Cost Effectiveness of Contracting Out Vaccination Services in Two Districts of Sindh, Pakistan

Objectives: To determine the differences in costs of providing vaccination services in contracted and non-contracted primary care facilities, and to analyze their effectiveness using vaccination volume data Design: Comparative case study Setting: The study was conducted from October to December 2024 in two contracted and two non-contracted districts in Sindh Province, Pakistan. Five primary healthcare centers were selected from each district. The CORE PLUS tool was used to estimate the costs. Main outcome measures: Data on actual vaccination volumes, standard treatment guidelines, catchment population, staff salaries, vaccines and supplies, work distribution time, and operating costs were collected for a period of one year. Annual average costs and vaccination service volumes per 10,000 population were estimated and compared between contracted and non-contracted facilities. The incremental cost effectives ratio (ICER) was calculated by dividing the incremental costs by the incremental vaccination service volumes per 10,000 population. Results: The overall annual standard cost of vaccination services per 10000 population was 14.8% higher in contracted facilities. Contracted facilities spent significantly more on salaries (p=0.028) and operating costs (p<0.001). A positive difference of 559.86 incremental vaccination doses per 10,000 population was observed in contracted facilities. The incremental cost effectiveness ratio (ICER) indicates that to provide one extra dose of vaccine, an additional 1.87 US$ were spent in contracted facilities. Average cost per DALY averted was US$137.12, which was within the threshold for contracting out to be a cost effective intervention. Conclusion: Contracting vaccination services resulted in higher service provision costs but was also effective in increasing service volumes.