Electronic Immunization Registries in Low and Middle Income Countries: Economic Evaluation

Abstract

Objectives: This Master thesis analyses the challenges and benefits, the differences in vaccination costs and vaccine program effectiveness, and the impact on disease events, health benefits, and cost-effectiveness when Electronic Immunisation Registries are used in place of paper-based records in Low -and Middle-Income Countries (LMICs). Methods: A cross-sectional analysis was carried out using primary data obtained from 61 facilities in 10 regions in Tanzania that comprised Electronic Immunisation Registry (EIR) users and non-users. The data was analysed to yield the difference in unit healthcare costs for vaccine activities per child registered in these facilities in a year and costs of 14 vaccination activities. Afterwards, a cost-effectiveness analysis was carried out using the UNIVAC model created by the Pan-American Health Organization (PAHO) and the London School of Hygiene and Tropical Medicine to assess the cost-effectiveness, and disease events averted when EIRs are used instead of paper-based records for rotavirus vaccination in Tanzania. Results: Of the 61 facilities evaluated, 36 had implemented EIRs at some point, but only 17 facilities were currently still using them. The unit healthcare costs for vaccine activities per child per year were 1.78 USD and 1.59 USD for EIR non-users and users, respectively. Facilities using EIRs had statistically significant lower costs in 6 out of the 13 staff costs and 2 out of the 5 non-staff cost components of the 14 activities. In the cost-effectiveness analysis, the cost per DALY averted was $92 and $39 from the government and societal perspectives, respectively, when EIR use was compared to paper-based record utilization. In addition, 302,496 rotavirus cases, 151,261 hospital visits, 15,101 hospitalizations, and 739 deaths were averted when EIRs were used instead of paper-based records. Conclusion: There are challenges to EIR utilization in LMICs, but EIRs result in cost savings and are cost-effective in comparison to paper-based records in LMICs.

Objectives: This Master thesis analyses the challenges and benefits, the differences in vaccination costs and vaccine program effectiveness, and the impact on disease events, health benefits, and cost-effectiveness when Electronic Immunisation Registries are used in place of paper-based records in Low -and Middle-Income Countries (LMICs). Methods: A cross-sectional analysis was carried out using primary data obtained from 61 facilities in 10 regions in Tanzania that comprised Electronic Immunisation Registry (EIR) users and non-users. The data was analysed to yield the difference in unit healthcare costs for vaccine activities per child registered in these facilities in a year and costs of 14 vaccination activities. Afterwards, a cost-effectiveness analysis was carried out using the UNIVAC model created by the Pan-American Health Organization (PAHO) and the London School of Hygiene and Tropical Medicine to assess the cost-effectiveness, and disease events averted when EIRs are used instead of paper-based records for rotavirus vaccination in Tanzania. Results: Of the 61 facilities evaluated, 36 had implemented EIRs at some point, but only 17 facilities were currently still using them. The unit healthcare costs for vaccine activities per child per year were 1.78 USD and 1.59 USD for EIR non-users and users, respectively. Facilities using EIRs had statistically significant lower costs in 6 out of the 13 staff costs and 2 out of the 5 non-staff cost components of the 14 activities. In the cost-effectiveness analysis, the cost per DALY averted was $92 and $39 from the government and societal perspectives, respectively, when EIR use was compared to paper-based record utilization. In addition, 302,496 rotavirus cases, 151,261 hospital visits, 15,101 hospitalizations, and 739 deaths were averted when EIRs were used instead of paper-based records. Conclusion: There are challenges to EIR utilization in LMICs, but EIRs result in cost savings and are cost-effective in comparison to paper-based records in LMICs.