Evaluation report

Health impact and cost-effectiveness of expanding routine immunization coverage in India through Intensified Mission Indradhanush: a quasi-experimental study and economic evaluation

Emma Clarke‐Deelder, Christian Suharlim, Susmita Chatterjee, Allison Portnoy, Logan Brenzel et al. · 27 Oct 2023

Summary

Written by AI, not yet AICS's view · claude-haiku-4-5-20251001

This study evaluated Intensified Mission Indradhanush (IMI), a large-scale immunization intensification program in India that aimed to increase childhood vaccination coverage. Using quasi-experimental methods and economic analysis, researchers measured the program's impact across 40 districts in 2017–2018. The program delivered an estimated 2.2 million additional vaccine doses and averted approximately 1,413 deaths, at a cost of about $376 per disability-adjusted life year (DALY) averted. The analysis found IMI to be cost-effective by standard public health thresholds, though the study notes that reaching remaining unvaccinated children may become progressively more expensive.

Key points

IMI increased vaccine delivery by an estimated 2.2 million doses across sampled districts
The program averted an estimated 1,413 deaths at an incremental cost of $15.7 million
Cost-effectiveness was $376 per DALY averted, meeting cost-effectiveness thresholds with 89% probability
Cost per zero-dose child reached was $95.24, indicating the program successfully targeted unvaccinated children
As vaccination programs expand coverage, unit costs may increase due to higher costs of reaching currently unvaccinated populations

Limitations

The study uses quasi-experimental design with uncertainty intervals that include zero for some estimates (e.g., deaths averted range from −350 to 3,129), limiting confidence in the precise magnitude of impact. The analysis is restricted to 40 sampled districts and may not generalize to all implementation settings across India.

Abstract

Abstract Background Many children do not receive a full schedule of childhood vaccines, yet there is limited evidence on the cost-effectiveness of strategies for improving vaccination coverage. We evaluated the cost-effectiveness of periodic intensification of routine immunization (PIRI), a widely applied strategy for increasing vaccination coverage. Methods Intensified Mission Indradhanush (IMI) was a large-scale PIRI intervention implemented in India in 2017–2018. In 40 sampled districts, we measured the incremental economic cost of IMI using primary data, and used a quasi-experimental impact evaluation to estimate incremental vaccination doses delivered. We estimated deaths and disability-adjusted life years (DALYs) averted using the Lives Saved Tool and reported cost-effectiveness from government provider and societal perspectives. Findings In sampled districts, IMI had an estimated incremental cost of 2021US$15.7 (95% uncertainty interval: 11.9 to 20.1) million from a provider perspective and increased vaccine delivery by an estimated 2.2 (−0.5 to 4.8) million doses, averting an estimated 1,413 (−350 to 3,129) deaths. The incremental cost was $7.14 per dose ($3.20 to dominated), $95.24 per zero-dose child reached ($45.48 to dominated), $375.98 ($168.54 to dominated) per DALY averted, $413.96 ($185.56 to dominated) per life-year saved, and $11,133 ($4,990 to dominated) per under-five death averted. At a cost-effectiveness threshold of 1x per-capita GDP per DALY averted, IMI was estimated to be cost-effective with 89% probability. Interpretation This evidence suggests IMI was both impactful and cost-effective for improving vaccination coverage. As vaccination programs expand coverage, unit costs may increase due to the higher costs of reaching currently unvaccinated children. Funding Bill & Melinda Gates Foundation

Findings the Hub has extracted

Each claim below is labelled by its type of design and links back to this report.

Survival

Problem

Many children in India do not receive complete childhood vaccination schedules, leading to preventable morbidity and mortality

Intervention: Intensified Mission Indradhanush (IMI), a periodic intensification of routine immunization strategy implemented through targeted campaigns in 2017–2018
Population: Children in 40 sampled districts across India; the program targeted both vaccinated and unvaccinated children to increase complete immunization coverage

Key finding

Incremental vaccine delivery: 2.2 million additional doses (95% UI: −0.5 to 4.8 million)

Experimental