{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T15:51:37Z","timestamp":1794066697518,"version":"4.8.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T00:00:00Z","timestamp":1730419200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T00:00:00Z","timestamp":1730419200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","award":["OPP1139192"],"award-info":[{"award-number":["OPP1139192"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","award":["OPP1139192"],"award-info":[{"award-number":["OPP1139192"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","award":["OPP1139192"],"award-info":[{"award-number":["OPP1139192"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","award":["OPP1139192"],"award-info":[{"award-number":["OPP1139192"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","award":["OPP1139192"],"award-info":[{"award-number":["OPP1139192"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","award":["OPP1139192"],"award-info":[{"award-number":["OPP1139192"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","award":["OPP1139192"],"award-info":[{"award-number":["OPP1139192"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","award":["OPP1139192"],"award-info":[{"award-number":["OPP1139192"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To improve the efficient use of scarce resources, low- and middle-income countries and development partners are increasingly encouraged to deliver multiple vaccines and other interventions in a single integrated campaign. However, little is known regarding the cost of delivering vaccines through integrated campaigns, and the extent to which efficiencies are achieved. To fill this evidence gap, we estimated the cost of integrated immunization campaigns in Nigeria and Sierra Leone, and the potential savings from integration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective ingredients-based costing study from a payer perspective of a campaign held in 2019 in Sierra Leone with measles-rubella vaccine and oral polio vaccine, during which nutrition supplements were also offered in part of the country, and yellow fever campaigns held in three states in Nigeria in 2019 and 2020, where in one state (Anambra) meningococcal A vaccines were co-delivered. We collected data from 108 health facilities, all relevant administrative levels, and implementing partners. We estimated the full financial and economic cost of each campaign, the average unit cost of delivery, as well as the cost by activity and resource type. We also estimated the cost savings from integration in Anambra state by modelling out the cost of the alternative of two standalone campaigns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The average financial delivery cost was $0.34 per dose in Sierra Leone, and the economic cost was $0.73 per dose. In Nigeria, the financial cost per dose was $0.29\u2013$0.35 across the three states, and the economic cost per dose was $0.62\u2013$0.85. Facilities and wards delivering more doses achieved a lower financial and economic unit cost of delivery, demonstrating evidence of economies of scale. We estimated that Anambra may have saved at least $1,204,133 in financial resources by integrating yellow fever and meningitis A vaccine delivery, amounting to $0.17 per dose delivered. When including opportunity costs, the economic cost saving was estimated at $0.34 per dose delivered.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The study offers evidence on what it costs to deliver integrated campaigns, and shows that integrated delivery is likely to result in significant cost savings. Where high delivery volumes can be achieved, integrated campaigns can benefit from economies of scale. The findings can be used to inform planning and budgeting for immunization campaigns in low- and middle-income countries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12913-024-11809-z","type":"journal-article","created":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T06:04:01Z","timestamp":1730441041000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Cost of integrated immunization campaigns in Nigeria and Sierra Leone: bottom-up costing studies"],"prefix":"10.1186","volume":"24","author":[{"given":"Laura","family":"Boonstoppel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia","family":"Moi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Banks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Sibeudu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Divine","family":"Obodoechi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Borces","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Obinna","family":"Onwujekwe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Logan","family":"Brenzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,11,1]]},"reference":[{"issue":"1","key":"11809_CR1","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1377\/hlthaff.2022.00343","volume":"42","author":"S Sriudomporn","year":"2023","unstructured":"Sriudomporn S, Sim SY, Mak J, Brenzel L, Patenaude BN. Financing and Funding Gap for 16 vaccines across 94 low- and Middle-Income Countries, 2011-30. Health Aff (Millwood). 