Economic Analysis of the Global Polio Eradication Initiative
by Radboud J. Duintjer Tebbens, Mark A. Pallansch, Stephen L. Cochi, Steven G. F. Wassilk, Jennifer Linkins, Roland W. Sutter, R. Bruce Aylward, and Kimberly M. Thompson, Vaccine 2011;29:334-343. PDF (published on-line October 26, 2010)
Press release - November 22, 2010 (also posted by the GPEI and Bill & Melinda Gates Foundation)
Technical appendix

Answers to frequently asked questions

What are the study’s main findings?
What are the study’s main recommendations?
What countries does the study include?
What key assumptions does the study make?
Background on polio

What are the study’s main findings?

• The base case analysis suggests that the Global Polio Eradication Initiative (GPEI) generates net benefits between 40 and 50 billion dollars during 1988-2035 compared to a policy relying only on routine vaccination, depending on the assumed extent of IPV use after OPV cessation.
• The very large net benefits accrue because of the prevention of 8 million paralytic poliomyelitis cases between 1988-2035 (4 million if discounted at a rate of 3%), leading to large savings associated with avoided treatment costs and losses of productivity that dwarf the costs of the GPEI activities.
• The cost-effectiveness ratios for the GPEI compared to only routine vaccination qualify as highly cost-effective based on standard international criteria (i.e., the costs per disability-adjusted life-year (DALY) saved are lower than the annual per-capita gross national income in each income group).
• Sensitivity analyses show that the net benefits remain positive across a wide range of model assumptions, suggesting that the economic justification of the GPEI is robust to assumptions that differ from those in the base case analysis. The most important assumptions in the model include the total economic costs of paralytic poliomyelitis cases, the discount rate, and the assumption about what would have happened in absence of the GPEI.
• Changing various assumptions about the costs of the GPEI activities did not significantly affect the estimates of total net benefits, including assumptions about a delay of several years in achieving the interruption of wild poliovirus type 1 and type 3 transmission, the extent of OPV use during the transition period after the last wild polio case and before OPV cessation, and the costs of IPV after OPV cessation.
• In addition to the net benefits related to preventing polio cases, the GPEI generated positive externalities by providing the infrastructure to deliver other health services, including Vitamin A supplementation, bed nets, surveillance, and other vaccines. While not included in the base case analysis, this study also estimates that the GPEI produced an additional 17 to 90 billion dollars in net benefits due to deaths prevented by delivering Vitamin A during polio campaigns.
• While the bulk of the costs occur in low-income countries, these countries benefit the most due to the huge incremental number of paralytic poliomyelitis cases prevented. Low-income countries account for approximately 85% of the estimated total net benefits generated by the GPEI in the base case analysis and 80% of the costs.
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• Appreciate the benefits - The GPEI has yielded substantial net benefits since 1988, and it provided individual and population immunity that protected generations of people from disease.
• Finish the job, as quickly as possible - The GPEI represents an excellent societal investment from an economic perspective, despite the rising cumulative costs. Eradicating faster is better, because it leads to lower cumulative costs and more cumulative cases prevented, but the study recognizes that small delays (i.e., on the order of a few years) do not significantly reduce the large expected economic net benefits of the GPEI.
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• The analysis in this study only includes the 64 low-income, 35 lower middle-income, and 5 upper middle-income countries that received direct support for their polio eradication activities from the GPEI.
• The analysis excludes the much larger net benefits of global eradication for countries that eliminated indigenous poliovirus transmission on their own (i.e., the Americas, all high-income countries, and most upper middle-income countries.) A prior study estimated that the economic benefits of national elimination of polio in the U.S. led to net benefits exceeding 180 billion dollars.
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• The analysis assumes the feasibility of interruption of transmission of wild polioviruses within a reasonably short time frame and successful containment of any post-eradication outbreaks including circulating vaccine-derived poliovirus outbreaks.
• We assume that in the absence of the GPEI, the countries in the model would have relied only on routine vaccination for polio (as they did before 1988).
• The base case assumes a relatively low estimated burden of polio before 1988 (i.e., approximately 270,000 paralytic cases per year) compared to the common estimate of 350,000 cases per year, excludes intangible costs associated with suffering from paralytic polio, and assumes that countries match 1:1 the GPEI contributions with national in-kind and other contributions. These assumptions tend toward underestimation of the net benefits of the GPEI.
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