Vaccine 29 (2011) 2371–2380 Contents lists available at ScienceDirect Vaccine journal homepage: www.elsevier.com/locate/vaccine Review Rethinking the benefits and costs of childhood vaccination: The example of the Haemophilus influenzae type b vaccine  Till Bärnighausen a,b , David E. Bloom a,* , David Canning a , Abigail Friedman a , Orin S. Levine c , Jennifer O’Brien a , Lois Privor-Dumm c , Damian Walker d a Department of Global Health and Population, Harvard School of Public Health, United States b Africa Centre for Health and Population Studies, University of KwaZulu-Natal, South Africa c Johns Hopkins Bloomberg School of Public Health, United States d Bill & Melinda Gates Foundation, United States article info Article history: Received 11 April 2010 Received in revised form 29 November 2010 Accepted 30 November 2010 Available online 13 December 2010 Keywords: Childhood vaccination Economic evaluation Review Haemophilus influenzae type b vaccine abstract Economic evaluations of health interventions, such as vaccinations, are important tools for informing health policy. Approaching the analysis from the appropriate perspective is critical to ensuring the valid- ity of evaluation results for particular policy decisions. Using the example of cost–benefit analysis (CBA) of Haemophilus influenzae type b (Hib) vaccination, we demonstrate that past economic evaluations have mostly adopted narrow evaluation perspectives, focusing primarily on health gains, health-care cost savings, and reductions in the time costs of caring, while usually ignoring other important benefits including outcome-related productivity gains (improved economic productivity due to prevention of mental and physical disabilities), behavior-related productivity gains (economic growth due to fertil- ity reductions as vaccination improves child survival), and community externalities (herd immunity and prevention of antibiotic resistance). We further show that potential cost reductions that could be attained through changes in the delivery of the Hib vaccine have also generally been ignored in economic eval- uations. Future economic evaluations of childhood vaccinations should take full account of benefits and costs, so that policymakers have sufficient information to make well-informed decisions on vaccination implementation. © 2010 Elsevier Ltd. All rights reserved. Contents 1. Introduction .......................................................................................................................................... 2372 2. The Haemophilus influenzae type b vaccine .......................................................................................................... 2372 3. Cost–benefit analysis of Hib vaccination ............................................................................................................ 2372 4. Rethinking the benefits of vaccination .............................................................................................................. 2373 4.1. Outcome-related productivity gains ......................................................................................................... 2373 4.2. Behavior-related productivity gains ......................................................................................................... 2374 4.3. Community externalities ..................................................................................................................... 2374 4.4. Broadening the perspective on benefits in cost–benefit analysis of Hib vaccination ....................................................... 2375 5. Rethinking the costs of Hib vaccination ............................................................................................................. 2375 5.1. Broadening the perspective on costs in cost–benefit analysis of Hib vaccination .......................................................... 2377 6. Discussion ............................................................................................................................................ 2377 Acknowledgements .................................................................................................................................. 2378 References ........................................................................................................................................... 2379  An earlier version of this paper was prepared for the Copenhagen Consensus. * Corresponding author. Tel.: +1 617 432 0866; fax: +1 617 432 6733. E-mail addresses: tbaernig@hsph.harvard.edu (T. Bärnighausen), dbloom@hsph.harvard.edu (D.E. Bloom), dcanning@hsph.harvard.edu (D. Canning), afriedm@fas.harvard.edu (A. Friedman), olevine@jhsph.edu (O.S. Levine), jobrien@hsph.harvard.edu (J. O’Brien), lprivord@jhsph.edu (L. Privor-Dumm), Damian.Walker@gatesfoundation.org (D. Walker). 0264-410X/$ – see front matter © 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.vaccine.2010.11.090