title: Costs of vaccine delivery in the Gambia before and after, pentavalent and pneumococcal conjugate vaccine introductions.
abstract: BACKGROUND
  The Gambia introduced seven-valent pneumococcal conjugate vaccine (PCV) in August 2009 and switched to 13-valent PCV in April 2011. In April 2009 monovalent hepatitis B and combined Diphtheria-Tetanus-Pertussis and Haemophilus influenzae type b vaccines were transitioned to a combined pentavalent vaccine. The current schedule offers three doses of PCV and pentavalent, and continues to give children monovalent hepatitis B vaccine at birth. We estimated the overall costs of the Gambian immunisation programme and the incremental costs of introducing pentavalent and the seven-valent PCV.
  
  
  METHODS
  Twenty health facilities out of a total of 56 were surveyed. Data collected included number of vaccine doses delivered, staff time spent on vaccine delivery, distance travelled to collect vaccines, and cold chain expansion due to new vaccine introduction. National level data were collected from key informant interviews. Annualised costs were calculated in 2009 US$.
  
  
  RESULTS
  With a PCV price of US$7 per dose, the incremental costs of introducing PCV was US$1.6 million, equivalent to US$25 per fully immunised child, with systems costs accounting for US$1.90. The switch to pentavalent vaccine resulted in cost savings of US$0.45 per fully immunised child. Total annual costs increased by 45% after the introduction of the new vaccines, amounting to US$ 3.0 million, or US$45 per fully immunised child.
  
  
  CONCLUSIONS
  Vaccine prices were the most important determinant of total incremental costs and cold chain expansion the biggest cost component of systems costs.
authors: MRC, Gambia Unit, The Gambia; Gambia Government, The Gambia; London School of Hygiene and Tropical Medicine, UK. Electronic address: effuau@gmail.com.
authors: E
authors: E
authors: Usuf
authors: MRC, Gambia Unit, The Gambia.
authors: G
authors: G
authors: Mackenzie
authors: Gambia Government, The Gambia.
authors: Y
authors: Y
authors: Lowe-Jallow
authors: Gambia Government, The Gambia.
authors: B
authors: B
authors: Boye
authors: PATH, USA.
authors: D
authors: D
authors: Atherly
authors: USAID, USA.
authors: C
authors: C
authors: Suraratdecha
authors: London School of Hygiene and Tropical Medicine, UK.
authors: U K
authors: UK
authors: Griffiths
mesh_terms: D002648:Child; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics*; D004356:Drug Storage / Q000191:economics; D005714:Gambia; D017048:Health Care Costs; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D011008:Pneumococcal Infections / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000191:economics*; D012034:Refrigeration / Q000191:economics; D014186:Transportation / Q000191:economics; D018074:Vaccines, Conjugate / Q000191:economics
chemical_list: D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate; C105256:five-valent pneumococcal conjugate vaccine
keywords: Costs; Gambia; Immunisation; Pneumococcal conjugate vaccine; Vaccine