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Keyword: costing

By: Dagna Constenla, PhD, MPhil, MPH, Director of Economics and Finance, International Vaccine Access Center (IVAC)

In Bangladesh, training experts to determine what a bout of diarrhea, measles, or pneumonia truly costs – and better evaluate investments in vaccines 

DOVE Team Photo

While vaccines are widely regarded as one of the most cost-effective public health interventions we still lack evidence on the broader economic impact of vaccines, including the costs of illness of vaccine-preventable diseases. 

Launched by the Johns Hopkins International Vaccine Access Center (IVAC) in 2011, the Decade of Vaccine Economics project estimates the global economic benefits, costs, financing, funding gap, and return on investment in national immunization programs.

As part of the project’s fourth phase (DOVE IV), my team at IVAC, in collaboration with icddr,b, is collecting primary data on the costs of illness associated with diarrhea, measles, and pneumonia. This research will help stakeholders in Bangladesh and other countries make more informed decisions about the true economic burden of childhood diseases—and provide evidence to support ongoing investment in the vaccines targeting these diseases.

DOVE IV will estimate both the cost of treatment and productivity losses in both public and private settings across multiple levels of care. Using robust data collection methods, our team will quantify the costs of disease control interventions. These data could help inform the ongoing financial commitment and prioritization of national immunization programs around the world.  

Building capacity in Bangladesh for costing studies on common childhood diseases

Field Research

During the first phase of DOVE IV, we are building capacity for research on the ground. To this end, our team met with icddr,b experts in Dhaka, Bangladesh July 26-28.

Attendees discussed standardized methods for collecting, entering, and monitoring cost data. In addition, field research officers and field research assistants learned the use of these methods in participating healthcare facilities, pharmacies, and households in Bangladesh.

Participants, such as our two Field Research Officers, Tajmul Haque and Palash Matsuddi, and our four Field Research Assistants, Md. Joynal Abedin, Md. Mosabbirul Hasan, Md. Kamal Hossain and Rakibul Haider Chowdhury below, engaged in role-playing activities and case study exercises to reinforce data entry and data monitoring procedures.

DOVE Training

Shortly after the training, a pilot test was conducted to assess the applicability of data collection tools in the Bangladesh context and to evaluate the accuracy of entering data electronically. 

Micro-costing study on childhood illness

The next phase of the project will consist of primary data collection on the costs of illness associated with diarrhea, measles, and pneumonia— taking into account both public and private settings across multiple levels of care (I took the photo above of Md. Zahid Hasan, Md. Joynal Abedin and Md. Mosabbirul Hasan conducting a caregiver interview in the  Diarrhea Hospital in Dhaka). The project’s data collection will take place in two divisions starting in 2017. This is a prospective and retrospective micro-costing study that includes three components:

  1. An assessment of costs for child health services at the healthcare facility level;
  2. An assessment of costs for child health services at the pharmacy level; and
  3. An assessment of the costs of accessing care by caretakers.

We look forward to sharing results by the end of 2018.

DOVE Study Field Research in Bangladesh

Thanks to the Bill & Melinda Gates Foundation for supporting this project.

Team members focused on this effort include my colleagues Jorge Martin del Campo and Gatien de Broucker of IVAC as well as Sayem Ahmed, Wazed Ali, and Jasim Uddin of ICDDR’b.

Thanks also to the other members of the study team—the Line Director, Maternal Neonatal Child and Adolescent Health and Program Manager, Expended Program on Immunization of the Ministry of Health and Family Welfare of the Government of Bangladesh.

By Dr. Dagna Constenla

Dengue is a painful and debilitating mosquito-borne virus affecting millions of people worldwide every year. Prior to 1970, the disease was endemic in just nine countries. Today it is endemic in more than 100 countries, and WHO estimates that 2.5 billion people are at risk of infection each year.

Dengue Costing Guidelines

Costing Dengue Cases and Outbreaks: A Guide to Current Practices and Procedures

As the global burden of dengue grows, so too does the realization of just how little we know about the health and economic toll of the disease. At the same time, the prospect of a licensed vaccine is growing near, and dengue-endemic countries will have to begin to consider whether or not to introduce the vaccine. An important question they must ask when weighing the costs against the benefits of vaccine introduction is, “how much does dengue cost?”

In response to the growing need to answer that question and lay the groundwork for vaccine decision making by endemic countries, the International Vaccine Access Center, as part of its work on the Dengue Vaccine Initiative (DVI), convened an expert panel in March 2012 to discuss and develop a standardized methodology for estimating costs of dengue in the Americas. The resulting guidelines, Costing Dengue Cases and Outbreaks: A Guide to Current Practices and Procedures, published late last month, aim to ensure robust assessment of the economic burden of dengue infections and to make the results of future dengue cost studies more comparable among Latin American countries. 

The guidelines highlight the many considerations that need to be taken into account when doing analysis to understand the overall economic burden borne by a community as a result of dengue, from understanding the health care system where the study is being conducted to determining the definition of a dengue outbreak. The expert panel concluded that, while there is no single theoretically correct approach to costing dengue, experts generally adhered to certain principles including:

  • The adoption of a societal (broad rather than individual) perspective;
  • The inclusion of all relevant costs and effects (direct medical and non-medical costs of treating a case of dengue, productivity loss of patient and caregiver, etc);
  • The use of an adequate sample size, and;
  • The optimal collection and valuation of unit cost data for use in multi-country settings (making sure that data collected from a variety of countries and settings is collected well and able to be compared).

Creation of these guidelines was just one piece of IVAC’s work on dengue. This spring we plan to convene leaders from Latin America to tackle another key challenge in dengue vaccine introduction – financing. We are also tasked, through the DVI, with linking epidemiologic and economic modeling to create a strategic demand forecast for dengue vaccines.

It is important to note that estimation of dengue costs is a new area in which there is little published literature and in which few of the guideline authors had practical experience. Dengue financing is also an area that experts are just now beginning to address. It is our hope that our work will spur further discussion and research that will help position countries to make well-informed decisions about vaccine introduction. We welcome your thoughts on the guidelines and other dengue costing and financing issues here, or via email to

Dagna Constenla, PhD, is the Director of Economics & Finance at IVAC.

Aug 2017