5. Main results of economic evaluations identified.

Study ID Country	Study period	Monetary unit	Schedule	Total program cost $ millions	Total program saving $ millions	Total benefits $ millions	Net incremental cost $ millions per year	Cost per case of VAPP prevented $ millions per year
Miller 1996 USA	1980‐1991	USD 1995	4 OPV (Ref)	375	‐	‐	‐	‐
			4 IPV	414.5	‐	11.4	28.1	3
			2 OPV 2 IPV	395.4	‐	5.7	14.7	3.1
Summary: cost‐benefit and cost‐effectiveness models were formulated to compare the USA national 4‐OPV dose with a 4‐dose IPV schedule or a sequential schedule of 2 doses of IPV followed by 2 doses of OPV. Changing to an IPV‐only or a sequential schedule would cost $28.1 million and $14.7 million, respectively. The costs per case of VAPP prevented were estimated as $3.0 million and $3.1 million for each option, respectively. It concluded that the introduction of IPV into the routine vaccination schedule would not be cost‐beneficial at 1995 vaccine prices and with the current compensation awards paid to VAPP cases since, the costs are higher than other public health prevention programs.
Biffi 2003 Italy	2000 (life expectancy of 75 years)	Euros 2000	4 OPV (Ref)	‐	‐	‐	‐	‐
			2 OPV 2 IPV	‐	‐	‐	2.8	2.9
Summary: in Italy, a sequential schedule based on two IVP doses followed by two OPV doses replaced in 1999 the OPV‐only schedule to reduce the incidence of VAPP, the most dangerous adverse event of OPV. Assuming an hypothetical VAPP reduction, an economic evaluation estimated that a sequential schedule would avoid 0.768 cases/year; however, the costs of the sequential schedule outweigh the expected economic benefits associated with a decreased incidence of VAPP.
Mascareñas 2005 Mexico	2002	USD 2002	4 OPV (Ref)	‐	‐	‐	‐	‐
			NIW	100,454 to 156,614	‐	‐	‐	‐
			4 IPV	‐	28.8	‐	‐	‐
			2 OPV 2 IPV	‐	18.6	‐	‐	‐
Summary: a prospective Mexican, micro‐costing study estimated that changing from the current OPV‐based intensive and routine schedule to a sequential IPV‐OPV routine schedule would save US $14.52 per vaccinated child, and changing to a full IPV routine schedule would save US $9.41 per vaccinated child. It also estimated a national immunisation week (NIW) cost.
Sartori 2015 Brazil	2011	USD 2011	5 OPV + 2 NIDs (Ref)	19,873,170	‐	‐	‐	‐
			1 IPV 4 OPV	14,608,419	−26.50%	‐	‐	‐
			2 IPV 3 OPV	22,852,799	15.00%	‐	‐	‐
			3 IPV 2 OPV	31,283,072	57.40%	‐	‐	‐
			4 IPV 4	38,936,547	95.90%	‐	‐	‐
			5 IPV	41,681,259	109.70%	‐	‐	‐
			1 IPV 4 OPV + 1 NID	21,409,159	7.70%	‐	‐	‐
			2 IPV 3 OPV + 1 NID	29,653,539	49.20%	‐	‐	‐
			3 IPV 2 OPV + 1 NID	38,083,812	91.60%	‐	‐	‐
			4 IPV 4 + 1 NID	45,737,287	130.20%	‐	‐	‐
			5 IPV + 1 NID	48,481,999	143.90%	‐	‐	‐
			1 IPV 4 OPV + 2 NID	28,209,899	41.90%	‐	‐	‐
			2 IPV 3 OPV + 2 NID	36,454,279	83.40%	‐	‐	‐
			3 IPV 2 OPV + 2 NID	44,884,552	125.90%	‐	‐	‐
			4 IPV 4 + 2 NID	52,538,027	164.40%	‐	‐	‐
			5 IPV + 2 NID	55,282,740	178.20%	‐	‐	‐
Summary: the introduction of IPV in Brazil increased the annual costs of the polio vaccines by 49.2% compared with the oral vaccine‐only regimen. This increase represented 1.13% of the expenditure of the national immunisation program on the purchase of vaccines in 2011.
Duintjer Tebbens 2006 Wordwide	‐	‐	HIC: IPV	6100	‐	‐	‐	‐
			HIC: AFP	800	‐	‐	‐	‐
			Total	6900	‐	‐	‐	‐
			UMIC: IPV	1300	‐	‐	‐	‐
			UMIC: SIAs	1700	‐	‐	‐	‐
			UMIC: OPV	700	‐	‐	‐	‐
			UMIC: AFP	400	‐	‐	‐	‐
			Total	4100	‐	‐	‐	‐
			LMIC: IPV	3100	‐	‐	‐	‐
			LMIC: SIAs	2100	‐	‐	‐	‐
			LMIC: OPV	1100	‐	‐	‐	‐
			LMIC: AFP	700	‐	‐	‐	‐
			Total	7000	‐	‐	‐	‐
			LIC: IPV	3900	‐	‐	‐	‐
			LIC: SIAs	1700	‐	‐	‐	‐
			LIC: OPV	1900	‐	‐	‐	‐
			LIC: AFP	1100	‐	‐	‐	‐
			LIC: Total	8600	‐	‐	‐	‐
Summary: a model for the expected future costs of different polio strategies estimated that a global transition from routine immunisation with OPV to IPV would increase the costs of managing polio globally, although routine IPV use remains less costly than routine OPV use with supplemental immunisation activities. The uncertainty in the aggregated costs, the discount rate and price and administration cost of IPV drives the expected incremental cost of routine IPV vs OPV immunisation.
Duintjer Tebbens 2015 200 countries	2013–2052	USD 2013	tOPV (Ref)	‐	‐	‐	‐	‐
			LIC: ≥ 1 IPV no SIAs	‐	‐	4700	‐	‐
			LMIC: ≥ 1 IPV no SIAs	‐	‐	15,000	‐	‐
			UMIC: ≥ 1 IPV no SIAs	‐	‐	−400	‐	‐
			HIC: ≥ 1 IPV no SIAs	‐	‐	−3500	‐	‐
			World: ≥ 1 IPV no SIAs	‐	‐	16,000	‐	‐
Summary: an integrated dynamic poliovirus transmission and stochastic risk model simulated possible futures and estimate the health and economic outcomes of maintaining the 2013 status quo of continued OPV use in most developing countries compared with OPV cessation policies with various assumptions about global IPV adoption. The authors estimated a global incremental net benefits during 2013‐2052 of approximately 16 US $2013 billion (almost 20 billion in LMICs) with at least one IPV routine immunisation dose in all countries until 2024 compared to continued OPV use, although significant uncertainty remains associated with the frequency of exportations between populations and the implementation of long‐term risk‐management policies.
AFP: acute flaccid paralysis; HIC: high‐income country; IPV: inactivated poliovirus vaccine; LIC: low‐income country;LMIC: lower‐middle income country; NID: national immunisation days;NIW: national immunisation week; OPV: oral poliovirus vaccine; SIA: supplemental immunisation days; UM: upper‐middle‐income country; USD: US dollars; VAPP: vaccine‐associated paralytic poliomyelitis.

For definition of schedules (e.g. sequential IOO), see Glossary in Appendix 1.