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Objective To estimate the economic impact likely to be achieved by efforts to vaccinate against 10 vaccine-preventable diseases between 2001 and 2020 in 73 low- and middle-income countries largely supported by Gavi, the Vaccine Alliance. Methods We used health impact models to estimate the economic impact of achieving forecasted coverages for vaccination against Haemophilus influenzae type b, hepatitis B, human papillomavirus, Japanese encephalitis, measles, Neisseria meningitidis serogroup A, rotavirus, rubella, Streptococcus pneumoniae and yellow fever. In comparison with no vaccination, we modelled the costs --expressed in 2010 United States dollars (US$)--of averted treatment, transportation costs, productivity losses of caregivers and productivity losses due to disability and death. We used the value-of-a-life-year method to estimate the broader economic and social value of living longer, in better health, as a result of immunization. Findings We estimated that, in the 73 countries, vaccinations given between 2001 and 2020 will avert over 20 million deaths and save US$ 350 billion in cost of illness. The deaths and disability prevented by vaccinations given during the two decades will result in estimated lifelong productivity gains totalling US$330 billion and US$9 billion, respectively. Over the lifetimes of the vaccinated cohorts, the same vaccinations will save an estimated US$ 5 billion in treatment costs. The broader economic and social value of these vaccinations is estimated at US$820 billion. Conclusion By preventing significant costs and potentially increasing economic productivity among some of the world's poorest countries, the impact of immunization goes well beyond health. Objectif Estimer l'impact economique qui pourrait decouler des efforts de vaccination contre 10 maladies a prevention vaccinale deployes entre 2001 et 2020 dans 73 pays a revenu faible et intermediaire, et largement soutenus par Gavi, I'Alliance du Vaccin. Methodes Nous avons utilise des modeles devaluation de l'impact sur la sante pour estimer l'impact economique qui decoulerait, si le taux de couverture prevu est atteint, des vaccinations contre Haemophilus influenzae type B, l'hepatite B, le papillomavirus humaln, l'encephalite japonaise, la rougeole, Neisseria meningitidis serogroupe A, le rotavirus, la rubeole, Streptococcus pneumoniae et la fievre jaune. Pour etablir une comparaison avec l'absence de vaccination, nous avons modelise les couts--exprimes en dollars des Etats-Unis 2010 (USD)--des traitements evites, les couts de transport, les pertes de productivite des soignants non professionnels et les pertes de productivite pour cause d'invalidite ou de deces. Nous avons utilise une methode permettant d'evaluer la valeur d'une annee de vie pour estimer la valeur economique et sociale au sens large d'une vie plus longue et en meilleure sante grace a la vaccination. Resultats D'apres nos estimations, les vaccinations pratiquees entre 2001 et 2020 dans les 73 pays permettront d'eviter plus de 20 millions de deces et d'economiser 350 milliards de dollars des Etats-Unis en couts sanitaires. Les cas de deces et d'invalidite evites grace a la vaccination pratiquee au cours de ees deux decennies entraineront des gains de productivite permanents respectivement estimes a 330 milliards de dollars des Etats-Unis et 9 milliards de dollars des Etats-Unis. On estime qu'au cours de la vie des cohortes vaccinees, les memes vaccinations permettront d'economiser 5 milliards de dollars des Etats-Unis en couts de traitement. La valeur economique et sociale au sens large de ees vaccinations est estimee a 820 milliards de dollars des Etats-Unis. Conclusion L'impact de la vaccination depasse le domaine de la sante, car il permet d'eviter d'importants couts et une augmentation potentielle de la productivite economique de certains des pays les plus pauvres du monde. Objetivo Estimarei impacto economico que probablemente se logaria con los esfuerzos de vacunar frente a 10 enfermedades evitables mediante la vacunacion entre 2001 y 2020 en 73 paises con ingresos bajos y medios ampliamente respaldados por la Gavi, la Vaccine Alliance. Metodos Se utilizaron modelos de impacto sanitario para estimar el impacto economico de lograr las coberturas previstas de vacunacion frente a Haemophilus influenzae tipo b, hepatitis B, virus del papiloma humano, encefalitis japonesa, sarampion, Neisseria meningitidis serogrupo A, rotavirus, rubeola, Streptococcus pneumoniae y fiebre amarilla. En comparacion con la no vacunacion, se modelaron los costes (expresados en dolares estadounidenses, USD, de 2010) de los tratamientos evitados, los costes de transporte, las perdidas de productividad de los proveedores de salud y las perdidas de productividad debido a la discapacidad y la muerte. Se utilizo el metodo de valor de vida anual para estimar de forma mas amplia el valor economico y social del hecho de vivir mas, con una mejor salud, como resultado de la inmunizacion. Resultados Se estimo que, en los 73 paises, las vacunas suministradas entre 2001 y 2020 evitaran mas de 20 millones de muertes y ahorraran 350 000 millones de USD en costes de enfermedades. Las muertes y las discapacidades evitadas gracias a las vacunas suministradas durante las dos decadas tendran como resultado unas ganancias permanentes estimadas en la productividad de un total de 330 000 millones de USD y 9 000 millones de USD, respectivamente. Durante la vida de las cohortes vacunadas, se estima que las mismas vacunaciones ahorraran 5 000 millones de USD en costes de tratamientos. El valor economico y social mas amplio de estas vacunas se estima en 820 000 millones de USD. Conclusion El impacto de las vacunas es positivo mas alla de la salud, ya que se evitan costes significativos y se aumenta potencialmente la productividad economica entre algunos de los paises mas pobres., Introduction While vaccination is generally regarded to be one of the most cost-effective interventions in public health, the introduction and sustained use of any new vaccine needs to be supported [...]

