Economic implications of switching to the hexavalent infant vaccine in an immunization program in India.

Combination vaccines can improve immunization coverage, timeliness, and acceptance by reducing the number of injections and simplifying program delivery. The hexavalent vaccine, which combines the pentavalent vaccine with inactivated polio vaccine (IPV), has been adopted in several countries to maintain polio immunity while streamlining routine immunization schedules. This study evaluates the economic implications of introducing the hexavalent vaccine into India's national immunization program. Two introduction scenarios were assessed: replacement of pentavalent and IPV, and replacement of pentavalent, IPV, and the Diphtheria-Tetanus-Pertussis (DTP) first booster. The analysis considered costs from both government provider and household perspectives, capturing changes in program costs as well as time savings for families associated with fewer vaccine administrations. The results indicate that introducing the hexavalent vaccine would increase overall program costs under both scenarios, driven primarily by the higher price per dose of the hexavalent vaccine. However, the switch also yields operational efficiencies and time savings for caregivers during immunization visits. Importantly, the findings show that price reductions substantially improve the economic case for adoption. A 50% reduction in the unit price of the hexavalent vaccine would offset the additional program costs in the first scenario, while further price reductions could generate net cost savings in the second scenario. Overall, the study suggests that adoption of the hexavalent vaccine in India could support more efficient and user-friendly immunization delivery. Achieving economic benefits, however, will depend critically on procurement strategies that successfully lower vaccine prices.