Brenzel, LoganSanderson, ColinGalayda, VictorMasud, TayyebHaq, Inaaml ul2013-05-282013-05-282011-10https://hdl.handle.net/10986/13585Pakistan has one of the highest infant mortality rates in the world, and over 50 percent of deaths in post-neonatal children are attributable to pneumonia, diarrhea, or meningitis diseases that can be prevented through vaccination. The purpose of the study is to compare the cost-effectiveness and financial implications of introducing pneumococcal (PCV-10), rotavirus (Rota-Teq), and Homophiles influenza type B (Hib) vaccines in Pakistan. The cost-effectiveness analysis was conducted using the Tri-Vac model, which is a static model that estimates the burden of disease and the costs of treatment and for the immunization program of children up to five years old in ten annual birth cohorts (2010 to 2019). Sensitivity analyses were conducted testing key assumptions related to disease burden, vaccine efficacy, and vaccine cost. The analysis of financial implications included a projection of cold chain needs and costs associated with the introduction of each new vaccine, as well as the financial outlays required by the government. Sensitivity testing was also conducted on major assumptions. All three vaccines were found to be cost-effective, with Hib vaccine the most cost-effective option at $22 per disability-adjusted-life-year (DALY). The cost-effectiveness figures for PCV and rotavirus vaccines were $225/DALY and $201/DALY, respectively. Sensitivity testing did not significantly alter the results. The combined financial requirement for the three new vaccines would peak in 2017 if GAVI assistance reduced to five rather than eight years ($213m). This cost would account for 40 percent of national immunization expenditures, and 15 percent of government health expenditures. Required cold chain investments would be small relative to the expenditure on vaccines, and represents a good return on investment. While the investment would be worthwhile from an economic perspective, introducing all three vaccines in Pakistan will present financial challenges unless overall health spending increases. Careful consideration needs to be given to long-term financing after GAVI support ends.en-USCC BY 3.0 IGOACUTE RESPIRATORY INFECTIONAGEDANTIGENSBACTERIAL INFECTIONSBCGBIRTH ATTENDANTSBREAST-FEEDINGBULLETINBURDEN OF DISEASECAUSES OF DEATHCHILD DEATHSCHILD MORTALITYCOLD CHAINDEATH RATEDEATH RATESDELIVERY COSTSDEVELOPING COUNTRIESDIARRHEADIPHTHERIADISABILITYDISEASE BURDENDISEASE CONTROLEXERCISESEXPENDITURESEXTERNALITIESGASTROENTERITISGLASSGROSS DOMESTIC PRODUCTHAZARDHEALTH CAREHEALTH CARE COSTSHEALTH CARE SYSTEMHEALTH CARE UTILIZATIONHEALTH CENTERSHEALTH ECONOMICSHEALTH EXPENDITUREHEALTH EXPENDITURESHEALTH ORGANIZATIONHEALTH POLICYHEALTH PROGRAMSHEALTH SERVICESHEALTH SURVEYSHEALTH SYSTEMHEALTHY LIFEHEPATITISHEPATITIS BHIGH FERTILITYHOSPITALHUMAN DEVELOPMENTHYGIENEIMMUNIZATIONIMMUNIZATIONSINCOMEINDEXESINEQUITIESINFANTINFANT MORTALITYINFANT MORTALITY RATEINFANT MORTALITY RATESINFECTIONINFECTIOUS DISEASESINFLUENZAINFORMANTSINFORMATION SYSTEMINTERVENTIONLARGE POPULATIONLIMITED RESOURCESLIVE BIRTHSLOW-INCOME COUNTRIESLOW-INCOME COUNTRYMATERNITY CAREMEASLESMEDICAL CAREMENINGITISMINISTRY OF HEALTHMORBIDITYMORTALITYNATIONAL LEVELNEWBORNNUMBER OF DEATHSNUTRITIONORAL REHYDRATIONORAL REHYDRATION THERAPYPATIENTPERTUSSISPNEUMOCOCCAL DISEASEPNEUMOCOCCAL INFECTIONSPNEUMONIAPOLICY MAKERSPOLIOPOPULATION GROUPSPOPULATION PROJECTIONSPREVALENCEPREVENTABLE DISEASESPUBLIC HEALTHPURCHASING POWERRATE OF TRANSMISSIONRESOURCE REQUIREMENTSRESPECTRISK OF INFECTIONROOMSROTAVIRUSRURAL AREASSERVICE DELIVERYSMALLPOXSOCIAL SCIENCESYRINGESTETANUSTRADITIONAL BIRTH ATTENDANTSTRANSPORTATIONTREATMENTTREATMENT SERVICESTROPICAL MEDICINETUBERCULOSISURBAN AREASVACCINATIONVACCINATION PROGRAMVACCINATION PROGRAMSVACCINEVACCINE COVERAGEVACCINESVDWORKERSWORLD HEALTH ORGANIZATIONWorld Bank10.1596/13585