Standardized country-level delivery unit cost estimates for routine childhood, routine adolescent, and campaign vaccination: an updated modeling analysis

Abstract Background Reliable estimates of immunization delivery costs are essential for planning, budgeting, and economic evaluation. Despite recent empirical studies, many low- and middle-income countries (LMICs) lack up-to-date cost estimates, particularly for adolescent and campaign vaccination. This study generated standardized country-level delivery cost estimates across vaccination modalities in LMICs. Methods Using data from empirical costing studies in the 2024 update of the Immunization Delivery Cost Catalogue, we fitted Bayesian meta-regression models to estimate per-dose delivery costs for routine childhood vaccination, routine adolescent vaccination (using human papillomavirus vaccination as a proxy), and mass campaigns. Models incorporated country-level covariates (gross domestic product per capita, population size, diphtheria-tetanus-pertussis third-dose coverage, urbanization, population density, and under-five mortality) and study-level characteristics (cost category and costing perspective). Fitted models were used to generate country-specific and population-weighted mean economic and financial costs per dose in 2024 US dollars. Results The analysis included 141 observations for routine childhood, 49 for adolescent, and 104 for campaign vaccination. The population-weighted mean economic cost per dose across LMICs was $4.36 (95% uncertainty interval: $2.07–8.33) for routine childhood vaccination, $21.53 ($8.21–56.01) for adolescent vaccination, and $8.25 ($4.14–16.34) for campaigns. Corresponding financial costs were $3.32 ($1.51–6.81), $8.18 ($3.06–29.61), and $5.50 ($2.47– 11.73). Substantial heterogeneity was observed across countries, delivery modalities, and cost perspectives. Conclusions Leveraging an expanded evidence-base and Bayesian meta-regression, this study provides updated delivery cost estimates across vaccination modalities for 136 LMICs. These estimates offer a practical resource for analyses where empirical cost data are unavailable.