David Bishai, Benjamin Johns, Amnesty Lefevre, Divya Nair, Emily Simons and Alya Dabbagh
Background: Policy makers choosing whether to eradicate or control measles need to know about the costs of eradication and its alternatives. Methods: This project used a dynamic age-tiered measles transmission model for 6 countries (Bangladesh, Brazil, Colombia, Ethiopia, Tajikistan, and Uganda), which was extrapolated to a linear model that was applied globally. Policy options were constant vaccine coverage at 2010 levels, eradication by 2020, eradication by 2025, 95% mortality reduction by 2015, and 98% mortality reduction by 2020. We compared cumulative discounted societal costs, caseloads, lives, and disability adjusted life years (DALYS) saved with each policy option from 2010 to 2050. Sensitivity analysis tested robustness to parameters. Findings: Strategies to eradicate measles in Bangladesh, Ethiopia, and Uganda cost more than twice as much as control strategies, but have similar costs per DALY averted. More generally, in low and middle income countries that have not yet eliminated measles, the incremental cost effectiveness of control at $20 to $25 per measles death averted is similar to eradication at $22 to $24 per measles death averted. For high income countries that have not yet eliminated measles, eradication by 2020 would prevent deaths and save $800 million more than measles control from 2010-2050 due to averted costs of outbreaks. Interpretation: Measles eradication and measles control are both cost effective. Measles control and eradication have equivalent costs per life saved in low income countries, but high income countries derive savings only if measles is eradicated and imported cases stop.