The Costs of Future Polio Risk Management Policies
by Radboud J. Duintjer Tebbens, Nalinee Sangrujee, and Kimberly M. Thompson,
Risk Analysis 2006;26(6):1507-1531
Abstract
Decisionmakers need information about the anticipated future
costs of maintaining polio eradication as a function of the policy options under
consideration. Given the large portfolio of options, we reviewed and synthesized
the existing cost data relevant to current policies to provide context for future
policies. We model the expected future costs of different strategies for continued
vaccination, surveillance, and other costs that require significant potential
resource commitments. We estimate the costs of different potential policy portfolios
for low-, middle-, and high-income countries to demonstrate the variability
in these costs. We estimate that a global transition from routine immunization
with oral poliovirus vaccine (OPV) to inactivated poliovirus vaccine (IPV) would
increase the costs of managing polio globally, although routine IPV use remains
less costly than routine OPV use with supplemental immunization activities.
The costs of surveillance and a stockpile, while small compared to routine vaccination
costs, represent important expenditures to ensure adequate response to potential
outbreaks. The uncertainty and sensitivity analyses highlight important uncertainty
in the aggregated costs and demonstrates that the discount rate and uncertainty
in price and administration cost of IPV drives the expected incremental cost
of routine IPV vs. OPV immunization.
Answers to frequently asked questions
What are the study’s main findings?
What are the study’s main recommendations?
Background on polio
What are the study’s main findings?
- The estimated costs of future polio risk management policies over the next
20 years depend on the policies selected. The study estimates billions of
dollars in costs for continued vaccination after eradication, with much higher
costs for vaccination with inactivated poliovirus vaccine (IPV) compared to
oral poliovirus vaccine (OPV), unless OPV is supplemented by regular national
immunization days. (See the full paper for the actual estimates and breakdowns
by country income levels.)
- Acute flaccid paralysis surveillance represents another major cost component,
while other components of risk management policies (activities to enhance
population immunity before OPV cessation, stockpile, global polio laboratory
network, maintenance of containment) represent relatively lower costs.
- Assumptions about vaccine schedule, formulation, and price projections,
and about the administration costs of IPV all represent major drivers of the
uncertainty in the results.
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What are the study’s main recommendations?
- Countries weighing the option of routine IPV immunization after eradication
should carefully consider the costs and feasibility of different IPV formulations
and schedules.
- Systematic collection of immunization expenditure data over time and by
country will help better characterize the costs of future immunization policies
and facilitate informed decision making.
- Additional research on the monetary valuation of paralytic polio cases
across different income levels will further help characterize the economic
benefits associated with post-eradication options.
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