2023;42(1):94\u2013104. https:\/\/doi.org\/10.1377\/hlthaff.2022.00343.","journal-title":"Health Aff (Millwood)"},{"key":"11809_CR2","volume-title":"United Nations Children\u2019s Fund (UNICEF) and Gavi, the Vaccine Alliance. The Big Catch-Up: An Essential Immunization Recovery Plan for 2023 and Beyond","author":"World Health Organization (WHO)","year":"2023","unstructured":"World Health Organization (WHO). United Nations children\u2019s Fund (UNICEF) and Gavi, the Vaccine Alliance. The Big Catch-Up: an essential immunization recovery plan for 2023 and Beyond. New York; 2023."},{"key":"11809_CR3","unstructured":"World Health Organization (WHO). Immunization Agenda 2030. A global strategy to leave no one behind. WHO. 2020. https:\/\/www.who.int\/immunization\/immunization_agenda_2030\/en\/\u00a0. Accessed 27 Mar 2022."},{"issue":"11","key":"11809_CR4","doi-asserted-by":"publisher","first-page":"e006397","DOI":"10.1136\/bmjgh-2021-006397","volume":"6","author":"H Jafari","year":"2021","unstructured":"Jafari H, Saarlas KN, Schluter WW, et al. Rethinking public health campaigns in the COVID-19 era: a call to improve effectiveness, equity and impact. BMJ Glob Health. 2021;6(11):e006397. https:\/\/doi.org\/10.1136\/bmjgh-2021-006397.","journal-title":"BMJ Glob Health"},{"key":"11809_CR5","doi-asserted-by":"publisher","first-page":"100034","DOI":"10.1016\/j.jvacx.2019.100034","volume":"2","author":"K Vaughan","year":"2019","unstructured":"Vaughan K, Ozaltin A, Mallow M, et al. The costs of delivering vaccines in low- and middle-income countries: findings from a systematic review. Vaccine X. 2019;2:100034. https:\/\/doi.org\/10.1016\/j.jvacx.2019.100034.","journal-title":"Vaccine X"},{"issue":"1","key":"11809_CR6","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1186\/s13561-023-00441-y","volume":"13","author":"AE Jean Baptiste","year":"2023","unstructured":"Jean Baptiste AE, Van der Schans J, Bawa S, et al. The cost of implementing measles campaign in Nigeria: comparing the stand-alone and the integrated strategy. Health Econ Rev. 2023;13(1):36.\u00a0https:\/\/doi.org\/10.1186\/s13561-023-00441-y.\u00a0Published 2023 Jun 13.","journal-title":"Health Econ Rev."},{"key":"11809_CR7","volume-title":"Ministry of Health and Sanitation (MOHS). Measles and Rubella Post Campaign Coverage Survey 2019 Analysis Report","author":"Government of Sierra Leone","year":"2020","unstructured":"Government of Sierra Leone. Ministry of Health and Sanitation (MOHS). Measles and Rubella Post Campaign Coverage Survey 2019 analysis report. MOHS; 2020."},{"key":"11809_CR8","volume-title":"Report on the Integrated Measles Rubella Campaign","author":"Government of Sierra Leone Ministry of Health and Sanitation (MOHS)","year":"2019","unstructured":"Government of Sierra Leone Ministry of Health and Sanitation (MOHS). Report on the Integrated Measles Rubella Campaign. MOHS; 2019."},{"key":"11809_CR9","unstructured":"National Bureau of Statistics. 2021 Integrated (Measles, Meningococcal and Yellow Fever) Post Campaign Coverage Survey Main Survey Report. National Bureau of Statistics; 2021."},{"key":"11809_CR10","unstructured":"Immunization, Economics. Sample Design Optimizer, Immunizationeconomics.org. http:\/\/immunizationeconomics.org\/sample-design-optimizer"},{"key":"11809_CR11","volume-title":"Making choices in health: WHO guide to cost-effectiveness analysis","author":"World Health Organization (WHO)","year":"2003","unstructured":"World Health Organization (WHO). Making choices in health: WHO guide to cost-effectiveness analysis. Geneva: WHO; 2003. https:\/\/iris.who.int\/handle\/10665\/42699."},{"key":"11809_CR12","unstructured":"Official exchange rate (LCU per US$, period average).World Bank website. https:\/\/data.worldbank.org\/indicator\/PA.NUS.FCRF. Accessed 1 Mar 2022."},{"key":"11809_CR13","unstructured":"World Economic Outlook Database. International Monetary Fund website. https:\/\/www.imf.org\/external\/pubs\/ft\/weo\/2020\/01\/weodata\/index.aspx. Accessed 25 Feb 2022."},{"key":"11809_CR14","unstructured":"Resch S, Menzies N, Portnoy A, Clarke-Deelder E, O\u2019Keeffe L, Suharlim C, Brenzel L. How to cost immunization programs: a practical guide on primary data collection and analysis. Cambridge. Immunizationeconomics.org\/ Harvard T.H. Chan School of Public Health. 2020"},{"key":"11809_CR15","volume-title":"How to Conduct an immunization campaign costing study: Methodological Guidance","author":"L Boonstoppel","year":"2021","unstructured":"Boonstoppel L, Banks C, Moi F, Vaughan K, Ozaltin A, Brenzel L. How to Conduct an immunization campaign costing study: Methodological Guidance. Washington, DC: ThinkWell; 2021.\u00a0"},{"key":"11809_CR16","unstructured":"ICAN. Database for Costs of Conducting the 2019 Integrated Measles-rubella Campaign in Sierra Leone. 2022. https:\/\/doi.org\/10.7910\/DVN\/NEEBLN, Harvard Dataverse, V1."