Abstract Background Insecticide-treated mosquito nets (ITNs) and indoor-residual spraying have been scaled-up across sub-Saharan Africa as part of international efforts to control malaria. These interventions have the potential to significantly impact child survival. The Lives Saved Tool (LiST) was developed to provide national and regional estimates of cause-specific mortality based on the extent of intervention coverage scale-up. We compared the percent reduction in all-cause child mortality estimated by LiST against measured reductions in all-cause child mortality from studies assessing the impact of vector control interventions in Africa. Methods We performed a literature search for appropriate studies and compared reductions in all-cause child mortality estimated by LiST to 4 studies that estimated changes in all-cause child mortality following the scale-up of vector control interventions. The following key parameters measured by each study were applied to available country projections: baseline all-cause child mortality rate, proportion of mortality due to malaria, and population coverage of vector control interventions at baseline and follow-up years. Results The percent reduction in all-cause child mortality estimated by the LiST model fell within the confidence intervals around the measured mortality reductions for all 4 studies. Two of the LiST estimates overestimated the mortality reductions by 6.1 and 4.2 percentage points (33% and 35% relative to the measured estimates), while two underestimated the mortality reductions by 4.7 and 6.2 percentage points (22% and 25% relative to the measured estimates). Conclusions The LiST model did not systematically under- or overestimate the impact of ITNs on all-cause child mortality. These results show the LiST model to perform reasonably well at estimating the effect of vector control scale-up on child mortality when compared against measured data from studies across a range of malaria transmission settings. The LiST model appears to be a useful tool in estimating the potential mortality reduction achieved from scaling-up malaria control interventions.

