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ARE VACCINATION SITES IN BANGLADESH SCALE EFFICIENT?

Published online by Cambridge University Press:  21 April 2004

Vivian Valdmanis
Affiliation:
London School of Hygiene & Tropical Medicine
Damian Walker
Affiliation:
London School of Hygiene & Tropical Medicine
Julia Fox-Rushby
Affiliation:
London School of Hygiene & Tropical Medicine

Abstract

Objectives: The overall aim of this study is to discern whether and to what degree vaccination sites exhibit constant returns to scale.

Methods: Data Envelopment Analysis is used to compare all the facilities in the sample in terms of input costs used to produce multiple outputs. The application considers the Expanded Program on Immunization (EPI), which operated in Dhaka City, Bangladesh, during 1999.

Results: A preponderance of EPI sites were determined to be operating at increasing returns to scale.

Conclusions: Our findings question the applicability of cost-effectiveness analyses that assume constant returns to scale.

Type
RESEARCH NOTES
Copyright
© 2004 Cambridge University Press

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References

Barnum HN, Tarantola D, Setiady IF. 1980 Cost-effectiveness of an immunization programme in Indonesia. Bull World Health Org. 58: 499- 513.Google Scholar
Birch S, Gafni A. 1992 Cost-effectiveness/utility analysis. Do current decision rules lead us to where we want to be? J Health Econ. 1: 279- 296.Google Scholar
Coelli TJ. 1996 A guide to DEAP version 2.1: A data envelopment analysis computer program. CEPA Working Paper No. 8/96. ISBN 1 86389 4969. Department of Econometrics, University of New England;
Cutts FT, Phillips M, Kortbeek S,et al. 1990 Door-to-door canvassing for immunization program acceleration in Mozambique: Achievements and costs. Int J Health Serv. 20: 717- 725.Google Scholar
England S, Loevinsohn B, Melgaard B,et al. 2001 The evidence base for interventions to reduce mortality from vaccine-preventable diseases in low and middle-income countries. CMH Working Paper Series. Paper No. WG5 10. Geneva, Switzerland: Commission on Macroeconomics and Health;
Färe R, Grosskopf S. 1985 A non-parametric cost approach to scale efficiency. Scand J Econ. 87: 594- 604.Google Scholar
Färe R, Grosskopf S, Lovell CAK. 1994 Production functions. Cambridge: Cambridge University Press;
Gilson L. 1992 Quality and cost of primary health care in rural Tanzania. PhD thesis. London: School of Hygiene and Tropical Medicine;
Jacobs P, Baladi JF. 1996 Biases in cost measurement for economic evaluation studies in health care. Health Econ. 5: 525- 529.Google Scholar
Kumaranayake L, Watts C. 1999 Costs of scaling up HIV program activities to a national level for sub-Saharan Africa: Methods and estimates. S Afr J Econ. 68: 1012- 1032.Google Scholar
Levine OS, Ortiz E, Contreras R,et al. 1993 Cost-benefit analysis for the use of Haemophilus influenzae type b conjugate vaccine in Santiago, Chile. Am J Epidemiol. 137: 1221- 1228.Google Scholar
Ramsey CR, Grant AM, Wallace SA,et al. 2000 Assessment of the learning curve in health technologies. A systematic review. Int J Technol Assess Health Care. 16: 1095- 1108.Google Scholar
Seiford LM. 1998 A bibliography of data envelopment analysis. In: Charnes A, Cooper WW, Lewin AY, Seiford LM, eds. Data envelopment analysts: Theory, methodology and application. Boston: Kluwer Academic Publishers, 437- 469.
Shepard DS, Sanoh L, Coffi E. 1986 Cost-effectiveness of the expanded programme on immunization in the Ivory Coast: A preliminary assessment. Soc Sci Med. 22: 369- 377.Google Scholar
Walsh JA, Warren KS. 1982 Strategies for primary health care: Technologies for the control of disease in the developing world. Chicago: The University of Chicago Press;
World Bank. 1993 World development report 1993. Investing in health. Oxford: Oxford University Press;