Costs of EPI : a review of cost and cost-effectiveness studies (1979-1987)

The 28 evaluations reviewed were found to vary in quality and to lack a consistent methodology; they were generally conducted on an ad hoc basis and their results have been inadequately disseminated. Nonetheless, three major generalizations can be extracted from the studies. (1) The average cost per child for full immunization coverage is $13; this figure could be used to estimate the cost of an EPI worldwide, regardless of the approach used. (2) The contributions of national governments to immunization programs (approximately 50%) are lower than reported earlier. With the bulk of EPI costs being borne by international organizations and donor agencies, sustaining EPI by using only government resources will be difficult in many countries, particularly where public health expenditures are already low. (3) The larger the population reached by the EPI, the larger the total program cost. Further, although it appears that average cost declines with increasing coverage rates, insufficient empirical data exist to verify such a conclusion.