{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T05:11:49Z","timestamp":1780463509352,"version":"3.54.1"},"reference-count":53,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2021,9,23]],"date-time":"2021-09-23T00:00:00Z","timestamp":1632355200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Shanghai Three-year Action Plan (2020-2022) for Public Health","award":["GWV-10.1-XK16 and GWV-1.1"],"award-info":[{"award-number":["GWV-10.1-XK16 and GWV-1.1"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>In Shanghai, China, a polio immunization schedule of four inactivated polio vaccines (IPV) has been implemented since 2020, replacing the schedules of a combination of two IPVs and two bivalent live attenuated oral polio vaccines (bOPV), and four trivalent live attenuated oral polio vaccines (tOPV). This study aimed to assess the cost-effectiveness of these three schedules in infants born in 2016, in preventing vaccine-associated paralytic poliomyelitis (VAPP). We performed a decision tree model and estimated incremental cost-effectiveness ratio (ICER). Compared to the four-tOPV schedule, the two-IPV-two-bOPV schedule averted 1.2 VAPP cases and 16.83 disability-adjusted life years (DALY) annually; while the four-IPV schedule averted 1.35 VAPP cases and 18.96 DALY annually. Consequently, ICERVAPP and ICERDALY were substantially high for two-IPV-two-bOPV (CNY 12.96 million and 0.93 million), and four-IPV (CNY 21.24 million and 1.52 million). Moreover, net monetary benefit of the two-IPV-two-bOPV and four-IPV schedules was highest when the cost of IPV was hypothesized to be less than CNY 23.75 or CNY 9.11, respectively, and willingness-to-pay was hypothesized as CNY 0.6 million in averting one VAPP-induced DALY. IPV-containing schedules are currently cost-ineffective in Shanghai. They may be cost-effective by reducing the prices of IPV, which may accelerate polio eradication in Chinese settings.<\/jats:p>","DOI":"10.3390\/vaccines9101062","type":"journal-article","created":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T23:08:31Z","timestamp":1632784111000},"page":"1062","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Cost-Effectiveness of Three Poliovirus Immunization Schedules in Shanghai, China"],"prefix":"10.3390","volume":"9","author":[{"given":"Jia","family":"Ren","sequence":"first","affiliation":[{"name":"Shanghai Municipal Center for Disease Control and Prevention, Institute of Immunization, Shanghai 200336, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hairenguli","family":"Maimaiti","sequence":"additional","affiliation":[{"name":"Ministry of Education Key Laboratory of Public Health Safety, Department of Epidemiology,  School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaodong","family":"Sun","sequence":"additional","affiliation":[{"name":"Shanghai Municipal Center for Disease Control and Prevention, Institute of Immunization, Shanghai 200336, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuoying","family":"Huang","sequence":"additional","affiliation":[{"name":"Shanghai Municipal Center for Disease Control and Prevention, Institute of Immunization, Shanghai 200336, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiechen","family":"Liu","sequence":"additional","affiliation":[{"name":"Shanghai Municipal Center for Disease Control and Prevention, Institute of Immunization, Shanghai 200336, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianping","family":"Yang","sequence":"additional","affiliation":[{"name":"Shanghai Municipal Center for Disease Control and Prevention, Institute of Immunization, Shanghai 200336, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi","family":"Li","sequence":"additional","affiliation":[{"name":"Shanghai Municipal Center for Disease Control and Prevention, Institute of Immunization, Shanghai 200336, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingrui","family":"Bai","sequence":"additional","affiliation":[{"name":"Shanghai Municipal Center for Disease Control and Prevention, Institute of Immunization, Shanghai 200336, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4651-9433","authenticated-orcid":false,"given":"Yihan","family":"Lu","sequence":"additional","affiliation":[{"name":"Ministry of Education Key Laboratory of Public Health Safety, Department of Epidemiology,  School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,23]]},"reference":[{"key":"ref_1","unstructured":"WHO (2016). Polio vaccines: WHO position paper\u2014March, 2016. Wkly. Epidemiol. Rec., 91, 145\u2013168."