Health-economics of vaccines in Ethiopia: equity considerations and cost-effectiveness analysis

Vaccines have been identified as one of the most effective public health preventive interventions for improving global health. However, the vaccine benefit is underutilized, particularly in developing countries, partly due to suboptimal and inequitable vaccination uptake as well as delays in introducing innovative vaccines with proven superior clinical benefits into the national immunization program. This thesis explores a range of health economic issues related to vaccination in Ethiopia, including drivers of the change in childhood vaccination uptake over time, factors associated with the uptake of newly introduced vaccines, socioeconomic inequality in vaccination uptake, and cost-effectiveness of nonavalent human papillomavirus(9vHPV) vaccine. It is found that the proportion of Ethiopian children who had received all of their vaccinations increased over time in Ethiopia, and the increase is primarily attributed to changes in the effect of explanatory variables including maternal educational level and maternal health care utilization over time. Moreover, the study also revealed significant socioeconomic inequalities in vaccination uptake that persist over time. Finally, a health economic evaluation of HPV vaccines in Ethiopia indicated that switching from the current quadrivalent human papillomavirus (4vHPV) vaccine to the 9vHPV vaccine provides an additional health benefit and is a cost-effective decision.