Abstract
Background
Measles is a highly contagious disease resulting from infection with the measles virus and is responsible for more than 100 000 deaths yearly. Each confirmed measles case can spread to about 12 to 18 people. Despite the low numbers, Zambia continues to register measles outbreaks, the most recent (2022) being 82 confirmed cases reported in Chirundu. Other outbreaks were recorded in Pemba and Sinazongwe of Southern Province. Measles is best prevented through two doses of measles-rubella vaccines, but the uptake of the second dose (MR2) remains low (63%) in Southern province. Urgent efforts are needed to increase stagnating coverage with two doses of measles vaccine through advocacy, education, and strengthening routine immunization systems. With funding from the Swedish Government, Clinton Health Access Initiative supported the Ministry of Health (MoH) to develop a policy brief to propose cost-effective interventions to increase the coverage of the MR2. Maintaining a high-level population immunity against measles is required to prevent disease outbreaks; thus, Zambia needs to improve the MR2 coverage. To achieve this, we identified and evaluated two possible policy options for cost-effectiveness: (i) introducing mandatory birth-registration and vaccination tracking in District Health Information System (DHIS2) and (ii) providing incentives for the measles second dose vaccination. The aim of this analysis was to compare the cost-effectiveness of the two policy options compared with the current interventions in Zambia.
Method
Secondary review of HMIS and research studies was conducted from February to October 2022 to establish the magnitude of the burden as well as review interventions implemented in similar settings and to understand their effectiveness. The cost-effectiveness analysis was done using decision tree using the service provider (MoH) perspective. The analytical horizon for the analysis was three years, and the outcome measure was measles cases averted. Micro costing was done for the activities, and further qualitative input was gathered from key stakeholders to inform the inputs for the model.
Results
The analysis showed that by implementing mandatory birth registration and vaccination tracking in DHIS2, Zambia’s Southern Province would avert 4,747 cases of measles in a year with an incremental cost per averted measles case of US$ 22.56 compared to the status quo. Furthermore, the budget impact analysis revealed that to design and implement this option, an additional US$230, 282; US$191, 707 and US$205, 298 will be required for year 0, Year 1, and Year 2 respectively (i.e., 1% above the cost of the status quo). We also conducted sensitivity analysis which showed that the results were robust enough to withstand uncertainties as most changes in our ICERs were below Zambia’s GDP per capita expenditure on health.
Conclusions and implications for policy and practice
Conducting economic evaluations and modeling health outcomes is key for decision-making. In this policy brief, evidence indicated that implementing the policy option on mandatory electronic birth registration and immunization tracking in DHIS2 is feasible, cost-effective, and sustainable. This policy option presents value for money as it would avert 4,747 measles cases per annum at minimal cost compared to other options.