2. Polio eradication
Bruce Aylward, Arnab Acharya, Sarah England, Mary Agocs, Jennifer Linkins
Direct Benefits: DALYs saved & cost-effectiveness
- Studies have analyzed the benefits and costs of polio eradication, showing substantial net benefits
- Analysis here of cost-effectiveness of GPEI 2001-2040 where:
- best case’ = cessation of OPV immunization after interruption of transmission (set at 2010)
- ‘worst case’ = replace routine OPV immunization with IPV vaccine in all countries
- Results sensitive to whether routine use of OPV is stopped and universal IPV adopted, and to price of IPV for low-income countries
A number of studies have analyzed the benefits and costs of polio eradication: Musgrove (1988) calculated the net present value of discounted savings resulting from polio eradication over the 15 years from 1988 to beUS$ 62.1 million, assuming a successful 5 year campaign and 10 year maintenance period, and that all polio victims were treated.
Bart et al (1996) conducted an analysis examining the period of 1986-2040, concluding that “the ‘break-even’ point at which benefits exceeded costs was the year 2007, with a saving of US$ 13 600 million by the year 2040”. Here an analysis was made of the cost-effectiveness of GPEI for 2001-2040. The most realistic ‘best case’ scenario was the cessation of OPV immunization after the interruption of wild poliovirus transmission (here set at 2010), and the ‘worst case’ to replace routine OPV immunization with the more expensive IPV vaccine in all countries to avoid the risk of vaccine-associated paralytic poliomyelitis or of an outbreak due to a circulating vaccine-derived poliovirus.
This analysis found that the burden of disease due to polio would still be significant were eradication not to take place - see next slide. Cost-effectiveness is highly sensitive to international decisions on the most appropriate and feasible polio immunization policy in the post-certification era, particularly whether to stop routine use of OPV and whether to adopt universal IPV immunization in its place, and to the public sector price of IPV for low-income countries (set at US$0.50 per dose administered in this analysis). Finally, it is important to note that the benefits of eradication could rise considerably (perhaps by as much as US$ 10 billion) should some or all industrialized countries decide to stop immunizing against polio in the post-eradication era.