Examining the cost of delivering routine immunization in Honduras.
BACKGROUND
Many countries have introduced new vaccines and expanded their immunization programs to protect additional risk groups, thus raising the cost of routine immunization delivery. Honduras recently adopted two new vaccines, and the country continues to broaden the reach of its program to adolescents and adults. In this article, we estimate and examine the economic cost of the Honduran routine immunization program for the year 2011.


METHODS
The data were gathered from a probability sample of 71 health facilities delivering routine immunization, as well as 8 regional and 1 central office of the national immunization program. Data were collected on vaccinations delivered, staff time dedicated to the program, cold chain equipment and upkeep, vehicle use, infrastructure, and other recurrent and capital costs at each health facility and administrative office. Annualized economic costs were estimated from a modified societal perspective and reported in 2011 US dollars.


RESULTS
With the addition of rotavirus and pneumococcal conjugate vaccines, the total cost for routine immunization delivery in Honduras for 2011 was US$ 32.5 million. Vaccines and related supplies accounted for 23% of the costs. Labor, cold chain, and vehicles represented 54%, 4%, and 1%, respectively. At the facility level, the non-vaccine system costs per dose ranged widely, from US$ 25.55 in facilities delivering fewer than 500 doses per year to US$ 2.84 in facilities with volume exceeding 10,000 doses per year. Cost per dose was higher in rural facilities despite somewhat lower wage rates for health workers in these settings; this appears to be driven by lower demand for services per health worker in sparsely populated areas, rather than increased cost of outreach.


CONCLUSIONS
These more-precise estimates of the operational costs to deliver routine immunizations provide program managers with important information for mobilizing resources to help sustain the program and for improving annual planning and budgeting as well as longer-term resource allocation decisions.
Comprehensive Family Immunization Unit, Pan American Health Organization, Washington, DC, USA. Electronic address: januszc@paho.org.
Cara Bess
CB
Janusz
Epidemiology and Public Health Evaluation Group, Universidad Nacional de Colombia, Bogota, Colombia.
Carlos
C
Castañeda-Orjuela
Programa Ampliado de Inmunizaciones, Secretaría de Salud, Tegucigalpa, Honduras.
Ida Berenice
IB
Molina Aguilera
Comprehensive Family Immunization Unit, Pan American Health Organization, Washington, DC, USA.
Ana Gabriela
AG
Felix Garcia
Programa Ampliado de Inmunizaciones, Secretaría de Salud, Tegucigalpa, Honduras.
Lourdes
L
Mendoza
Programa Ampliado de Inmunizaciones, Secretaría de Salud, Tegucigalpa, Honduras.
Iris Yolanda
IY
Díaz
Center for Health Decision Science, Harvard School of Public Health, Boston, MA, USA.
Stephen C
SC
Resch
D000293:Adolescent; D000328:Adult; D002675:Child, Preschool; D017048:Health Care Costs; D006268:Health Facilities / Q000191:economics; D006282:Health Personnel / Q000191:economics; D006298:Health Services Administration / Q000191:economics*; D006721:Honduras; D006801:Humans; D017589:Immunization Programs / Q000191:economics* / Q000458:organization & administration; D007223:Infant; D007231:Infant, Newborn; D012034:Refrigeration / Q000191:economics; D014611:Vaccination / Q000191:economics* / Q000379:methods; D014612:Vaccines / Q000191:economics* / Q000600:supply & distribution
D014612:Vaccines
Cost and cost analysis; Honduras; Immunization; Latin America; New vaccines