Health impact and cost-effectiveness of expanding routine immunization coverage in India through Intensified Mission Indradhanush

Many children do not receive a full schedule of childhood vaccines, and there is limited evidence on the cost-effectiveness of strategies to improve vaccination coverage, particularly for ‘zero-dose children’ who have not received any vaccines. This study evaluated the cost-effectiveness of the Intensified Mission Indradhanush (IMI), a large-scale periodic intensification of routine immunization (PIRI) intervention in India from 2017-2018. In 40 sampled districts, the incremental economic cost of IMI was measured, and the increase in vaccination doses delivered was estimated using controlled interrupted time-series regression. The Lives Saved Tool was used to estimate deaths and disability-adjusted life years (DALYs) averted. The study found that IMI had an incremental cost of US$13.7 million and increased vaccine delivery by 2.2 million doses over 12 months, averting an estimated 1,413 deaths. The cost per dose was $6.21, per zero-dose child reached was $82.99, per DALY averted was $327.63, per life-year saved was $360.72, and per under-5 death averted was $9,701.35. At a cost-effectiveness threshold of 1× per-capita GDP per DALY averted, IMI was estimated to be cost-effective with a 90% probability. However, there is significant uncertainty in these results, and as vaccination programs expand, unit costs may increase due to the higher costs of reaching unvaccinated children.