Cost-effectiveness of an Intervention to Increase Immunization Coverage in Pakistan

Reasons include a lack of political commitment, unreliable vaccine supplies, high cost, lack of motivation among Expanded Program on Immunization (EPI) staff, and a scarcity of data present coverage rates, the size of the birth cohort, and the incidence of vaccine-preventable diseases. The Government of Sindh Province in Pakistan sought technical assistance from the USAID-funded Health Systems Strengthening Project to improve immunization uptake in four low-coverage districts of Jacobabad, Kashmore, Tharparkar, and Thatta. The intervention aimed to increase immunization coverage through a combination of strategies, including training of EPI staff, improvement of vaccine supply chain management, and community mobilization. The implementing partner, John Snow International (JSI), collected program effectiveness data routinely, while cost data were collected retrospectively from accounting records. The analysis used a cost-effectiveness model to estimate the effectiveness and efficiency of the intervention from both the USAID and health system perspectives. The model input data included vaccination coverage data, cost data, and effectiveness data. Vaccination coverage data were obtained from routine program reports, while cost data were collected from accounting records. Effectiveness data were obtained from program reports and literature reviews. The cost-effectiveness calculation method used was the incremental cost-effectiveness ratio (ICER), which compares the cost of the intervention to the health benefits achieved. The results of the analysis showed that the intervention was highly cost-effective, with an ICER of $1.23 per disability-adjusted life year (DALY) averted from the USAID perspective. Sensitivity analysis showed that the ICER was sensitive to changes in the effectiveness of the intervention, with a decrease in effectiveness leading to an increase in the ICER. From the health system perspective, the ICER was $2.15 per DALY averted, indicating that the intervention was also cost-effective from this perspective. The discussion highlights the limitations of the analysis, including the use of retrospective data and the potential for biases in the data collection process. However, the results of the analysis provide valuable insights into the effectiveness and efficiency of the intervention and can inform future immunization programs in Pakistan. The conclusion emphasizes the importance of continued support for immunization programs in Pakistan and the need for further research to improve the effectiveness and efficiency of these programs. The intervention was implemented in four low-coverage districts of Jacobabad, Kashmore, Tharparkar, and Thatta, and the results showed a significant increase in immunization coverage in these districts. The analysis also showed that the intervention was highly cost-effective, with an ICER of $1.23 per DALY averted from the USAID perspective. The results of the analysis provide valuable insights into the effectiveness and efficiency of the intervention and can inform future immunization programs in Pakistan. The Government of Sindh Province in Pakistan sought technical assistance from the USAID-funded Health Systems Strengthening Project to improve immunization uptake in four low-coverage districts of Jacobabad, Kashmore, Tharparkar, and Thatta. The intervention aimed to increase immunization coverage through a combination of strategies, including training of EPI staff, improvement of vaccine supply chain management, and community mobilization. The implementing partner, John Snow International (JSI), collected program effectiveness data routinely, while cost data were collected retrospectively from accounting records.