title: Comparing the health and social protection effects of measles vaccination strategies in Ethiopia: An extended cost-effectiveness analysis.
abstract: Vaccination coverage rates often mask wide variation in access, uptake, and cost of providing vaccination. Financial incentives have been effective at creating demand for social services in a variety of settings. Using methods of extended cost-effectiveness analysis, we compare the health and economic implications of three different vaccine delivery strategies for measles vaccination in Ethiopia: i) routine immunization, ii) routine immunization with financial incentives, and iii) mass campaigns, known as supplemental immunization activities (SIAs). We examine annual birth cohorts of almost 3,000,000 births over a ten year period, exploring variation in these outcomes based on economic status to understand how various options may improve equity. SIAs naturally achieve higher levels of vaccine coverage, but at higher costs. Routine immunization combined with financial incentives bolsters demand among more economically vulnerable households. The relative appeal of routine immunization with financial incentives and SIAs will depend on the policy environment, including short-term financial limitations, time horizons, and the types of outcomes that are desired. While the impact of financial incentives has been more thoroughly studied in other policy arenas, such as education, consideration of this approach alongside standard vaccination models such as SIAs is timely given the dialog around measles eradication.
authors.affiliation: Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: driessen@pitt.edu.
authors.forename: Julia
authors.initials: J
authors.lastname: Driessen
authors.affiliation: Health Services and Policy Analysis, University of California, Berkeley, CA, USA.
authors.forename: Zachary D
authors.initials: ZD
authors.lastname: Olson
authors.affiliation: Global Health Sciences, University of California, San Francisco, CA, USA; Department of Global Health, University of Washington, Seattle, WA, USA.
authors.forename: Dean T
authors.initials: DT
authors.lastname: Jamison
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Electronic address: verguet@hsph.harvard.edu.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Verguet
mesh_terms: D002675:Child, Preschool; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data*; D005002:Ethiopia / Q000453:epidemiology; D006801:Humans; D007223:Infant; D032541:Mass Vaccination / Q000191:economics* / Q000331:legislation & jurisprudence; D008457:Measles / Q000453:epidemiology; D008458:Measles Vaccine / Q000191:economics / Q000627:therapeutic use*; D011640:Public Policy
chemical_list: D008458:Measles Vaccine
keywords: Ethiopia; Extended cost-effectiveness analysis; Financial incentives; Measles; Routine immunization; Supplementary immunization activities; Vaccination