Background
Methods
Process of developing the consensus statement
Review of vaccine delivery costing guidance documents and tools
Results
Existing immunization delivery costing workstreams
Existing guidance documents on vaccine delivery costing
Developer | Guidelines | Publication year | Target Interventions | Purposes | Workstream(s)a |
---|---|---|---|---|---|
EPIC | Common approach for the costing and financing analyses of routine immunization and new vaccine introduction costs [11] | 2013 | Existing and new vaccine programs | Methods for data collection for routine immunization programs and new vaccine introduction (including delivery costs) and financial flows | (1) (2) |
EPIC | How to cost immunization programs - a practical guide on primary data collection and analysis [12] | 2020 | Existing and new vaccine programs | Practical guidance on how to conduct a facility-based exercise on immunization program costs, including sampling and analytical techniques | (1) |
Global Health Cost Consortium (GHCC) | GHCC Reference Case [8] | 2017 | Health interventions in general | Improve quality of cost estimates | Not specific to a workstream |
ICAN | Methodology note for systematic review, cost catalog, and analytics [6] | 2019 | Immunization delivery costs | Designed for users of data, including national and sub-national planners and policymakers, researchers, and international partners supporting country immunization and health system policy, planning, and financing | (1) (2) |
IVI/WHO | CHOLTOOL User Guide [13] | 2015 | Cholera-specific vaccination programs, including campaigns | Instructions for users of costing tools | (2) (3) |
WHO | Guidelines for estimating costs of introducing new vaccines into the national immunization system [14] | 2002 | New vaccine programs | Assist countries in planning for introduction of new vaccines | (3) |
WHO | C4P tool: HPV Vaccination Module User Guide [15] | 2012-2019 | HPV vaccination programs | Instructions for users of costing tool | (2) (3) |
WHO | cMYP Costing and Financing Tool User Guide [16] | 2014 | Immunization Program Costs | Instructions for users of costing tool | (3) (4) |
WHO | Flutool plus (SIICT): introduction planning and costing [17] | 2017 | Seasonal influenza vaccination, including campaigns | Instructions for users of costing tool | (2) (3) |
EPIC (including ‘How to Cost Immunization Programs’ and the Common Approach) | GHCC | ICAN | WHO 2002 Guidelines for Introducing New Vaccines | Costing Tools’ User Manuals (CHOLTOOL, C4P, SIICT)a | WHO cMYP Guideline | |
---|---|---|---|---|---|---|
Vaccine delivery cost | All resources used, whether immunization-specific, or ‘shared, and whether consumed at immunization delivery “sites” or above the level of service delivery, with and without the new vaccine (How to cost immunization programs, pg. 4) [12] | NA | Costs associated with delivering immunizations to target populations, exclusive of vaccine costs (pg.11) [6] | NA | Vaccine delivery includes startup costs, service delivery (personnel time, supplies and transport/allowance), vaccine procurement, monitoring and supervision, and other costs (C4P guide, pg. 262) [15] (Not included in other tool manuals) | NA |
Financial cost | A financial costing is concerned with accounting transactions (i.e., monetary outlays or expenditures) (How to cost immunization programs, pg. 7) [12] | Capture the resources that are “paid” for (pg. A-8) [8] | Financial outlays, usually with straight-line depreciation of capital items (pg. 31) [6] | Actual expenditure for resources used for goods or services purchased. Does not include cost of existing health personnel time or donated goods (pg. 2) [14] | Actual monetary flows of the buyer such as the Ministry of Health. Does not include the value of resources already paid for, such as personnel time (SIICT guide, pg. 21) [17] | NA |
Economic cost | An economic costing values resources based on their opportunity cost, regardless of whether a financial transaction occurred (How to cost immunization programs, pg. 7) [12] | The value of the highest alternative health intervention opportunity forgone; captures the full value forgone of all resources used (pg. A-8) [8] | Financial outlays plus opportunity costs such as health worker time and any donated items such as vaccines (pg. 56) [6] | Resources that have been foregone for alternative uses, or opportunity costs (pg. 2) [14] | Estimates all costs of an intervention, regardless of the source of funding, so that the opportunity cost of all resources is accounted for in the analysis, includes in-kind and donor contributions (SIICT guide, pg. 21) [17] | NA |
Undepreciated financial costs (sometimes called initial investment in costing tool guides and referred to as fiscal costs in previous analyses) | Reflect what governments and donors have paid for activities, services, and goods (Common Approach, pg. 19) [11] | NA | Financial outlays, usually without depreciation of capital items (pg. 31) [6] | NA | Initial upfront resource requirements (C4P guide, pg. 268) [15] | NA |
