A Cost-Benefit Analysis of Typhoid Fever Immunization Programmes in an Indian Urban Slum Community

Many economic analyses of immunization programmes focus on the benefits in terms of public-sector
cost savings, but do not incorporate estimates of the private cost savings that individuals receive from
vaccination. This paper considers the implications of Bahl et al.'s cost-of-illness estimates for typhoid
immunization policy by examining how community-level incidence estimates and information on distribution
of costs of illness among patients and the public-health sector can be used in the economic
analysis of vaccination-programme options.

The findings illustrate why typhoid vaccination programmes
may often appear to be unattractive to public-health officials who adopt a public budgetary
perspective. Under many plausible sets of assumptions, public-sector expenditure on typhoid vaccination
does not yield comparable public-sector cost savings. If public-health officials adopt a societal
perspective on the economic benefits of vaccination, there are many situations in which different vaccination
programmes will make economic sense. The findings show that this is especially true when
public decision-makers recognize that (a) the incidence of typhoid fever is underestimated by blood
culture-positive cases and (b) avoided costs of illness represent a significant underestimate of the actual
economic benefits to individuals of vaccination.