Cost-benefit analysis of a second dose measles inoculation of children

  • G. M. Ginsberg
  • T. H. Tulchinsky


The traditional emphasis on single-dose immunization against measles has failed to meet control or eradication requirements even in the most developed parts of the world. A single dose strategy is limited because of insufficient coverage rates in infancy, schoolage epidemics and primary and secondary vaccination failure. A second measles booster dose in required in order to reduce population susceptibility to sufficiently low levels to allow the goal of measles elimination to be achieved. This paper estimates the costs and benefits of a decision taken in Israel in 1988 to add school age measles immunization to the present 15 month old use of measles vaccine in Israel. The second dose policy of immunizing all Israeli children aged 6 for the years 1988–2008, costs around $1.81 million and has estimated benefits of $14.15 million, yielding a benefit-to-cost ratio of 7.86/1. The vaccination programme was estimated to prevent over a 20 year period, approximately 80 300 simple cases, 9162 hospitalized cases, 21 non-fatal cases of encephalitis, 18 cases of SSPE and to save 85 lives. The break-even point for benefits to the health services alone, occurs if vaccine costs were to rise from $0.42 to $2.59 per dose. Therefore the decision to introduce a second measles dose in Israel seems to be fully justifiable on monetary grounds alone. Extremely high benefit-to-cost ratios for the adoption of a two dose policy, were also estimated for the UK (86.3/1), Spain (76.1/1) and Italy (53.0/1). For the Philippines and Nigeria the benefit to cost ratios were 11.4/1 and 20.6/1 respectively, though in the Philippines the benefit-to-cost ratio to the health services alone was less than unity. Limitations in resources for preventive health care remains a serious problem, even in developed countries. However, our cost-benefit calculations show the two-dose approach to be economically justifiable for many developing and developed countries.


Cost Ratio Central Bureau Measle Vaccine Ambulatory Visit Subacute Sclerosing Panencephalitis 
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Copyright information

© Springer-Verlag/Wien 1993

Authors and Affiliations

  • G. M. Ginsberg
    • 1
  • T. H. Tulchinsky
    • 2
  1. 1.Departments of InformationMinistry of HealthJerusalemIsrael
  2. 2.Personal and Community Preventive Health ServicesMinistry of HealthJerusalemIsrael

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