title: Health economics of rubella: a systematic review to assess the value of rubella vaccination.
abstract: BACKGROUND
  Most cases of rubella and congenital rubella syndrome (CRS) occur in low- and middle-income countries. The World Health Organization (WHO) has recently recommended that countries accelerate the uptake of rubella vaccination and the GAVI Alliance is now supporting large scale measles-rubella vaccination campaigns. We performed a review of health economic evaluations of rubella and CRS to identify gaps in the evidence base and suggest possible areas of future research to support the planned global expansion of rubella vaccination and efforts towards potential rubella elimination and eradication.
  
  
  METHODS
  We performed a systematic search of on-line databases and identified articles published between 1970 and 2012 on costs of rubella and CRS treatment and the costs, cost-effectiveness or cost-benefit of rubella vaccination. We reviewed the studies and categorized them by the income level of the countries in which they were performed, study design, and research question answered. We analyzed their methodology, data sources, and other details. We used these data to identify gaps in the evidence and to suggest possible future areas of scientific study.
  
  
  RESULTS
  We identified 27 studies: 11 cost analyses, 11 cost-benefit analyses, 4 cost-effectiveness analyses, and 1 cost-utility analysis. Of these, 20 studies were conducted in high-income countries, 5 in upper-middle income countries and two in lower-middle income countries. We did not find any studies conducted in low-income countries. CRS was estimated to cost (in 2012 US$) between $4,200 and $57,000 per case annually in middle-income countries and up to $140,000 over a lifetime in high-income countries. Rubella vaccination programs, including the vaccination of health workers, children, and women had favorable cost-effectiveness, cost-utility, or cost-benefit ratios in high- and middle-income countries.
  
  
  CONCLUSIONS
  Treatment of CRS is costly and rubella vaccination programs are highly cost-effective. However, in order for research to support the global expansion of rubella vaccination and the drive towards rubella elimination and eradication, additional studies are required in low-income countries, to tackle methodological limitations, and to determine the most cost-effective programmatic strategies for increased rubella vaccine coverage.
authors.affiliation: Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, USA. babijo@uw.edu
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Babigumira
authors.forename: Ian
authors.initials: I
authors.lastname: Morgan
authors.forename: Ann
authors.initials: A
authors.lastname: Levin
mesh_terms: D003362:Cost-Benefit Analysis; D019049:Developed Countries; D003906:Developing Countries; D005260:Female; D017048:Health Care Costs; D006801:Humans; D032541:Mass Vaccination / Q000191:economics; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000276:immunology / Q000517:prevention & control; D012409:Rubella / Q000191:economics / Q000276:immunology* / Q000517:prevention & control; D012410:Rubella Syndrome, Congenital / Q000191:economics / Q000276:immunology / Q000517:prevention & control; D012411:Rubella Vaccine / Q000191:economics* / Q000627:therapeutic use
chemical_list: D012411:Rubella Vaccine