Volume 75, Issue 2_suppl
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


This report presents an approach to costing the delivery of a malaria vaccine through the expanded program on immunization (EPI), and presents the predicted cost per dose delivered and cost per fully immunized child (FIC) in Tanzania, which are key inputs to the cost-effectiveness analysis. The costs included in the analysis are those related to the purchase of the vaccine taking into account the wastage rate; the costs of distributing and storing the vaccine at central, zonal, district, and facility level; those of managing the vaccination program; the costs of delivery at facility level (including personnel, syringes, safety boxes, and waste management); and those of additional training of EPI personnel and of social mobilization activities. The average cost per FIC increases almost linearly from US$4.2 per FIC at a vaccine price of US$1 per dose to US$31.2 at vaccine price of US$10 per dose. The marginal cost is approximately 5% less than the average cost. Although the vaccine price still determines most of the total delivery costs, the analysis shows that other costs are relevant and should be taken into account before marketing the vaccine and planning its inclusion into the EPI.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Tediosi F, Maire N, Smith T, Ross A, Tanner M, Hutton G, 2006. Predicting the cost-effectiveness of introducing a pre-erythrocytic malaria vaccine into the expanded program of immunization schedule in Tanzania. Am J Trop Med Hyg 75 (Suppl 2): 131–143.
    [Google Scholar]
  2. Drummond M, O’Brien BJ, Stoddart GL, Torrance G, 1997. Methods for the Economic Evaluation of Health Care Programmes. Second edition. New York: Oxford University Press.
  3. Gold MR, Gold SR, Weinstein MC, 1996. Cost-Effectiveness in Health and Medicine. Oxford, United Kingdom: Oxford University Press.
  4. Little I, Mirrlees J, 1969. Manual of Industrial Project Analysis in Developing Countries. Paris: Organization of Economic Cooperation and Development.
  5. United Nations Industrial Development Organization, 1972. Guidelines for Project Evaluation. New York: United Nations.
  6. Dasgupta P, 1970. An analysis of two approaches to project evaluation in developing countries. Industrialization and Productivity Bulletin. New York: United Nations Industrial Development Organization.
  7. Sugden R, Williams A, 1978. Principles of Practical Cost-Benefit Analysis. Oxford, United Kingdom: Oxford University Press.
  8. Drummond MF, Stoddart GL, Torrance GW, 1987. Methods for the Economic Evaluation of Health Care Programmes. First edition. Oxford, United Kingdom: Oxford University Press.
  9. Levin HM, 1983. Cost-Effectiveness - A Primer. London: Sage Publications.
  10. Drummond M, 1980. Principles of Economic Appraisal in Health Care. Oxford, United Kingdom: Oxford University Press.
  11. World Health Organization, 1988. Estimating Costs for Cost-Effectiveness Analysis: Guidelines for Managers of Diarrhoeal Disease Control Programmes. Geneva: World Health Organization. WHO/CDD/SER/88.3.
  12. Luce BR, Elixhauser A, 1990. Estimating costs in the economic evaluation of medical technologies. Int J Tech Assess Health Care 6 : 57–75.
    [Google Scholar]
  13. Creese A, Parker D, 1994. Cost Analysis in Primary Health Care: A Training Manual for Programme Managers. Geneva: World Health Organization.
  14. Drummond MF, Jefferson TO, 1996. Guidelines for authors and peer reviewers of economic sumissions to the BMJ. The BMJ Economic Evaluation Working Party. BMJ 313 : 275–283.
    [Google Scholar]
  15. Tan-Torres Edejer T, Baltussen R, Adam T, Hutubessy R, Acharya A, Evans D, Murray C, 2003. Making Choices in Health: WHO Guide to Cost-Effectiveness Analysis. World Health Organization, Geneva.
  16. Baladi JF, 1996. A Guidance Process for the Costing Process. Ottawa, Ontario, Canada: Canadian Coordinating Office for Health Technology Assessment.
  17. Udvarhelyi IS, Colditz GA, Rai A, Epstein AM, 1992. Cost-effectiveness and cost-benefit analyses in the medical literature. Are the methods being used correctly? Ann Intern Med 116 : 238–244.
    [Google Scholar]
  18. Drummond M, Brandt A, Luce B, Rovira J, 1993. Standardising methodologies for economic evaluation in health care. Int J Tech Assess Health Care 9 : 26–36.
    [Google Scholar]