Abstract Background Trends in the causes of child mortality serve as important global health information to guide efforts to improve child survival. With child mortality declining in Bangladesh, the distribution of causes of death also changes. The three verbal autopsy (VA) studies conducted with the Bangladesh Demographic and Health Surveys provide a unique opportunity to study these changes in child causes of death. Methods To ensure comparability of these trends, we developed a standardized algorithm to assign causes of death using symptoms collected through the VA studies. The original algorithms applied were systematically reviewed and key differences in cause categorization, hierarchy, case definition, and the amount of data collected were compared to inform the development of the standardized algorithm. Based primarily on the 2004 cause categorization and hierarchy, the standardized algorithm guarantees comparability of the trends by only including symptom data commonly available across all three studies. Results Between 1993 and 2004, pneumonia remained the leading cause of death in Bangladesh, contributing to 24% to 33% of deaths among children under 5. The proportion of neonatal mortality increased significantly from 36% (uncertainty range [UR]: 31%-41%) to 56% (49%-62%) during the same period. The cause-specific mortality fractions due to birth asphyxia/birth injury and prematurity/low birth weight (LBW) increased steadily, with both rising from 3% (2%-5%) to 13% (10%-17%) and 10% (7%-15%), respectively. The cause-specific mortality rates decreased significantly due to neonatal tetanus and several postneonatal causes (tetanus: from 7 [4-11] to 2 [0.4-4] per 1,000 live births (LB); pneumonia: from 26 [20-33] to 15 [11-20] per 1,000 LB; diarrhea: from 12 [8-17] to 4 [2-7] per 1,000 LB; measles: from 5 [2-8] to 0.2 [0-0.7] per 1,000 LB; injury: from 11 [7-17] to 3 [1-5] per 1,000 LB; and malnutrition: from 9 [6-13] to 5 [2-7]). Conclusions Pneumonia remained the top killer of children under 5 in Bangladesh between 1993 and 2004. The increasing importance of neonatal survival is highlighted by the growing contribution of neonatal deaths and several neonatal causes. Notwithstanding the limitations, standardized computer-based algorithms remain a promising tool to generate comparable causes of child death using VA data.

Background: Diarrhea remains a leading cause of mortality among young children in low- and middle-income countries. Although the evidence for individual diarrhea prevention and treatment interventions is solid, the effect a comprehensive scale-up effort would have on diarrhea mortality has not been estimated. Methods and Findings: We use the Lives Saved Tool (LiST) to estimate the potential lives saved if two scale-up scenarios for key diarrhea interventions (oral rehydration salts [ORS], zinc, antibiotics for dysentery, rotavirus vaccine, vitamin A supplementation, basic water, sanitation, hygiene, and breastfeeding) were implemented in the 68 high child mortality countries. We also conduct a simple costing exercise to estimate cost per capita and total costs for each scale-up scenario. Under the ambitious (feasible improvement in coverage of all interventions) and universal (assumes near 100% coverage of all interventions) scale-up scenarios, we demonstrate that diarrhea mortality can be reduced by 78% and 92%, respectively. With universal coverage nearly 5 million diarrheal deaths could be averted during the 5-year scale-up period for an additional cost of US$12.5 billion invested across 68 priority countries for individual-level prevention and treatment interventions, and an additional US$84.8 billion would be required for the addition of all water and sanitation interventions. Conclusion: Using currently available interventions, we demonstrate that with improved coverage, diarrheal deaths can be drastically reduced. If delivery strategy bottlenecks can be overcome and the international community can collectively deliver on the key strategies outlined in these scenarios, we will be one step closer to achieving success for the United Nations' Millennium Development Goal 4 (MDG4) by 2015., Introduction Diarrhea remains a leading cause of morbidity and mortality among children under 5 y of age in low- and middle-income countries [1]. Diarrhea mortality has declined from an estimated [...]

Science to Action Gap in Maternal, Neonatal, and Child Health in Sub-Saharan Africa Over 13,000 mothers, newborns, and children die every day in sub-Saharan Africa--almost nine deaths every minute [1,2]. [...]

While the importance of mHealth scale-up has been broadly emphasized in the mHealth community, it is necessary to guide scale up efforts and investment in ways to help achieve the mortality reduction targets set by global calls to action such as the Millennium Development Goals, not merely to expand programs. We used the Lives Saved Tool (LiST)–an evidence-based modeling software–to identify priority areas for maternal and neonatal health services, by formulating six individual and combined interventions scenarios for two countries, Bangladesh and Uganda. Our findings show that skilled birth attendance and increased facility delivery as targets for mHealth strategies are likely to provide the biggest mortality impact relative to other intervention scenarios. Although further validation of this model is desirable, tools such as LiST can help us leverage the benefit of mHealth by articulating the most appropriate delivery points in the continuum of care to save lives. [ABSTRACT FROM AUTHOR]