{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T05:34:34Z","timestamp":1789623274114,"version":"build-2803163510"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Gavi, the Vaccine Alliance"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The Immunization Agenda 2030 calls for reaching all people with immunization services, including \u201czero-dose\u201d children\u2014children who have not received any routine vaccines. To plan and finance efforts to fully vaccinate these children and improve coverage and equity, decision-makers need reliable cost estimates. However, primary data on the costs of reaching zero-dose children, typically part of disadvantaged and hard-to-reach populations, are scarce. This study approximates these costs using standardized, country-level estimates of vaccine delivery unit costs for outreach delivery in low- and middle-income countries (LMICs). We extracted outreach delivery cost per dose estimates for childhood immunization services from the 2024 update of the Immunization Delivery Cost Catalogue. Using these data, we developed a meta-regression model to estimate standardized outreach vaccine delivery unit costs. The generalized linear model assumed a Gamma-distributed outcome with a log link and included both country-level and study-level predictors: study year, economic or financial cost basis, routine or campaign delivery, and full or incremental costing approach. The fitted model was used to estimate 2024 outreach delivery costs per dose for 129 LMICs. The model was estimated using 48 observations from 19 countries focused on outreach or mobile vaccine delivery. The best-fitting specification included diphtheria-tetanus-pertussis coverage, per capita gross domestic product, and under-five population size as predictors. For 2024, the predicted mean economic cost per dose was $8.65 (95% credible interval $2.33\u201323.71), averaged across all 129 LMICs. To fully immunize a zero-dose child with 13 recommended vaccinations, the equivalent cost estimate was $112.45 ($30.29\u2013308.23). Reaching zero-dose children is crucial for improving equity in global health, and estimates of the costs of doing so are needed to inform budgeting for immunization programs. These meta-regression-based cost estimates can help countries to improve budgeting, planning, and resource allocation for efforts to reach zero-dose children.<\/jats:p>","DOI":"10.1093\/heapol\/czag085","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T16:12:29Z","timestamp":1782922349000},"page":"1269-1279","source":"Crossref","is-referenced-by-count":1,"title":["Approximating vaccine delivery costs to reach zero-dose children: a Bayesian meta-regression analysis"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8467-1324","authenticated-orcid":false,"given":"Allison","family":"Portnoy","sequence":"first","affiliation":[{"name":"Department of Global Health, Boston University School of Public Health , 801 Massachusetts Avenue, Boston, MA 02118 ,","place":["United States"]},{"name":"Center for Health Decision Science, Harvard T.H. Chan School of Public Health , Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8306-2375","authenticated-orcid":false,"given":"Emma","family":"Clarke-Deelder","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Public Health, Swiss Tropical & Public Health Institute , Kreuzstrasse 2, Allschwil 4123 ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1907-2218","authenticated-orcid":false,"given":"Taylor A","family":"Holroyd","sequence":"additional","affiliation":[{"name":"Gavi, the Vaccine Alliance , Chem. du Pommier 40, Le Grand-Saconnex 1218 ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1636-2594","authenticated-orcid":false,"given":"Daniel R","family":"Hogan","sequence":"additional","affiliation":[{"name":"Gavi, the Vaccine Alliance , Chem. du Pommier 40, Le Grand-Saconnex 1218 ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3475-3599","authenticated-orcid":false,"given":"Tewodaj","family":"Mengistu","sequence":"additional","affiliation":[{"name":"Gavi, the Vaccine Alliance , Chem. du Pommier 40, Le Grand-Saconnex 1218 ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"2026081802320132700_czag085-B1","doi-asserted-by":"publisher","first-page":"A13","DOI":"10.1016\/j.vaccine.2014.12.066","article-title":"Costs and financing of routine immunization: approach and selected findings of a multi-country study (EPIC)","volume":"33","author":"Brenzel","year":"2015","journal-title":"Vaccine"},{"key":"2026081802320132700_czag085-B2","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1093\/heapol\/czae024","article-title":"Health impact and cost-effectiveness