Appraising the cost-effectiveness of vaccines in the UK: Insights from the Department of Health Consultation on the revision of methods guidelines

Abstract

The UK Department of Health and Social Care recently held a consultation on proposals to revise the methods for the appraisal of cost-effectiveness of vaccines as applied by the Joint Committee on Vaccination and Immunisation (JCVI). This presents a useful opportunity to review the current methods applied by the JCVI and examine the proposals for their improvement. Reviewing such methods is timely as there is mounting evidence that key elements of the health economic appraisal of all healthcare interventions in the UK need to be revised. In particular, there is a need to reassess both the cost-effectiveness threshold used to judge if an intervention is cost-effective and the discount rates used to assess the present value of health gains that occur in the future. Accordingly, we critically appraise the methods and their proposed changes. Overall, the 27 recommendations made within the recent consultation on proposed changes indicate a sensible and carefully considered approach to methods reform. We identify 11 recommendations that deserve further comment or reconsideration. In particular, there are reasons to question the basis for the proposed reduction of the discount rate from 3.5% to 1.5%. We also find that aspects of the current methods for considering uncertainty in the cost-effectiveness of vaccines require revision. Both the discounting and uncertainty analyses recommendations do not appear to be well grounded in economic theory, empirically justified or consistent with the methods set out by the National Institute for Health and Care Excellence.