Thirty years of vaccination in Vietnam: Impact and cost-effectiveness of the national Expanded Programme on Immunization.
BACKGROUND
Countries like Vietnam transitioning to middle-income status increasingly bear the cost of both existing and new vaccines. However, the impact and cost-effectiveness of the Expanded Programme on Immunization (EPI) as a whole has never been assessed on a country level.


METHODS
Data on vaccine-preventable disease incidence and mortality from Vietnam's national surveillance was analysed to estimate the likely impact that vaccination in 1980-2010 may have had. Adjustment for under-reporting was made by examining trends in reported mumps incidence and in case-fatality risks for each disease. The same data were separately analysed using the Lives Saved Tool (LiST) to give an alternative estimate of impact. The financial cost of EPI in 1996-2010 was also estimated from the perspective of service provider.


RESULTS
National surveillance data suggests that up to 5.7 million diseases cases and 26,000 deaths may have been prevented by EPI. Analysis using LiST suggests that even more deaths (370,000) may have been prevented by measles and pertussis vaccination alone. The cost-effectiveness of EPI is estimated to be around $1000-$27,000 per death prevented.


CONCLUSIONS
Two separate approaches to assessing EPI impact in Vietnam give different quantitative results but a common conclusion: that EPI has made a substantial impact on mortality and represents good value for money.
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Modelling and Economics Unit, Public Health England, London, UK. Electronic address: mark.jit@phe.gov.uk.
Mark
M
Jit
National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.
Thi Thanh Huyen
TT
Dang
John Hopkins Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, USA.
Ingrid
I
Friberg
Center for Health System Research, Hanoi Medical University, Hanoi, Vietnam.
Van Minh
VM
Hoang
Center for Health System Research, Hanoi Medical University, Hanoi, Vietnam.
Tuan Kiet
TK
Pham Huy
John Hopkins Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, USA.
Neff
N
Walker
National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.
Van Cuong
VC
Nguyen
National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.
Nhu Duong
ND
Tran
World Health Organization Representative Office for Viet Nam, Hanoi, Vietnam.
Kohei
K
Toda
World Health Organization, Geneva, Switzerland.
Raymond
R
Hutubessy
World Health Organization Regional Office for the Western Pacific, Manila, Philippines.
Kimberley
K
Fox
National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.
Tran Hien
TH
Nguyen
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003141:Communicable Diseases / Q000191:economics* / Q000453:epidemiology* / Q000401:mortality; D003362:Cost-Benefit Analysis; D006291:Health Policy; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D015233:Models, Statistical; D016019:Survival Analysis; D014611:Vaccination / Q000191:economics* / Q000379:methods* / Q000706:statistics & numerical data; D014744:Vietnam / Q000453:epidemiology; D055815:Young Adult
Cost-effectiveness; Diphtheria; Immunization; Measles; Pertussis; Polio