PIN25 A Systematic Review of the Use of Productivity Loss/GAIN in Cost-Effectiveness Analyses for Vaccines

Abstract

Cost-effectiveness is one factor that is sometimes considered when deciding whether or not to recommend a vaccine for coverage and/or inclusion in immunization programs. Vaccines are associated with a range of cost implications including direct healthcare costs and indirect costs such as productivity gains and losses. This review describes the use of productivity-related costs in cost-effectiveness analyses (CEA) and cost-utility analyses (CUA) for vaccines. A systematic literature review was conducted based on a search of Medline, Embase, and Cochrane Library and a bibliography search to identify CEAs and CUAs for vaccines and vaccine programs that included productivity-related costs. A description of the studies included in terms of their country of origin, disease targeted, study design, analysis perspective, and more is provided. Moreover, the kind of productivity-related cost elements, their calculation approach, and the impact of their inclusion on cost-effectiveness outcomes are summarized. Eighty-eight studies were identified that evaluated the cost-effectiveness of vaccines and included costs associated with productivity. The specific productivity cost elements included were reported for 71 studies (81%) with absenteeism being the most widely included productivity cost element. Caregiver absenteeism was the only productivity cost element included for 39 studies (44%) and 18 studies (20%) included only patient absenteeism as a productivity cost element. Although the specific elements included were not always reported, 76 studies (86%) reported the impact of including productivity losses and gains on the ICER, with a majority of those studies reporting a more favorable cost-effectiveness based on their inclusion. Inclusion of productivity-related costs such as costs associated with absenteeism and premature mortality for CEA and CUA of vaccines resulted in more favorable cost-effectiveness – i.e. a lower ICER – based on the studies reviewed. However, the specific cost elements included tend to differ depending on the target disease and/or population.