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Background: Policy makers choosing whether to eradicate or control measles need to know about the costs of eradication and its alternatives. Methods: This project used a dynamic age-tiered measles transmission model for 6 countries (Bangladesh, Brazil, Colombia, Ethiopia, Tajikistan, and Uganda), which was extrapolated to a linear model that was applied globally. Policy options were constant vaccine coverage at 2010 levels, eradication by 2020, eradication by 2025, 95% mortality reduction by 2015, and 98% mortality reduction by 2020. We compared cumulative discounted societal costs, caseloads, lives, and disability adjusted life years (DALYS) saved with each policy option from 2010 to 2050. Sensitivity analysis tested robustness to parameters. Findings: Strategies to eradicate measles in Bangladesh, Ethiopia, and Uganda cost more than twice as much as control strategies, but have similar costs per DALY averted. More generally, in low and middle income countries that have not yet eliminated measles, the incremental cost effectiveness of control at $20 to $25 per measles death averted is similar to eradication at $22 to $24 per measles death averted. For high income countries that have not yet eliminated measles, eradication by 2020 would prevent deaths and save $800 million more than measles control from 2010-2050 due to averted costs of outbreaks. Interpretation: Measles eradication and measles control are both cost effective. Measles control and eradication have equivalent costs per life saved in low income countries, but high income countries derive savings only if measles is eradicated and imported cases stop.

Countries currently choose from several different measles and rubella containing vaccine options and use a wide range of vaccination schedules as they control the transmission of measles only or measles and rubella viruses within their borders and cooperate and coordinate to achieve regional and/or global goals. This paper discusses the current national options that countries use or could use for national measles and/or rubella control or elimination and existing associated regional goals to characterize the expected current global path and identify alternative paths. With highly effective, relatively inexpensive, and safe vaccines available we can potentially end indigenous measles and rubella virus transmission. The Pan American Health Organization eliminated endemic transmission of both measles and rubella, which demonstrated the possibility of global eradication, and four other regions of the World Health Organization are now pursuing targets for regional elimination. We discuss the choice of a global strategy of control compared to eradication to highlight the choices, opportunities, issues, and challenges that will ultimately determine the magnitude of human and financial costs of measles and rubella globally over the next several decades and beyond.