The Risks, Costs, and Benefits of Possible Future Global Policies for Managing Polioviruses

• Published in: American journal of public health (1971) Vol. 98; no. 7; pp. 1322 - 1330
• Main Authors: Thompson, Kimberly M, Tebbens, Radboud J. Duintjer, Pallansch, Mark A, Kew, Olen M, Sutter, Roland W, Aylward, R. Bruce, Watkins, Margaret, Gary, Howard E., Jr, Alexander, James, Jafari, Hamid, Cochi, Stephen L
• Format: Journal Article
• Language: English
• Published: Washington, DC Am Public Health Assoc 01-07-2008; American Public Health Association
• Subjects: Biological and medical sciences; Child; Confidence intervals; Cost analysis; Cost control; Cost sharing; Cost-Benefit Analysis; Developing countries; Disease Outbreaks - prevention & control; Effectiveness; Epidemics; Estimates; Global Health; Health Policy; High income; Humans; Immunization; Immunization Programs - economics; Immunization Programs - trends; Industrialized nations; LDCs; Low income groups; Medical sciences; Miscellaneous; Models, Economic; Poliomyelitis; Poliomyelitis - prevention & control; Poliovirus Vaccine, Inactivated - economics; Poliovirus Vaccine, Oral - economics; Poliovirus Vaccines - economics; Poliovirus Vaccines - therapeutic use; Population; Prices; Public Health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Reproducibility of Results; Research and Practice; Risk management; Risk Management - economics; Risk Management - methods; Risk Management - organization & administration; Surveillance; Vaccines; Human; Costs; Health policy; Efficiency; Health economy; Risk factor; Risk; Economic aspect; Public health
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2007.122192

We assessed the costs, risks, and benefits of possible future major policy decisions on vaccination, surveillance, response plans, and containment following global eradication of wild polioviruses.
We developed a decision analytic model to estimate the incremental cost-effectiveness ratios and net benefits of risk management options for polio for the 20-year period and stratified the world according to income level to capture important variability between nations.
For low-, lower-middle-, and upper-middle-income groups currently using oral poliovirus vaccine (OPV), we found that after successful eradication of wild polioviruses, OPV cessation would save both costs and lives when compared with continued use of OPV without supplemental immunization activities. We found cost-effectiveness ratios for switching from OPV to inactivated poliovirus vaccine to be higher (i.e., less desirable) than other health investment opportunities, depending on the actual inactivated poliovirus vaccine costs and assumptions about whether supplemental immunization activities with OPV would continue.
Eradication promises billions of dollars of net benefits, although global health policy leaders face difficult choices about future policies. Until successful eradication and coordination of posteradication policies, health authorities should continue routine polio vaccination and supplemental immunization activities.