economics; D006373:Helminthiasis / Q000188:drug therapy / Q000191:economics; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D008458:Measles Vaccine / Q000191:economics / Q000627:therapeutic use; D023321:Poliovirus Vaccines / Q000191:economics / Q000627:therapeutic use; D013019:South Africa; D014801:Vitamin A / Q000191:economics / Q000627:therapeutic use; D014815:Vitamins / Q000191:economics / Q000627:therapeutic use
chemical_list: D000871:Anthelmintics; D008458:Measles Vaccine; D023321:Poliovirus Vaccines; D014815:Vitamins; D014801:Vitamin A
keywords: child health; cost-effectiveness; integrated delivery platform; measles; sub-Saharan Africa; supplementary immunization activity