Abstract

ObjectivesIllustrate 3 economic evaluation methods whose value measures may be useful to decision makers considering vaccination programs. MethodsKeyword searches identified example publications of cost-effectiveness analysis (CEA), fiscal health modeling (FHM), and constrained optimization (CO) for economic evaluation of a vaccination program in countries where at least 2 of the methods had been used. We examined the extent to which different value measures may be useful for decision makers considering adoption of a new vaccination program. With these findings, we created a guide for selecting modeling approaches illustrating the decision-maker contexts and policy objectives for which each method may be useful. ResultsWe identified 8 countries with published evaluations for vaccination programs using >1 method for 4 infections: influenza, human papilloma virus, rotavirus, and malaria. CEA studies targeted health system decision makers using a threshold to determine the efficiency of a new vaccination program. FHM studies targeted public sector spending decision makers estimating lifetime changes in government tax revenue net of transfer payments. CO studies targeted decision makers selecting from a mix of options for preventing an infectious disease within budget and feasibility constraints. Cost and utility inputs, epidemiologic models, comparators, and constraints varied by modeling method. ConclusionsAlthough CEAs measures of incremental cost-effectiveness ratios are critical for understanding vaccination program efficiency for all decision makers determining access and reimbursement, FHMs provide measures of the program’s impact on public spending for government officials, and COs provide measures of the optimal mix of all prevention interventions for public health officials.

Highlights

  • Vaccines are critical for preventing infectious diseases.[1]

  • Decision makers determine access to new vaccination programs based on their policy objectives and decision context, which have been defined by The Professional Society for Health Economics and Outcomes Research (ISPOR) Task Force on Economic Evaluation of a Vaccination Program as “their perceived interests and obligations.”[2]

  • The 5 fiscal health modeling (FHM) studies and 5 constrained optimization (CO) studies identified were matched by country, disease, and similar vaccination program to a cost-effectiveness analysis (CEA) study and data extracted on policy objectives, contexts, study design, value measures, and policy conclusions

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Summary

Introduction

Vaccines are critical for preventing infectious diseases.[1] After their development, testing, and production, delivery to a population is determined by multiple decision makers who may be responsible for recommending, purchasing, and distributing the vaccines or designing or implementing vaccination and other programs for the prevention of infectious diseases. Such decision makers include global donors or nongovernmental organizations, national or country-specific public health organizations, national immunization technical advisory groups, government or private third-party payers, and employers or employee representatives.[2] Decision makers determine access to new vaccination programs based on their policy objectives and decision context, which have been defined by The Professional Society for Health Economics and Outcomes Research (ISPOR) Task Force on Economic Evaluation of a Vaccination Program as “their perceived interests (eg, values and preferences) and obligations (eg, policies, regulations, and constraints).”[2]. Chemoprophylaxis in at-risk populations may be used to prevent diseases such as malaria (for those living in endemic areas), human immunodeficiency virus infection (to prevent infection or transmission of disease), or latent tuberculosis (to prevent active disease)

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