Economic Benefits of Vaccines in Low-Income Countries and Transitional Economies: A Systematic Review

Background: Despite the availability of effective vaccines, vaccine-preventable diseases continue to create substantial clinical and economic burdens for households, health systems, and government budgets.  Ongoing global economic uncertainties and rising vaccine costs are forcing governments, particularly those in low- and medium-income countries (LMIC), to prioritize public health interventions. A better understanding of the positive public health and economic benefits of vaccination can inform decisions aimed at maximizing vaccines and efficient public health resource use.  Methods: We conducted a systematic review of literature published during 2000–2013 on cost-effectiveness and cost-benefit analysis of vaccines. We searched PubMed, Web of Science, Embase, EconLit, and ProQuest data bases using the terms “economics and immunization,” “economics or socioeconomic benefits and immunization,” and “cost-effectiveness or cost-benefits or economic benefits and vaccines or immunization.” One hundred and seventy relevant studies from 63 LMIC countries were identified from 3,743 search returns. The studies covered 25 types of vaccines, 16 of which were already integrated into routine vaccination schedules; the remaining 9 were in clinical trials or were entering the market.  Results: Of the 170 studies, 90 (53%) used primary data sources, and the remaining studies used secondary and hypothetical data sources or models. Overall, 136 (80%) studies focused only on health gains and cost savings resulting from disease reduction after vaccine use.  Broader economic benefits, such as healthcare system savings, changes in demographic characteristics of the population, and increased earning capacity at both the micro and macro level, were reported in 34 (20%) studies. Information on long-term societal gains, including economic expansion through growth in gross domestic product, long term savings from catastrophic health expenditures, strengthening of the healthcare system with additional resources realized from health system savings and overtime increase of household level productivity secondary to vaccine use, was very limited across all the studies. Vaccine costs varied from $80 to $1,000 per disability adjusted life year averted.  Conclusions: Our literature review emphasizes the often-missed important broader economic benefits of vaccines. The economic evaluation studies accentuate the importance of efficient resource use through smart public health investments. Moreover, the review underscores important knowledge gaps in vaccine economics. A better understanding of broad micro- and macro-economic benefits of vaccines is important to inform vaccine policy-making decisions, particularly given the ever-increasing resource constraints facing public health choices.