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The economic disease burden of measles in Japan and a benefit cost analysis of vaccination, a retrospective study

Kenzo Takahashi12*, Yasushi Ohkusa3 and Jong-Young Kim4

Author Affiliations

1 Clinical Research Center Sanno Hospital, International University of Health and Welfare, 8-10-16 Akasaka, Minato-ku, Tokyo, 107-0052, Japan

2 Department of International Health Cooperation, Japan(IMCJ), National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo,162-8655, Japan

3 Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan

4 Department of Pediatrics, Chiba-Nishi General Hospital, 107-1 Kanegasaku, Matsudo-shi, Chiba, 270-2251, Japan

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BMC Health Services Research 2011, 11:254  doi:10.1186/1472-6963-11-254

Published: 7 October 2011



During 1999-2003, Japan experienced a series of measles epidemics, and in Action Plans to Control Measles and the Future Problems, it was proposed that infants be immunized soon after their one-year birthday.

In this study, we attempted to estimate the nationwide economic disease burden of measles based on clinical data and the economic effectiveness of this proposal using the benefit cost ratio.


Our survey target was measles patients treated at Chiba-Nishi general hospital from January 1999 to September 2001. Two hundred ninety-one cases were extracted from the database. The survey team composed of 3 pediatricians and 1 physician from Chiba-Nishi general hospital examined patient files and obtained additional information by telephone interview.

We analyzed data based on a static model, which assumed that the number of measles patients would be zero after 100% coverage of single-antigen measles vaccine.

Costs were defined as the direct cost for measles treatment, vaccination and transportation and the indirect cost of workdays lost due to the nursing of patients, hospital visits for vaccination or nursing due to adverse reactions. Benefits were defined as savings on direct and indirect costs. Based on these definitions, we estimated the nationwide costs of treatment and vaccination.


Using our static model, the nationwide total cost for measles treatment was estimated to be US$ 404 million, while the vaccination cost was US$165 million. The benefit cost ratio of the base case was 2.48 and ranged from 2.21 to 4.97 with sensitivity analysis.


Although the model has some limitations, we conclude that the policy of immunizing infants soon after their one-year birthday is economically effective.