  19. Rovira J, 1994. Standardising economic appraisal of health technology in the European Community. Soc Sci Med 38 : 1675–1678.
    [Google Scholar]
  20. Weinstein M, Siegel J, Gold M, Kamlet M, Russell L, 1996. Recommendations of the panel of cost-effectiveness in medicine. JAMA 276 : 1253–1341.
    [Google Scholar]
  21. Parent du Chatelet I, Gessner BD, da Silva A, 2001. Comparison of cost-effectiveness of preventive and reactive mass immunization campaigns against meningococcal meningitis in west Africa: a theoretical modeling analysis. Vaccine 19 : 3420–3431.
    [Google Scholar]
  22. Brenzel L, Claquin P, 1994. Immunization programs and their costs. Soc Sci Med 39 : 527–536.
    [Google Scholar]
  23. Monath TP, Nasidi A, 1993. Should yellow fever vaccine be included in the expanded program of immunization in Africa? A cost-effectiveness analysis for Nigeria. Am J Trop Med Hyg 48 : 274–299.
    [Google Scholar]
  24. Feilden R, 1990. Estimating vaccine costs for EPI (Expanded Programme on Immunization) cost-effectiveness analysis. Int J Health Plann Manage 5 : 221–226.
    [Google Scholar]
  25. Brenzel LE, 1990. The Cost of EPI: A Review of Cost and Cost-Effectiveness Studies (1978–1987). Arlington, VA: REACH project.
  26. Shepard DS, Sanoh L, Coffi E, 1986. Cost-effectiveness of the expanded programme on immunization in the Ivory Coast: a preliminary assessment. Soc Sci Med 22 : 369–377.
    [Google Scholar]
  27. Shepard DS, Robertson RL, Cameron CS, Saturno P, Pollack M, Manceau J, Martinez P, Meissner P, Perrone J, 1989. Cost-effectiveness of routine and campaign vaccination strategies in Ecuador. Bull World Health Organ 67 : 649–662.
    [Google Scholar]
  28. Creese AL, 1986. Cost-effectiveness and cost-benefit analyses of immunization programs in developing countries. Jelliffe D, Jelliffe EFP, eds. Advances in International Maternal and Child Health. Volume 6. New York: Oxford University Press, 901–927.
  29. Martin JF, 1984. Consequences of the introduction of the new inactivated poliovirus vaccine into the Expanded Programme on Immunization. Rev Infect Dis 6 (Suppl 2): 480–482.
    [Google Scholar]
  30. Creese AL, Henderson RH, 1980. Cost-benefit analysis and immunization programmes in developing countries. Bull World Health Organ 58 : 491–497.
    [Google Scholar]
  31. Griffiths UK, Hutton G, das Dores Pascoal E, 2005. Cost-effectiveness of introducing hepatitis B vaccine into the infant immunization schedule in Mozambique. Health Policy Plann 20 : 50–59.
    [Google Scholar]
  32. Edmunds WJ, Dejene A, Mekonnen Y, Haile M, Alemnu W, Nokes DJ, 2000. The cost of integrating hepatitis B virus vaccine into national immunization programmes: a case study from Addis Ababa. Health Policy Plann 15 : 408–416.
    [Google Scholar]
  33. Hall AJ, Robertson RL, Crivelli PE, Lowe Y, Inskip H, Snow SK, Whittle H, 1993. Cost-effectiveness of hepatitis B vaccine in The Gambia. Trans R Soc Trop Med Hyg 87 : 333–336.
    [Google Scholar]
  34. Goodman C, Coleman PG, Mills A, 2001. The cost-effectiveness of antenatal malaria prevention in sub-Saharan Africa. Am J Trop Med Hyg 64 : 45–56.
    [Google Scholar]
  35. Ministry of Health, 2003. GAVI National Immunization Program Financial Sustainability Plan 2003. Dar es Salaam: Ministry of Health, Tanzania.
  36. Semali IAJ, 2003. Understanding Stakeholders’ Roles in Health Sector Reform Process in Tanzania: The Case of Decentralizing the Immunization Program. PhD Thesis. University of Basel, Basel, Switzerland.
  37. Ministry of Health, 2003. Report of EPI Annual Evaluation Meeting. March 3–7, 2003. Iringa, Tanazania: Department of Preventive Services, Ministry of Health.
  38. Ministry of Health, 2004. Expanded Program on Immunization Five Years National Strategic Plan 2000–2004. Dar es Salaam, Tanzania, Ministry of Health.
  39. World Health Organization, 2002. Guidelines for Estimating Costs of Introducing New Vaccines into the National Immunization System. Geneva: World Health Organization. WHO/ V&B/02.11.
  40. GAVI, 2002. Annual Progress Report to the Global Alliance for Vaccines and Immunization and the Vaccine Fund by the Government of the United Republic of Tanzania. Available from http://wwwvaccinealliance org/home/index php.
  41. United Nations Population Division, 2003. World Population Prospects UN 2003. New York: United Nations.

Data & Media loading...

  • Received : 18 Sep 2005
  • Accepted : 25 Nov 2005
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error