The Costs of Future Polio Risk Management Policies
by Radboud J. Duintjer Tebbens, Nalinee Sangrujee, and Kimberly M. Thompson, Risk Analysis 2006;26(6):1507-1531

Abstract

Decisionmakers need information about the anticipated future costs of maintaining polio eradication as a function of the policy options under consideration. Given the large portfolio of options, we reviewed and synthesized the existing cost data relevant to current policies to provide context for future policies. We model the expected future costs of different strategies for continued vaccination, surveillance, and other costs that require significant potential resource commitments. We estimate the costs of different potential policy portfolios for low-, middle-, and high-income countries to demonstrate the variability in these costs. We estimate that a global transition from routine immunization with oral poliovirus vaccine (OPV) to inactivated poliovirus vaccine (IPV) would increase the costs of managing polio globally, although routine IPV use remains less costly than routine OPV use with supplemental immunization activities. The costs of surveillance and a stockpile, while small compared to routine vaccination costs, represent important expenditures to ensure adequate response to potential outbreaks. The uncertainty and sensitivity analyses highlight important uncertainty in the aggregated costs and demonstrates that the discount rate and uncertainty in price and administration cost of IPV drives the expected incremental cost of routine IPV vs. OPV immunization.

Answers to frequently asked questions

What are the study’s main findings?
What are the study’s main recommendations?
Background on polio

What are the study’s main findings?

  • The estimated costs of future polio risk management policies over the next 20 years depend on the policies selected. The study estimates billions of dollars in costs for continued vaccination after eradication, with much higher costs for vaccination with inactivated poliovirus vaccine (IPV) compared to oral poliovirus vaccine (OPV), unless OPV is supplemented by regular national immunization days. (See the full paper for the actual estimates and breakdowns by country income levels.)
  • Acute flaccid paralysis surveillance represents another major cost component, while other components of risk management policies (activities to enhance population immunity before OPV cessation, stockpile, global polio laboratory network, maintenance of containment) represent relatively lower costs.
  • Assumptions about vaccine schedule, formulation, and price projections, and about the administration costs of IPV all represent major drivers of the uncertainty in the results.
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What are the study’s main recommendations?
  • Countries weighing the option of routine IPV immunization after eradication should carefully consider the costs and feasibility of different IPV formulations and schedules.
  • Systematic collection of immunization expenditure data over time and by country will help better characterize the costs of future immunization policies and facilitate informed decision making.
  • Additional research on the monetary valuation of paralytic polio cases across different income levels will further help characterize the economic benefits associated with post-eradication options.
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