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S268","DOI":"10.1093\/infdis\/jit332","article-title":"Poliomyelitis eradication in China: 1953\u20132012","volume":"210","author":"Yu","year":"2014","journal-title":"J. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1016\/j.vaccine.2018.01.019","article-title":"Recipient vaccine-associated paralytic poliomyelitis in China, 2010\u20132015","volume":"36","author":"Wu","year":"2018","journal-title":"Vaccine"},{"key":"ref_4","first-page":"6","article-title":"Epidemiological analysis of the vaccine-associated paralytic poliomyelitis in 1980\u20131998 in Shanghai","volume":"6","author":"Wu","year":"1999","journal-title":"Chin. J. Vaccines Immun."},{"key":"ref_5","unstructured":"World Health Organization (2021, June 25). Poliomyelitis: WHO Response. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/poliomyelitis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.15585\/mmwr.mm6845a5","article-title":"Progress toward poliomyelitis eradication\u2014Pakistan, January 2018\u2013September 2019","volume":"68","author":"Hsu","year":"2019","journal-title":"MMWR. Morb. Mortal. Wkly. Rep."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Pan, J., Wang, Y., Cao, L., Wang, Y., Zhao, Q., Tang, S., Gong, W., Guo, L., Liu, Z., and Wen, Z. (2021). Impact of immunization programs on 11 childhood vaccine-preventable diseases in China: 1950\u20132018. Innovation, 2.","DOI":"10.1016\/j.xinn.2021.100113"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1017\/S0950268816002569","article-title":"Wild and vaccine-derived poliovirus circulation, and implications for polio eradication","volume":"145","author":"Lopalco","year":"2016","journal-title":"Epidemiol. Infect."},{"key":"ref_9","first-page":"513","article-title":"Immunogenicity analysis of sequential inoculation of different strains of poliomyelitis vaccines in Shanghai","volume":"53","author":"Huang","year":"2019","journal-title":"Chin. J. Prev. Med."},{"key":"ref_10","first-page":"627","article-title":"Polio antibody levels in infants during 2015\u20132016 in Shanghai before and after polio vaccination strategy adjustment","volume":"32","author":"Liu","year":"2020","journal-title":"Shanghai J. Prev. Med."},{"key":"ref_11","unstructured":"Shanghai Municipal Health Commission (2021, May 14). Notice on the Adjustment of the Immunization Program of Polio Vaccine and Measles-Containing Vaccine in the City, Available online: http:\/\/wsjkw.sh.gov.cn\/jbfk2\/20200724\/784eaeeaf7ce4ebd8e2528cdd6d35280.html."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.vaccine.2010.10.026","article-title":"Economic analysis of the global polio eradication initiative","volume":"29","author":"Tebbens","year":"2010","journal-title":"Vaccine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2034","DOI":"10.1016\/j.vaccine.2008.02.008","article-title":"Economics of polio vaccination in the post-eradication era: Should OPV-using countries adopt IPV?","volume":"26","author":"Khan","year":"2008","journal-title":"Vaccine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.2105\/AJPH.2007.122192","article-title":"The risks, costs, and benefits of possible future global policies for managing polioviruses","volume":"98","author":"Thompson","year":"2008","journal-title":"Am. J. Public Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1590\/S1020-49892010000500005","article-title":"Economic impact of introducing the injectable inactivated polio vaccine in Colombia","volume":"27","author":"Alvis","year":"2010","journal-title":"Rev. Panam. Salud. Publica"},{"key":"ref_16","unstructured":"Li, R.P. (2007). Strategic Analysis and Cost Estimation on OPV Switching to Sabin-IPV at the Stage of the Endgame of Polio Eradication in China, Shandong University."