Systematic review of the incremental costs of interventions that increase immunization coverage

Vaccine. 2018 Jun 14;36(25):3641-3649. doi: 10.1016/j.vaccine.2018.05.030. Epub 2018 May 10.


Achieving and maintaining high vaccination coverage requires investments, but the costs and effectiveness of interventions to increase coverage remain poorly characterized. We conducted a systematic review of the literature to identify peer-reviewed studies published in English that reported interventions aimed at increasing immunization coverage and the associated costs and effectiveness of the interventions. We found limited information in the literature, with many studies reporting effectiveness estimates, but not providing cost information. Using the available data, we developed a cost function to support future programmatic decisions about investments in interventions to increase immunization coverage for relatively low and high-income countries. The cost function estimates the non-vaccine cost per dose of interventions to increase absolute immunization coverage by one percent, through either campaigns or routine immunization. The cost per dose per percent increase in absolute coverage increased with higher baseline coverage, demonstrating increasing incremental costs required to reach higher coverage levels. Future studies should evaluate the performance of the cost function and add to the database of available evidence to better characterize heterogeneity in costs and generalizability of the cost function.

Keywords: Cost; Effectiveness; Intervention; Review; Vaccination.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Review
  • Systematic Review

MeSH terms

  • Bacterial Infections / economics
  • Bacterial Infections / immunology
  • Bacterial Infections / prevention & control
  • Bacterial Vaccines / administration & dosage
  • Bacterial Vaccines / economics*
  • Cost-Benefit Analysis / methods
  • Developed Countries / economics
  • Developing Countries / economics
  • Health Care Costs / statistics & numerical data*
  • Humans
  • Immunization Programs / economics
  • Income / statistics & numerical data
  • Models, Statistical*
  • Vaccination / economics*
  • Vaccination / statistics & numerical data
  • Vaccination Coverage / economics*
  • Vaccination Coverage / statistics & numerical data
  • Viral Vaccines / administration & dosage
  • Viral Vaccines / economics*
  • Virus Diseases / economics
  • Virus Diseases / immunology
  • Virus Diseases / prevention & control


  • Bacterial Vaccines
  • Viral Vaccines