Cost-effectiveness of supplementary immunization for measles in India.

OBJECTIVE This study aims to estimate the incremental cost effectiveness of a supplementary immunization activity (SIA) for measles in a district of India with measles vaccine coverage equivalent to the National average. DESIGN A state transition model is used to estimate the effect of routine vaccination with measles vaccine as well as with measles vaccine during the SIA. The model follows each sub-cohort in the target population at respective age (1-5 years) to five years of age, using age specific incidence rate and vaccination rate to determine the number of cases of measles. Using age specific incidence rates and complication rates for measles; deaths and disability adjusted life year (DALY) averted is estimated. RESULTS Using base-case assumptions, an estimated 65479 cases of measles and 1637 deaths due to measles will be prevented in a span of four years from a single supplementary immunization activity in a pediatric population (1-5 years of age) of size 839,473. The cost per measles vaccine dose delivered is INR 30. Using base case analysis the cost to avert a death is INR 15381 and the cost per disability adjusted life year (DALY) averted is INR 430. CONCLUSIONS Supplementary immunization activity for measles is cost-effective. However, this cannot be considered superior to a second dose of measles in routine immunization.