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Herd Immunity Effects in Cost-Effectiveness Analyses among Low- and Middle-Income Countries


  • Siyu Ma

    (The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center)

  • Tara A. Lavelle

    (The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center
    Tufts University School of Medicine)

  • Daniel A. Ollendorf

    (The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center
    Tufts University School of Medicine)

  • Pei-Jung Lin

    (The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center
    Tufts University School of Medicine)


Background Herd immunity (HI) is a key benefit of vaccination programs, but the effects are not routinely included in cost-effectiveness analyses (CEAs). Objective This study investigated how the inclusion of HI in CEAs may influence the reported value of immunizations in low- and middle-income countries (LMICs) and illustrated the implications for COVID-19 immunization. Methods We reviewed immunization CEAs published from 2000 to 2018 focusing on LMICs using data from the Tufts Medical Center CEA Registries. We investigated the proportion of studies that included HI, the methods used, and the incremental cost-effectiveness ratios (ICERs) reported. When possible, we evaluated how ICERs would change with and without HI. Results Among the 243 immunization CEAs meeting inclusion criteria, 44 studies (18%) included HI. Of those studies, 11 (25%) used dynamic transmission models, whereas the remainder used static models. Sixteen studies allowed for ICER calculations with and without HI (n = 48 ratios). The inclusion of HI always resulted in more favorable ratios. In 20 cases (42%), adding HI decreased the ICERs enough to cross at least one or more common cost-effectiveness benchmarks for LMICs. Among pneumococcal vaccination studies, including HI in the analyses decreased seven of 24 ICERs enough to cross at least one cost-effectiveness benchmark. Conclusion The full value of immunization may be underestimated without considering a scenario in which HI is achieved. Given the evidence in pneumococcal CEAs, COVID-19 vaccine value assessments should aim to show ICERs with and without HI to inform decision-making in LMICs.

Suggested Citation

  • Siyu Ma & Tara A. Lavelle & Daniel A. Ollendorf & Pei-Jung Lin, 2022. "Herd Immunity Effects in Cost-Effectiveness Analyses among Low- and Middle-Income Countries," Applied Health Economics and Health Policy, Springer, vol. 20(3), pages 395-404, May.
  • Handle: RePEc:spr:aphecp:v:20:y:2022:i:3:d:10.1007_s40258-021-00711-y
    DOI: 10.1007/s40258-021-00711-y

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    References listed on IDEAS

    1. Christian Schaetti & Mitchell G Weiss & Said M Ali & Claire-Lise Chaignat & Ahmed M Khatib & Rita Reyburn & Radboud J Duintjer Tebbens & Raymond Hutubessy, 2012. "Costs of Illness Due to Cholera, Costs of Immunization and Cost-Effectiveness of an Oral Cholera Mass Vaccination Campaign in Zanzibar," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 6(10), pages 1-10, October.
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