Cost effectiveness of alternative strategies for poliomyelitis immunization in Brazil.

Costs for immunization programs are reported for 16 municipalities in Brazil (January to June 1982). Costs per immunization are higher for all immunizations when given by routinely available, on-demand services. Both intensification of services, in which the medical staff provides outreach immunization clinics, and mass campaign strategies have lower average costs than do the routine services. In the case of immunization with oral poliovirus vaccine, average costs fall from approximately +1.59 to +0.68 (U.S.) when routine and mass campaign strategies are compared. Choice of the most cost-effective immunization policy is shown to involve considerations of vaccine types and target groups as well as delivery strategies and thus involves linking the economic data to epidemiologic considerations (vaccine efficacy and morbidity and mortality levels with and without immunization). Multiple-vaccine programs are likely to have a greater impact per dollar spent than are single-vaccine programs because of the low incremental costs of providing additional vaccinations.