Serious consideration of child health economic evaluation cannot proceed without adressing how to improve health for children in the developing world. Reducing mortality in children under 5 years is a goal of the UN millennium Declaration. With funding available from external donor funding agencies, decision-makers in developing countries are faced with how to achieve optimal allocative efficiency in implementing health care programs for children. This session will feature three renown experts in the conduct of pediatric health economic evaluation for children in developing countries.

Dr. Tessa Tan-Torres Edejer, will speak on the application of the WHO Choosing Interventions that are Cost Effective (CHOICE) standardised framework to interventions that reduce childhood morbidity and mortality, including oral rehydration therapy; case management of pneumonia; supplementation and fortification with vitamin A or zinc; provision of supplementary food during weaning, with counselling on nutrition; and measles immunisation. Results showed that fortification with zinc or vitamin A was the most cost effective. Other WHO-CHOICE work shows that community-based management of neonatal pneumonia, community newborn packages including breast feeding support and care of low birth weight babies, treatment of malaria with artemisinin-based combinations and prevention of maternal to child transmission of HIV are as cost-effective as fortification interventions.

Dr. Donald Shepard will address the economic feasibility of a pediatric tetravalent dengue vaccine for children in Southeast Asia and Panama. It was demonstrated that the cost per disability adjusted life year (DALY) saved by a pediatric vaccine would be $50 in Southeast Asia. In Panama, the estimated cost offsets would be 178% of vaccination costs for infants. Thus, dengue vaccination appears to be highly cost-effective. As interventions such as pediatric vaccines involve favorable externalities, a conventional cost-effectiveness analysis is often insufficient. When a child is ill, he will often miss school as a result. Potentially, the absence is not only a loss of good health for the child, but a lost opportunity for learning for the child and economic growth for the country. When these favorable externalities are incorporated, vaccination in Panama is even more cost-effective than traditional analyses suggest and societies should be willing to accept relatively higher (expensive) cost-effectiveness ratios.

Dr. Damian Walker will address the health economic evidence for vaccines in the deverloping world. The Expanded Programme on Immunization vaccines are considered to be among the most efficient uses of scarce health care resources. Today, there are many under-used and new vaccines available, with more in the pipeline. These will not cost the few cents per dose that traditional vaccines do, but will be 'multi-dollar' vaccines. Decision-makers will require information on their relative cost-effectiveness. Reviews have indicated that there is scope for improving the transparency, completeness and comparability of economic evaluations of immunization programmes. Adherence to guidelines would increase the quality, interpretability and transferability of future analyses; however, more specific advice for vaccination programmes might be needed.

Each presenter will speak for 10-15 minutes followed by a Panel discussion addressing unique challenges related to health economic evaluation in children in developing countries. These issues may include study design considerations, the use of the DALY, specifying adequate time horizons and capturing externalities. Audience members will be invited to pose questions to the Panel.

The session is expected to of great interest to those involved in health economic evaluation and policy decision-making for children as well as those with a special interest in improving health outcomes for children in the developing world.