Costs of routine immunization services in Moldova: Findings of a facility-based costing study.
OBJECTIVE
Available estimates on how much it costs to provide routine immunization services are out-dated. This study attempts to address gaps in evidence by evaluating the total economic and unit costs of delivering routine immunization (RI) services in Moldova as part of a multi-country study on the costs and financing of routine immunization (EPIC).


METHODS
This cross-sectional study is based on a multistage stratified random sample of fifty primary health care facilities. Data on inputs, prices, and outputs were collected retrospectively for 2011 and analyzed using an ingredient-based costing approach in Excel and SPSS.


RESULTS
The average total annual facility cost for RI was $11,943 ranging from $565 to $112,548 and labor cost was the main driver of routine immunization costs contributing 65%, followed by capital costs - 16.3% and the cost of vaccines and injection supplies accounting for 9%. The average cost per dose was $18.3, the cost per child was $316.6 and the cost per fully immunized child was $332.3. The results show considerable variation in the costs of routine immunization services across facility type and depending on a facility scale i.e. annual doses administered.


CONCLUSIONS
The study shows that the cost of fully immunizing a child in a middle-income country is much higher than previous estimates. These results will be used by the government for better planning and financing of routine immunization services, leading to greater sustainability.
Curatio International Foundation (CIF), 37d Chavchavadze Avenue, 0162, Tbilisi, Georgia. Electronic address: k.goguadze@curatio.com.
K
K
Goguadze
Curatio International Foundation (CIF), 37d Chavchavadze Avenue, 0162, Tbilisi, Georgia.
I
I
Chikovani
Ministry of Health of the Republic of Moldova, 67A Gh. Asachi Street, Chişinău, Republic of Moldova.
C
C
Gaberi
Center for the Study of State and Society (CEDES), Buenos Aires, Argentina.
D
D
Maceira
Curatio International Foundation (CIF), 37d Chavchavadze Avenue, 0162, Tbilisi, Georgia.
M
M
Uchaneishvili
Curatio International Foundation (CIF), 37d Chavchavadze Avenue, 0162, Tbilisi, Georgia.
N
N
Chkhaidze
Curatio International Foundation (CIF), 37d Chavchavadze Avenue, 0162, Tbilisi, Georgia.
G
G
Gotsadze
D003430:Cross-Sectional Studies; D017048:Health Care Costs; D006268:Health Facilities / Q000191:economics; D006282:Health Personnel / Q000191:economics; D006298:Health Services Administration / Q000191:economics*; D006801:Humans; D017589:Immunization Programs / Q000191:economics* / Q000458:organization & administration; D007223:Infant; D007231:Infant, Newborn; D008966:Moldova; D011897:Random Allocation; D012034:Refrigeration / Q000191:economics; D014611:Vaccination / Q000191:economics* / Q000379:methods; D014612:Vaccines / Q000191:economics* / Q000600:supply & distribution
D014612:Vaccines
Cost-effectiveness; Costs; Moldova; Routine immunization; Sustainability