<p>Markov model input parameters.</p>

The later assumed increased investments to reach hard-to-reach populations. A threshold of USD 1,280 per disability adjusted life year (DALY) averted was applied. A budget impact analysis was also conducted.

Over a 10-year time horizon, the constant coverage improvement scenario led to 6% fewer deaths (213 (161–276)) and was cost-effective (incremental cost-effectiveness ratio, ICER = USD 1,269 ($1,205-$1,333) per DALY averted) compared to the base scenario. Increasing coverage in the intensified investment scenario, further reduced deaths by 25% (879(626--1,284)) and was more cost effective, ICER 1,093 (1,029 -1,157) per DALY averted, compared to the constant improvement scenario.

The constant improvement scenario had a moderate budget impact while the intensified improvement scenario had a very high budget impact, when assessed against Kenya’s health expenditure. Our findings suggest that accelerating measles coverage through intensified investments towards measles elimination is cost-effective but has a high budget impact. Therefore, policy makers should consider market shaping interventions and strategies to mobilize and allocate sufficient resources to increase vaccination coverage and ensure sustained health gains.</p></div>