of expanding routine immunization coverage in India through Intensified Mission Indradhanush","volume":"39","author":"Clarke-Deelder","year":"2024","journal-title":"Health Policy Plan"},{"key":"2026081802320132700_czag085-B3","author":"Gelman"},{"key":"2026081802320132700_czag085-B4","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1214\/06-BA117A","article-title":"Prior distributions for variance parameters in hierarchical models","volume":"1","author":"Gelman","year":"2006","journal-title":"Bayesian Anal"},{"key":"2026081802320132700_czag085-B5","first-page":"1593","article-title":"The No-U-Turn sampler: adaptively setting path lengths in Hamiltonian Monte Carlo","volume":"15","author":"Hoffman","year":"2014","journal-title":"J Mach Learn Res"},{"key":"2026081802320132700_czag085-B6","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines11040781","article-title":"Why reaching zero-dose children holds the key to achieving the sustainable development goals","volume":"11","author":"Hogan","year":"2023","journal-title":"Vaccines (Basel)"},{"key":"2026081802320132700_czag085-B7","author":"Immunization Costing Action Network (ICAN)"},{"key":"2026081802320132700_czag085-B8","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines12121431","article-title":"Scoping review of current costing literature on interventions to reach zero-dose children in low- and middle-income countries","volume":"12","author":"Levin","year":"2024","journal-title":"Vaccines (Basel)"},{"key":"2026081802320132700_czag085-B9","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines13101040","article-title":"Strengthening primary health care through implementation research: strategies for reaching zero-dose children in low- and middle-income countries\u2019 immunization programs","volume":"13","author":"Oyugi","year":"2025","journal-title":"Vaccines (Basel)"},{"key":"2026081802320132700_czag085-B10","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.jval.2020.08.2097","article-title":"What we do not know about the costs of immunization programs in low- and middle-income countries","volume":"24","author":"Portnoy","year":"2021","journal-title":"Value Health"},{"key":"2026081802320132700_czag085-B11","doi-asserted-by":"publisher","first-page":"995","DOI":"10.1007\/s40273-020-00930-6","article-title":"Producing standardized country-level immunization delivery unit cost estimates","volume":"38","author":"Portnoy","year":"2020","journal-title":"Pharmacoeconomics"},{"key":"2026081802320132700_czag085-B12","author":"UNICEF"},{"key":"2026081802320132700_czag085-B13","author":"United Nations"},{"key":"2026081802320132700_czag085-B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvacx.2019.100034","article-title":"The costs of delivering vaccines in low- and middle-income countries: findings from a systematic review","volume":"2","author":"Vaughan","year":"2019","journal-title":"Vaccine X"},{"key":"2026081802320132700_czag085-B15","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines10091568","article-title":"Exposure of zero-dose children to multiple deprivation: analyses of data from 80 low- and middle-income countries","volume":"10","author":"Wendt","year":"2022","journal-title":"Vaccines (Basel)"},{"key":"2026081802320132700_czag085-B16","author":"World Bank"},{"key":"2026081802320132700_czag085-B17","volume-title":"World Bank Country and Lending Groups","author":"World Bank","year":"2025"},{"key":"2026081802320132700_czag085-B18","author":"World Health Organization"},{"key":"2026081802320132700_czag085-B19","author":"World Health Organization"},{"key":"2026081802320132700_czag085-B20","author":"World Health Organization"}],"container-title":["Health Policy and Planning"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/heapol\/advance-article-pdf\/doi\/10.1093\/heapol\/czag085\/68677404\/czag085.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/heapol\/article-pdf\/41\/7\/1269\/68677404\/czag085.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/heapol\/article-pdf\/41\/7\/1269\/68677404\/czag085.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T06:32:07Z","timestamp":1787034727000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/heapol\/article\/41\/7\/1269\/8723463"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":20,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,2]]},"published-print":{"date-parts":[[2026,8,18]]}},"URL":"https:\/\/doi.org\/10.1093\/heapol\/czag085","relation":{},"ISSN":["0268-1080","1460-2237"],"issn-type":[{"value":"0268-1080","type":"print"},{"value":"1460-2237","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8]]},"published":{"date-parts":[[2026,7,2]]}}}