20. Vaccine–Preventable Diseases

Data were collected from 19 government health facilities in three districts in Peru, including five hospitals and 14 health centers (Walker and others 2004). Total annual costs per center included vaccines, supplies, personnel, cold chain, overhead, and shared inputs. The average cost per dose for traditional EPI antigens plus yellow fever varied from US$1.50 to US$3.20 per dose as shown in the table, with vaccines and personnel accounting for the bulk of costs.

At 2,000 doses, the marginal cost of delivering one more dose is US$1.08, increasing to US$5.33 for 12,000 doses. Average and marginal costs are equal (US$1.18) when 5,000 doses are provided per site. When an outlier delivering many vaccines at a high cost was removed, cost-minimizing output rose to 6,000 doses at US$1.11.

Although each vaccination facility is likely to be associated with different average and marginal costs, considering vaccine provision across a range of providers is relevant, because targets for vaccination can be set by site. Information about marginal costs can help determine what the most efficient size for vaccination facilities is in the long run and how to minimize costs across different size units in the short run, given targets (see figure).

When hepatitis B, Hib, and the pentavalent vaccine (DTP-hepatitis B-Hib) are added to the delivery schedule, the total annual additional cost increases to US$4,121, US$11,886, and US$25,261, respectively, with an average incremental cost per dose of vaccine of US$0.20, US$4.14, and US$4.24, respectively. Adding these new vaccines increased the total cost of providing 5,100 doses from US$5,840 to US$9,415 and changed the minimum average cost from US$1.18 per dose to US$1.68. Therefore, the addition of new vaccines shifts both average and marginal costs upward.

Marginal and Average Vaccination in Sample Facilities in Peru (2001 US$)