},{"key":"11809_CR17","doi-asserted-by":"crossref","unstructured":"ICAN. Database for The cost of delivering yellow fever and meningitis A vaccines through campaigns in Nigeria. 2022. https:\/\/doi.org\/10.7910\/DVN\/KOJ2LY, Harvard Dataverse, V1.","DOI":"10.1142\/9781786349880_0001"},{"key":"11809_CR18","doi-asserted-by":"publisher","first-page":"392","DOI":"10.29011\/2577-2228.100392","volume":"7","author":"AJ Oteri","year":"2023","unstructured":"Oteri AJ, Kolawole AO, Mogekwu F, Nwachukwu CB, Ibizugbe S, et al. Nigeria\u2019s journey to Integration of Injectable Antigens in Mass Vaccination campaign; benefits and challenges using the 2019 Meningitis A and Measles Integrated Campaign. J Community Med Public Health. 2023;7:392. https:\/\/doi.org\/10.29011\/2577-2228.100392.","journal-title":"J Community Med Public Health"},{"issue":"1","key":"11809_CR19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/21645515.2021.1961471","volume":"18","author":"S Chatterjee","year":"2022","unstructured":"Chatterjee S, Song D, Das P, et al. Cost of conducting Measles-Rubella vaccination campaign in India. Hum Vaccin Immunother. 2022;18(1):1\u20138. https:\/\/doi.org\/10.1080\/21645515.2021.1961471.","journal-title":"Hum Vaccin Immunother"},{"key":"11809_CR20","doi-asserted-by":"publisher","unstructured":"Kaucley L, Levy P. Cost-effectiveness analysis of routine immunization and supplementary immunization activity for measles in a health district of Benin. Cost Eff Resour Alloc. 2015;13:14. Published 2015 Aug 20. https:\/\/doi.org\/10.1186\/s12962-015-0039-7.","DOI":"10.1186\/s12962-015-0039-7"},{"key":"11809_CR21","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1186\/1756-0500-6-100","volume":"6","author":"GE Sume","year":"2013","unstructured":"Sume GE, Fouda AA, Kobela M, Nguel\u00e9 S, Emah I, Atem P. A locally initiated and executed measles outbreak response immunization campaign in the nylon health district, Douala Cameroon 2011. BMC Res Notes. 2013;6:100. https:\/\/doi.org\/10.1186\/1756-0500-6-100. Published 2013 Mar 16.","journal-title":"BMC Res Notes."},{"key":"11809_CR22","doi-asserted-by":"publisher","first-page":"383","DOI":"10.3917\/spub.094.0383","volume":"4","author":"P Zengbe-Acray","year":"2009","unstructured":"Zengbe-Acray P, Douba A, Traore Y, et al. Co\u00fbts De La riposte Vaccinale Contre La fi\u00e8vre Jaune \u00e0 Abidjan, 2001. Sant\u00e9 Publique. 2009;4:383\u201391.","journal-title":"Sant\u00e9 Publique"},{"issue":"33","key":"11809_CR23","doi-asserted-by":"publisher","first-page":"5474","DOI":"10.1016\/j.vaccine.2011.05.058","volume":"29","author":"A Colombini","year":"2011","unstructured":"Colombini A, Badolo O, Gessner BD, et al. Costs and impact of meningitis epidemics for the public health system in Burkina Faso. Vaccine. 2011;29(33):5474\u201380.","journal-title":"Vaccine"},{"key":"11809_CR24","doi-asserted-by":"publisher","first-page":"86","DOI":"10.2471\/BLT.13.123471","volume":"92","author":"P Lydon","year":"2013","unstructured":"Lydon P, Zipursky S, Tevi-Benissan C, et al. Economic benefits of keeping vaccines at ambient temperature during mass vaccination: the case of meningitis A vaccine in Chad. Bull World Health Organ. 2013;92:86\u201392.","journal-title":"Bull World Health Organ"},{"issue":"37","key":"11809_CR25","doi-asserted-by":"publisher","first-page":"5947","DOI":"10.1016\/j.vaccine.2020.06.072","volume":"38","author":"FT Sibeudu","year":"2020","unstructured":"Sibeudu FT, Onwujekwe OE, Okoronkwo IL. Cost analysis of supplemental immunization activities to deliver measles immunization to children in Anambra state, South-East Nigeria. Vaccine. 2020;38(37):5947\u201354.","journal-title":"Vaccine"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-024-11809-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12913-024-11809-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-024-11809-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T06:05:19Z","timestamp":1730441119000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-024-11809-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,1]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["11809"],"URL":"https:\/\/doi.org\/10.1186\/s12913-024-11809-z","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-3953393\/v1","asserted-by":"object"}]},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,1]]},"assertion":[{"value":"13 February 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 October 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 November 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Health Research Ethics Committee from the University of Nigeria Teaching Hospital (reference: NHREC\/05\/01\/2008B-FWA00002458-1RB00002323) and by the Sierra Leone Ethics and Scientific Review Committee (no reference provided). In both countries, respondents were asked to sign an informed consent forms before interviews started, and ensured that their personal data would be kept private and not entered into the analysis dataset.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1334"}}