TY - JOUR T1 - Cost of Delivering Tetanus Toxoid and Tetanus-Diphtheria Vaccination in Vietnam and the Budget Impact of Proposed Changes to the Schedule JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT DO - 10.9745/GHSP-D-21-00482 VL - 10 IS - 2 SP - e2100482 AU - Vu Quynh Mai AU - Laura Boonstoppel AU - Kelsey Vaughan AU - Carl Schutte AU - Annette Ozaltin AU - Duong Thi Hong AU - Nguyen Mai Khanh AU - Hoang Manh Thang AU - Tran Tuan Anh AU - Hoang Van Minh Y1 - 2022/04/28 UR - http://www.ghspjournal.org/content/10/2/e2100482.abstract N2 - Key FindingsFor routine vaccination in Vietnam, we estimated that using an outreach strategy was the costliest delivery strategy to deliver the tetanus-diphtheria (Td) vaccination to children aged 7 years and tetanus toxoid (TT) vaccine to girls aged 15–16 years in high-risk areas compared to facility-based and school-based delivery of the TT vaccine.We estimated the budgetary impact of ceasing delivery of TT vaccines to girls aged 15–16 years in high-risk areas, introducing a dose of Td to all children aged 7 years in the country through 3 different delivery strategy options, and gradually decreasing Td campaigns in outbreak areas. We projected that if a facility-based or school-based strategy is chosen for the additional Td booster dose for all children aged 7 years, the new schedule would be less costly to the Expanded Program on Immunization than the 2017 vaccination schedule.Key ImplicationThese projected cost savings must be considered with extreme caution and evaluated against the impact on coverage and equity that these changes would have. EPI must closely track surveillance data to ensure the adequacy of its proposed transition phase schedule.Introduction:In 2017, aligned with global World Health Organization tetanus guidelines, Vietnam prepared evidence to support a recommendation to introduce the tetanus-diphtheria (Td) vaccine into routine immunization. This study aimed to provide evidence on the costs and budgetary impact of the potential replacement of the tetanus-toxoid (TT) vaccine with the Td vaccine, considering different possible delivery strategies.Method:We used an activity-based ingredients costing approach to estimate the 2017 program costs of providing TT vaccination to girls aged 15–16 years and conducting Td campaigns in outbreak areas. We performed a budget impact analysis for 2018–2025 using the cost per dose estimates based on the current delivery of these vaccines. We assumed complete cessation of TT vaccination of girls aged 15–16 years and a transition period where Td outbreak control campaigns would still occur. Td vaccine was assumed to be provided to children aged 7 years using either facility- or school-based delivery or combined facility- and school-based delivery.Results:The delivery cost per dose for current TT vaccination for girls aged 15–16 years was US$1.49 for school-based delivery, US$1.76 for facility-based delivery, and US$3.86 for delivery via outreach. Td vaccination through campaigns was estimated to cost US$3.56/dose. During 2018–2025, replacing the TT vaccine for girls aged 15–16 years with the Td vaccine for children aged 7 years is estimated to save US$4.61 million in immunization delivery costs if a school-based delivery strategy is used or US$1.04 million if facility-based delivery is used.Conclusion:Compared to the current plan, delivery of Td routine vaccination via a school-based strategy was the most cost saving. These results were used in late 2019 to support the delivery of Td vaccination using a school-based delivery strategy for children aged 7 years in 30 Northern provinces in Vietnam. ER -