Report on the economics of integration of immunization and PHC

Integration of deworming, growth monitoring, vitamin A supplementation, family planning, and insecticide-treated bednet (ITN) distribution during routine immunization or campaign delivery has been used in many countries to achieve sustainable development and universal health coverage goals. The comparative effectiveness of integrated vs. non-integrated health care services has been investigated in several published reviews, including reviews with a specialized focus on immunization. Cost savings are seen as a major reason to integrate programs; however, none of these reviews found evidence addressing the costs and cost effectiveness of integration of immunization and primary health care services (although there was cost evidence for integration of other health care services). A review by the EPIC team at Harvard, with support from the Bill & Melinda Gates Foundation, aimed to fill this evidence gap by describing the available research on the costs and cost-effectiveness of integrating immunization with primary health care (PHC) services in low- and middle-income countries (LMICs).

For this review, a total of 2,268 abstracts met the criteria and once duplicates were removed the number of unique abstracts to screen was 1,436. Of those abstracts, only 132 were deemed eligible for full text review, 128 of which were not eligible to be included in this study. In the end, four papers were evaluated and each paper was able to highlight that integration led to an overall decrease in costs and increase in cases averted when compared to no integration. While this review was able to extract some cost-effectiveness information from integration studies, there are limited conclusions that can be drawn without comparison of integrated compared to non-integrated delivery in a standardized framework, which limits ability to directly inform policies around integration.

To inform the future research agenda, a convening was organized on 1 February 2022 as a learning process to shed light on what is currently known regarding the economics of integration of immunization and PHC and what the strategic gaps are for understanding a successful transition to integrated delivery from an economic perspective. Future research on the economics of integration of immunization and PHC services requires a strong emphasis on comparing both costs and disease burden when integration is adopted compared to when health services are delivered separately.

Citation: Portnoy A, Regan MC, Brenzel L, Resch SC. Landscape report on the economics of integration of immunization and primary health care services in low- and middle-income countries [version 1; not peer reviewed]. Gates Open Res 2022, 6:61 (document).