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"5670","DOI":"10.1016\/j.vaccine.2006.05.032","article-title":"The cost-effectiveness of alternative polio immunization policies in South Africa","volume":"24","author":"Griffiths","year":"2006","journal-title":"Vaccine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1111\/j.1467-842X.2001.tb00648.x","article-title":"Cost-effectiveness analysis of changing from live oral poliovirus vaccine to inactivated poliovirus vaccine in Australia","volume":"25","author":"Tucker","year":"2001","journal-title":"Aust. N. Zealand J. Public Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1001\/jama.1996.03540120045032","article-title":"Cost-effectiveness of incorporating inactivated poliovirus vaccine into the routine childhood immunization schedule","volume":"276","author":"Miller","year":"1996","journal-title":"JAMA"},{"key":"ref_20","first-page":"1","article-title":"An economic analysis of poliovirus risk management policy options for 2013\u20132052","volume":"15","author":"Tebbens","year":"2015","journal-title":"BMC Infect. Dis."},{"key":"ref_21","unstructured":"Yang, L.X. (2015). Incremental Cost Study of Inactivated Poliovirus Vaccine into National Immunization Program."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1111\/j.1539-6924.2006.00831.x","article-title":"Retrospective cost-effectiveness analyses for polio vaccination in the United States","volume":"26","author":"Thompson","year":"2006","journal-title":"Risk Anal."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1590\/S0034-8910.2015049005492","article-title":"Polio inactivated vaccine costs into routine childhood immunization in Brazil","volume":"49","author":"Sartori","year":"2015","journal-title":"Rev. Saude Public"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.puhe.2016.10.016","article-title":"Budget impact of polio immunization strategy for India: Introduction of one dose of inactivated poliomyelitis vaccine and reductions in supplemental polio immunization","volume":"142","author":"Khan","year":"2017","journal-title":"Public Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"S143","DOI":"10.1093\/infdis\/jit588","article-title":"Introduction of sequential inactivated polio vaccine-oral polio vaccine schedule for routine infant immunization in Brazil\u2019s National Immunization Program","volume":"210","author":"Domingues","year":"2014","journal-title":"J. Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2163","DOI":"10.1002\/jmv.24285","article-title":"The expanded program on immunization laboratory team\u2014Uganda Virus Research Institute (EPI LAB\u2014UVRI) Vaccine associated paralytic poliomyelitis cases from children presenting with acute flaccid paralysis in Uganda","volume":"87","author":"Nanteza","year":"2015","journal-title":"J. Med. Virol."},{"key":"ref_27","first-page":"242","article-title":"Update on vaccine-derived polioviruses\u2014Worldwide, July 2012\u2013December 2013","volume":"63","author":"Diop","year":"2014","journal-title":"MMWR. Morb. Mortal. Wkly. Rep."},{"key":"ref_28","unstructured":"(2021, May 14). WS 294-2016 Poliomyelitis Diagnosis, Available online: http:\/\/www.nhc.gov.cn\/wjw\/s9491\/201606\/55fca4a0e4b0458bba1-659fda26c22e6.shtml."},{"key":"ref_29","unstructured":"Shanghai Bureau of Statistics National Investigation Corps, Shanghai Bureau of Statistics (2017). 2017 Shanghai Statistical Yearbook."},{"key":"ref_30","unstructured":"TreeAge (2017). Tornado diagrams. TreeAge Pro 2017 User\u2019s Manual, TreeAge Software, Inc."},{"key":"ref_31","first-page":"327","article-title":"Cost-effectiveness of ribociclib plus endocrine therapy versus placebo plus endocrine therapy in HR-positive, HER2-negative breast cancer","volume":"27","author":"Le","year":"2021","journal-title":"J. Manag. Care Spe\u00e9c. Pharm."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12962-018-0097-8","article-title":"Cost-effectiveness of the recommended medical intervention for the treatment of dysmenorrhea and endometriosis in Japan","volume":"16","author":"Arakawa","year":"2018","journal-title":"Cost Eff. Resour. Alloc."},{"key":"ref_33","unstructured":"(2021, July 07). Practical Regulations for Vaccination in Shanghai (2017 Edition), Available online: http:\/\/wsjkw.sh.gov.cn\/mygh-zcwj\/20191012\/0012-65397.html."},{"key":"ref_34","first-page":"134","article-title":"Wastage factor estimation of bivalent polio attenuated live vaccine in China","volume":"23","author":"Duan","year":"2017","journal-title":"Chin. J. Vaccines Immun."},{"key":"ref_35","unstructured":"(2021, June 25). Shanghai Compensation Measures for Vaccination Related Abnormal Reactions (for Trial Implementation), Available online: http:\/\/wsjkw.sh.gov.cn\/mygh-zcwj\/20191012\/0012-65399.html."