HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2007.122192v1 98/7/1322    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Thompson, K. M. Articles by Cochi, S. L. PubMed PubMed Citation Articles by Thompson, K. M. Articles by Cochi, S. L. Related Collections Epidemiology Global Health Health Policy Immunization/Vaccines Other Infections

Kimberly M. Thompson, ScD, Radboud J. Duintjer Tebbens, PhD, Mark A. Pallansch, PhD, Olen M. Kew, PhD, Roland W. Sutter, MD, MPH, R. Bruce Aylward, MD, MPH, Margaret Watkins, MPH, BSN, Howard E. Gary, Jr, PhD, James Alexander, MD, MEd, Hamid Jafari, MD and Stephen L. Cochi, MD, MPH

Kimberly M. Thompson and Radboud J. Duintjer Tebbens are with the Kids Risk Project, Harvard School of Public Health, Boston, MA. Mark A. Pallansch, Olen M. Kew, Margaret Watkins, Howard E. Gary Jr, James Alexander, and Stephen L. Cochi are with the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA. Roland W. Sutter and R. Bruce Aylward are with the Polio Eradication Initiative, World Health Organization, Geneva, Switzerland. Hamid Jafari is with the National Polio Surveillance Project, World Health Organization, New Delhi, India.

Correspondence: Requests for reprints should be sent to Kimberly M. Thompson, Kids Risk Project, Harvard School of Public Health, 677 Huntington Ave, Third Floor, Boston, MA 02115 (e-mail: kimt{at}hsph.harvard.edu).

Objectives. We assessed the costs, risks, and benefits of possible future major policy decisions on vaccination, surveillance, response plans, and containment following global eradication of wild polioviruses.

Methods. We developed a decision analytic model to estimate the incremental cost-effectiveness ratios and net benefits of risk management options for polio for the 20-year period and stratified the world according to income level to capture important variability between nations.

Results. For low-, lower-middle-, and upper-middle-income groups currently using oral poliovirus vaccine (OPV), we found that after successful eradication of wild polioviruses, OPV cessation would save both costs and lives when compared with continued use of OPV without supplemental immunization activities. We found cost-effectiveness ratios for switching from OPV to inactivated poliovirus vaccine to be higher (i.e., less desirable) than other health investment opportunities, depending on the actual inactivated poliovirus vaccine costs and assumptions about whether supplemental immunization activities with OPV would continue.

Conclusions. Eradication promises billions of dollars of net benefits, although global health policy leaders face difficult choices about future policies. Until successful eradication and coordination of posteradication policies, health authorities should continue routine polio vaccination and supplemental immunization activities.