Recurrent cost | Recurrent items include labor and consumable items such as vaccines doses, supplies and travel costs (How to cost immunization, pg. 11) [12] | Value of resources/inputs with useful lives of less than one year (pg. 61) [8] | NA | Items that are used up during a year (pg. 3) [14] | Goods or items used in the delivery of a service or intervention that last less than a year, e.g., personnel salaries (SIICT guide, pg. 21) [17] (Not included in all tool manuals) | Costs of resources consumed within one year (CMYP guide, pg. 19) [16] |
Capital cost (sometimes called investment cost) | Capital items are durable items such as building, equipment, and vehicles (How to cost immunization, pg. 11) [12] | One-time costs for items that have a useful life of over one year (pg. B-23) [8] | NA | Items that last longer than one year and are therefore incurred only every few years rather than annually (pg. 3) [14] | Goods that last for longer than one year, such as equipment (SIICT guide, pg. 21) [17] | An input that has a useful life of more than one year (cMYP guide, pg. 19) [16] |
Incremental cost | Make assumptions about what particular resources were affected by the intervention, and only measure those resources (How to cost immunization, pg. 8) [12] | Cost of adding a new or a batch of services or intervention over and above an existing program (pg. 59) [8] | Additional costs associated with introducing new vaccines or making changes in delivery (pg. 32) [6] | Only looks at the cost of an addition, e.g., a new vaccine, to existing services (pg. 2) [14] | Additional resources required to add an intervention to an existing immunization program (CHOLTOOL guide, pg. 6) [13] (Not included in other tool manuals) | NA |
Full cost | Full costs include baseline cost as well as the additional cost of the new intervention (How to cost immunization, pg. 8) [12] | NA | The sum of all costs associated with vaccination delivery (pg. 31) [6] | NA | NA | NA |
Cost projections | NA | NA | NA | NA | NA | Total future costs of both recurrent and capital inputs to the NIP (cMYP guide, pg. 108) [16] |
Prospective data collection | Direct observation (How to Cost Immunization Programs, pg. 21) [12] | Direct observation of resource use (pg. B-18) [8] | NA | NA | NA | NA |
Retrospective data collection | NA | Data collection takes place after resource use (pg. B-18) [8] | NA | NA | NA | NA |
Start-up or introduction costs | Costs that are incremental to the routine immunization system and specifically incurred as a result of introduction of the new vaccine (Common Approach, pg.6) [11] All resources used for one-time activities (e.g., social mobilization, cold chain capacity mobilization expansion) in a defined time period around the introduction (How to Cost Immunization, pg. 4) [12] | NA | NA | NA | Initial one-time programmatic activities and include micro-planning, initial training activities, and initial sensitization/social mobilization/IEC (SIICT guide, pg.21) [17] (Not included in other tool manuals) | NA |
Perspectives included in guidance documents | Data Sources recommended in guidance documents | Data Collection guidance provided | Sampling guidance provided | How is uncertainty characterized? | Source Documents | |
---|---|---|---|---|---|---|
Retrospective routine immunization cross-sectional costing | Provider, Payer, or Societal | Health facility records; interviews with national and sub-national program managers | Strategies for data collection provided | Representative sampling of health facilities (stratified, random) | Characterized based on number of sites in sample, stratification of units, and basis of probability of selection; one-way sensitivity testing or scenario analysis | |
Retrospective single-vaccine costing | Provider payer, or Societal | Interviews with national and sub-national program managers; not described for costing tools | Some advice but not available for costing tools | Representative sampling of health facilities or campaign sites; not specified for costing tools | Characterized based on number of sites in sample, stratification of units, and basis of probability of selection; costing tools are not specific but suggest use of scenarios | |
Projection of new vaccine introduction costs | Provider, payer, or Societal | Not described in guidance documents | Provided for some tools but not others | Not specified | Costing tools are not specific but suggest use of scenarios | |
Projection of Immunization program costs | Provider | Interviews with national and sub-national program managers; visits to selected health facilities sometimes | Provides data collection guidance | Can collect data at the sub-national as well as national levels | Conduct scenario analysis to have a range of estimates | [16] |