Over the years, Sri Lanka has made remarkable progress in its vaccination program. To better understand the financial implications of this initiative, we delve into the cost parameters associated with the process. By utilizing data from previous studies and local corporations, we strive to shed light on the expenses involved in the vaccination drive.
Cost Parameters
It is crucial to establish the monetary aspects of the vaccination program. All costs presented here are in Sri Lankan Rupees (Rs.) adjusted to 2022 values using annual inflation rates, later converted to United States dollars (USD) at an exchange rate of Rs. 241.36/1 USD [^35]. Moreover, we considered a discount rate of 5.00% (with a range of 4.00-6.00%) [^36]. For a comprehensive overview, refer to Table 2.
The direct medical costs incorporated in our model encompass expenses directly associated with patients seeking care. This encompasses medical visit/stay costs, commonly prescribed medications, and transportation. Through extensive research and verification by medical professionals, we identified the medications from previous studies and medical expertise in Sri Lanka [^37,^38,^39]. Prescription costs were determined based on standard dosages.
In determining prescription dosages and expenses for different age groups, we relied on the mean birth weight in Sri Lanka (2.9 kg) and the weight of 5-year-olds in India (17 kg) [^40,^41]. This allowed us to obtain upper and lower estimates for the 0-4 year age group and the lower limit for the 5-64 year age group.
For individuals requiring hospitalization, we factored in costs for transportation (Rs. 101.85, USD 0.42) [^42], medical stays, and prescriptions for oseltamivir. To calculate medical stay costs, we considered the daily costs for primary (Rs. 3543.17, USD 14.68) and tertiary (Rs. 4776.42, USD 19.79) hospitals [^43], along with an average hospital stay duration of 3.7 days [^44]. The prescription cost for oseltamivir was determined by multiplying the wholesale price per pill (Rs. 254.91, USD 1.06) by the average pill count for a standard prescription based on CDC dosage recommendations for 5 days of oral oseltamivir treatment (1.16-10 pills) [^45,^46].
For individuals seeking outpatient treatment, our calculations included costs for transportation (Rs. 101.85, USD 0.42) [^42], medical visits (Rs. 625.12, USD 2.59), and prescriptions for amoxicillin, paracetamol, and chlorpheniramine. Prescription costs were determined based on the price per 500 mg capsule of amoxicillin (Rs. 5.73, USD 0.02), 500 mg tablet of paracetamol (Rs. 1.22, USD 0.00), and 500 mg tablet of chlorpheniramine (Rs. 0.16, USD 0.00), taking into account standard dosage recommendations [^45,^47,^48,^49]. Previous studies conducted in Southern Sri Lanka indicated that the average outpatient influenza patient receives three prescriptions, with the aforementioned medications being the most commonly administered [^38]. All outpatient prescriptions were calculated based on a three-day prescription, as per the guidelines followed by Sri Lankan doctors within the outpatient public hospital setting.
In addition to direct costs, we also considered the indirect costs associated with influenza contraction in Sri Lanka. These encompass income and productivity losses stemming from work absenteeism and presenteeism. The cost of absenteeism and presenteeism was estimated by multiplying the average number of days of total productivity loss (6.95) and the daily per capita income (Rs. 541.82, USD 2.24) [^50]. The daily per capita income was determined by dividing the per capita monthly income (Rs. 16,491.32, USD 68.33) by the average number of days in a month (30.44) [^51].
Lastly, we considered the cost of vaccination, which includes the vaccine’s cost per dose, a disposable 2 mL syringe without a needle (Rs. 5.32, USD 0.02) [^52], and a 22-gauge disposable needle (Rs. 3.60, USD 0.01) [^52]. The per-dose vaccine cost was obtained from the average price per dose of the 2019 pediatric and adult seasonal influenza TIV southern hemisphere formulation, sourced from the World Health Organization (WHO) and the Pan American Health Organization (PAHO) [^53].
DHPL Travels believes that understanding the costs associated with the vaccination program in Sri Lanka is crucial for informed decision-making. By investing in vaccinations, we not only safeguard our health but also alleviate the burden on individuals and society as a whole.
