Abstract
ABSTRACTBackground: Economic evaluations should form part of the basis for public health decision making on new vaccine programs. While Canada's national immunization advisory committee does not systematically include economic evaluations in immunization decision making, there is increasing interest in adopting them. We therefore sought to examine the extent and quality of economic evaluations of vaccines in Canada. Objective: We conducted a systematic review of economic evaluations of vaccines in Canada to determine and summarize: comprehensiveness across jurisdictions, studied vaccines, funding sources, study designs, research quality, and changes over time. Methods: Searches in multiple databases were conducted using the terms “vaccine,” “economics” and “Canada.” Descriptive data from eligible manuscripts was abstracted and three authors independently evaluated manuscript quality using a 7-point Likert-type scale scoring tool based on criteria from the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Results: 42/175 articles met the search criteria. Of these, Canada-wide studies were most common (25/42), while provincial studies largely focused on the three populous provinces of Ontario, Quebec and British Columbia. The most common funding source was industry (17/42), followed by government (7/42). 38 studies used mathematical models estimating expected economic benefit while 4 studies examined post-hoc data on established programs. Studies covered 10 diseases, with 28/42 addressing pediatric vaccines. Many studies considered cost-utility (22/42) and the majority of these studies reported favorable economic results (16/22). The mean quality score was 5.9/7 and was consistent over publication date, funding sources, and disease areas. Conclusions: We observed diverse approaches to evaluate vaccine economics in Canada. Given the increased complexity of economic studies evaluating vaccines and the impact of results on public health practice, Canada needs improved, transparent and consistent processes to review and assess the findings of the economic evaluations of vaccines.
Highlights
Canadian public health expenditures on vaccines amount to approximately $450 million annually and are expected to grow considerably in the decade to come.[1]
We found that Industry funded the majority of the studies in the literature (17/42 studies), followed by government (7/42 studies), while academic research grants only funded a few (2/42) studies. 22/42 studies considered cost-utility analysis and 16/22 of these reported favorable economic results, i.e. below the Canadian implicit cost-effectiveness threshold of $20,000 - $100,000/quality adjusted life years (QALYs)
Had the World Health Organization (WHO)-recommended cost-effectiveness threshold been used in our analysis, all but one cost-utility study would have been reported favorable results. 38/42 studies employed mathematical models and we noted an increase in model complexity over time
Summary
Canadian public health expenditures on vaccines amount to approximately $450 million annually and are expected to grow considerably in the decade to come.[1]. In Canada and abroad, wide scale adoption of some vaccines post-licensure has not occurred because their economic value has been questioned. Economic evaluations should form part of the basis for public health decision making on new vaccine programs. We sought to examine the extent and quality of economic evaluations of vaccines in Canada. Objective: We conducted a systematic review of economic evaluations of vaccines in Canada to determine and summarize: comprehensiveness across jurisdictions, studied vaccines, funding sources, study designs, research quality, and changes over time. Given the increased complexity of economic studies evaluating vaccines and the impact of results on public health practice, Canada needs improved, transparent and consistent processes to review and assess the findings of the economic evaluations of vaccines
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