},{"key":"ref_36","unstructured":"World Bank (2021, June 25). Country Income Groups. Available online: http:\/\/chartsbin.com\/view\/2438."},{"key":"ref_37","unstructured":"Mao, Z.H., and Hu, D.W. (2004). Medical Economics 2004, China Statistics Press."},{"key":"ref_38","unstructured":"(2021, September 21). Circulating Vaccine-derived Poliovirus (cVDPV). Available online: https:\/\/polioeradication.org\/wp-content\/uploads\/2020\/12\/20201118_cVDPV2_Global_Update_EN.pdf."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"S380","DOI":"10.1093\/infdis\/jiu184","article-title":"Vaccine-associated paralytic poliomyelitis: A review of the epidemiology and estimation of the global burden","volume":"210","author":"Platt","year":"2014","journal-title":"J. Infect. Dis."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Sutter, R.W., Kew, O.M., and Cochi, S.L. (2008). Poliovirus vaccine-live. Vaccines, 631\u2013685.","DOI":"10.1016\/B978-1-4160-3611-1.50030-1"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.ijid.2018.08.017","article-title":"Vaccine-associated paralytic poliomyelitis in the Russian Federation in 1998\u20132014","volume":"76","author":"Ivanova","year":"2018","journal-title":"Int. J. Infect. Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1696","DOI":"10.1001\/jama.292.14.1696","article-title":"Vaccine policy changes and epidemiology of poliomyelitis in the United States","volume":"292","author":"Alexander","year":"2004","journal-title":"JAMA"},{"key":"ref_43","unstructured":"World Health Organization Department Immunization (2014). Principles and Considerations for Adding a Vaccine to a National Immuniza-tion Programme: From Decision to Implementation and Monitoring, WHO."},{"key":"ref_44","first-page":"337","article-title":"Analysis of poliomyelitis eradication and recommendations for immunization strategies","volume":"15","author":"Huang","year":"2020","journal-title":"J. Microbes Infect."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"WHO (2017). Polio vaccines: WHO position paper, March 2016\u2014Recommendations. Vaccine, 35, 1197\u20131199.","DOI":"10.1016\/j.vaccine.2016.11.017"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1080\/21645515.2015.1088617","article-title":"Polio elimination in Nigeria: A review","volume":"12","author":"Nasir","year":"2015","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_47","unstructured":"Shanghai Bureau of Statistics (2013). Shanghai Statistical Bulletin of National Economic and Social Development, 2011. Statistical Science and Practice."},{"key":"ref_48","unstructured":"Shanghai Bureau of Statistics (2013). Shanghai Statistical Bulletin of National Economic and Social Development, 2012. Statistical Science and Practice."},{"key":"ref_49","unstructured":"Shanghai Bureau of Statistics (2014). Shanghai Statistical Bulletin of National Economic and Social Development, 2013. Statistical Science and Practice."},{"key":"ref_50","unstructured":"Shanghai Bureau of Statistics (2015). Shanghai Statistical Bulletin of National Economic and Social Development, 2014. Statistical Science and Practice."},{"key":"ref_51","unstructured":"Shanghai Bureau of Statistics (2016). Shanghai Statistical Bulletin of National Economic and Social Development, 2015. Statistical Science and Practice."},{"key":"ref_52","first-page":"101","article-title":"Occurrence and Epidemiological Characteristics of Vaccine-associated Paralytic Poliomyelitis","volume":"21","author":"Zhang","year":"2015","journal-title":"Chin. J. Vaccines. Immun."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e83","DOI":"10.1542\/peds.107.5.e83","article-title":"Surveillance for poliovirus vaccine adverse events, 1991 to 1998: Impact of a sequential vaccination schedule of inactivated poliovirus vaccine followed by oral poliovirus vaccine","volume":"107","author":"Wattigney","year":"2001","journal-title":"Pediatrics"}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/9\/10\/1062\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:03:57Z","timestamp":1760166237000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/9\/10\/1062"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,23]]},"references-count":53,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10]]}},"alternative-id":["vaccines9101062"],"URL":"https:\/\/doi.org\/10.3390\/vaccines9101062","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,23]]}}}