Review of economic burden evidence for nine diseases

Vaccines are considered a highly cost-effective, public health intervention that can reduce the healthcare and household costs incurred by vaccine-preventable illnesses (VPD). To measure the scale of the economic burden from VPD, researchers rely on cost-of-illness (COI) studies to assess the costs associated with a specified illness and perspective. Cost-of-illness studies estimate the costs associated with treating and managing illnesses paid for by patients, governments, insurers, and charitable organizations. They also reveal costs borne by households to obtain healthcare, from travel and accommodations costs to the loss of income. As such, COI studies reflect a comprehensive view of the economic burden of disease and uncovers gaps in the health system that compromise equal access to healthcare.

The ‘Cost of Nine Pediatric Infectious Illnesses in Low‑ and Middle‑Income Countries: A Systematic Review of Cost‑of‑Illness Studies’ review yielded 37 articles and 267 sets of cost estimates. No cost-of-illness studies with cost estimates for hepatitis B, measles, rubella, or yellow fever from primary data were found. Most estimates were from countries in Gavi preparatory (28%) and accelerated (28%) transition, followed by those who are initiating self-financing (22%) and those not eligible for Gavi support (19%). Thirteen articles compared household expenses to manage illnesses with income and two articles with other household expenses, such as food, clothing, and rent. An episode of illness represented 1–75% of the household’s monthly income or 10–83% of its monthly expenses.

Articles that presented both household and government perspectives showed that most often governments incurred greater costs than households, including non-medical and indirect costs, across countries of all income statuses, with a few notable exceptions. Although limited for low- and middle-income country settings, cost estimates generated from primary data collection provided a ‘real-world’ estimate of the economic burden of vaccine-preventable diseases. Additional information on whether common situations preventing the application of official clinical guidelines (such as medication stock-outs) occurred would help reveal deficiencies in the health system. Improving the availability of cost-of-illness evidence can inform the public policy agenda about healthcare priorities and can help to operationalize the healthcare budget in local health systems to respond adequately to the burden of illness in the community.