Economic Evaluations Of Vaccines Research Articles

Economic evaluation of vaccination against COVID‐19: A systematic review

AbstractBackground and AimsCoronavirus has burdened considerable expenditures on the different health systems. Vaccination programs, the critical solution against pandemic diseases, are known as safe and effective interventions to prevent and control epidemics. We aimed to perform a systematic review to provide economic evidence of the value of different types of vaccines available to combat the Covid‐19 to all health policymakers worldwide.MethodsElectronic searches conducted on Medline/PubMed, Cochrane Library, Web of Science, Scopus, Embase, and other economic evaluation databases. Related and published articles searched up to March 2022 by using keywords such as “Vaccination,” “Covid‐19,” “Cost‐benefit,” “Cost‐utility,” “Cost‐effectiveness,” “Economic Assessment,” and “Economic evaluation.” Followed by choosing the most suitable articles according to inclusion and exclusion criteria, data captured and the results extracted. The quality assessment of the articles performed by the checklist of CHEERS 2022. Finally, 13 articles included in the review.ResultsAll messenger RNA vaccines were dominant with approximately 70% coverage against no vaccination in the primary vaccination program except in one study that looked at booster effects. From a payer's perspective, a dollar invested in a vaccine would be less profitable than from a societal perspective. Therefore, primary mass vaccination can be considered a cost‐effective intervention in primary vaccination to save more lives and produce more positive externalities. However, the cost‐benefit ratio for all vaccines increases when statistical lifetime value and global economic and educational disadvantages are considered.ConclusionThe COVID‐19 primary vaccination programs in regional outbreaks, from a long‐term perspective, will demonstrate substantial cost‐effectiveness. It is suggested that due to the positive externalities of vaccination, primary mass vaccination, with the help of COVAX‐19TM, could be considered a reliable way to combat viral epidemics compared to the loss of individual lives and economic and educational disturbances around the world.

An economic evaluation of vaccination in children against meningococcal infection in Moscow

Meningococcal infection (MI) is one of the most serious and life-threatening with an average mortality rate of 15 %. Infection accounts for the largest number of deaths of all infectious diseases among children under 17 years of age. Aim. Using simulation mathematical modeling to evaluate the potential epidemiological and economic benefits of vaccination against MI for children under the age of 1 year in Moscow with a Meningococcal (Groups A, C, Y and W-135) Polysaccharide Diphtheria Toxoid Conjugate Vaccine. Methods. The assessment of potential indicators of morbidity and mortality of children under the age of 1 year after vaccination in a hypothetic cohort was carried out, considering a period of the stable post-vaccination immunity. Data were compared with the indicators of the MI incidence in Moscow. Monetary equivalents of economic benefits are calculated, considering the cost of vaccination, direct and indirect costs. Results. It is possible to reduce the number of MI cases by 73 %, mortality by an average on 85 % after vaccination, in the horizon of 5 years of maintaining immunity tension, Vaccination of children under one year old can reduce the number of disability cases that occur after severe forms of infection. As a result, the economic impact from the mentioned disease can be reduced by 75 %. Conclusion. The resulting economic benefits in the future may significantly exceed the cost of vaccination. It seems expedient to accelerate the introduction of vaccination of children's contingents against MI.

EE98 Health Economic Evaluation of COVID-19 Vaccines: A Systematic Literature Review

The COVID19 pandemic caused over six million deaths worldwide as of 2022 and made necessary the rapid development of vaccines. The objective of this Systematic Literature Review is to summarise the main evidence from economic evaluations of vaccines against COVID19. Searches were conducted on PubMed on July 13th 2022. The selected papers considered COVID19 vaccination scenarios without population limits. The types of study design examined were cost-benefit and cost-effectiveness analyses. Overall, 16 articles from an initial list of 1842 were included in this review. Out of the 16 models, there were five Markov cohort models (three of them were combined with a decision tree model), four dynamic transmission models, three microsimulation models, three epidemiological models (without further information on the model structure) and one decision tree model. Model characteristics were considerably consistent between high-, middle- or low-income countries. Five studies considered both the healthcare and societal perspective, while seven studies reported only the former, and one only the latter. Two studied did not specify the study perspective. Ten of the studies did not consider any level of herd immunity, and no study considered cross-protection. Although eight studies used “naïve” comparisons between vaccines, none of the studies conducted thorough indirect treatment comparison. All the models suggest that vaccines are cost-effective as they prevent death and transmission, and reduce the severity of cases. Although the sources of effectiveness estimates were always stated, the details of those studies were rarely reported. Nevertheless, the outcome measures and the key parameters used in the models were generally clearly stated and justified. This SLR highlights several challenges for conducting Health Economic evaluations of COVID19 vaccines. The quality of the models and their estimates suffered from the very fast pace of COVID19 research. Therefore, economic evidence on vaccination programs requires additional rigorous research.

Acceptance and application of a broad population health perspective when evaluating vaccine

The traditional health economic analysis is limited to estimating the impact on the treated patient. As vaccines are usually aimed at preventing infectious diseases, they may be associated with additional values for the non-treated wider population. Although there are valid reasons for treating vaccines differently, and a wide support for a broader perspective in the literature (i.e., beyond the net costs and health gain related to the outcome for the vaccinated individual), it remains unclear to what extent the Health Technology Assessment (HTA) agencies accept and apply a broader perspective.The purpose of this study is to examine and discuss what type of consequences are relevant for a health economic analysis of vaccines and which consequences are considered by HTA agencies. The study includes a strategic review of literature and HTA decisions in Sweden and other countries, online round-table discussions with stakeholders in Sweden, and a basic estimation of the value of a COVID-19 vaccination in Sweden.The study shows that, other than herd effect, broader economic consequences for the population are generally not included in the economic evaluation of vaccines. Also, all economic consequences for the treated patient (production loss) and caregiver (health loss) are not always considered. The perspective chosen can have a major impact on the outcome of the analysis. A vaccine for COVID-19 is estimated to provide a value of €744–€956 per dose when using a societal perspective including broader consequences for the population.Providing a complete and appropriate picture of the value of vaccination is of importance to allocate resources efficiently, to provide incentives for vaccine development, and to show the cost of delaying decisions to implement a new vaccine.

A visual approach to the economic evaluation of vaccines: opening the health economic black box

ABSTRACT Objectives The economic evaluation of vaccines has attracted a great deal of controversy. In the academic literature, several vaccination advocates argue that the evaluation frame for vaccines should be expanded to give a more complete picture of their benefits. We seek to contribute to the debate and facilitate informed dialogue about vaccine assessment using visualization, as able to support both deliberation by technical committees about the substance of evaluation and communication of the underlying rationale to non-experts. Methods We present two visualizations, an Individual Risk Plot (IRP), and a Population Impact Plot (PIP), both showing the beneficiary population on one axis and the degree of individual benefit and cost of an individual dose on the second axis. We sketch out such graphs for 10 vaccines belonging to the UK routine childhood immunization schedule and present our own analysis for the rotavirus and meningitis B vaccines. Results While the IRPs help classify diseases by morbidity and mortality, the PIPs display the health and economic loss averted after introducing a vaccine, allowing further comparisons. Conclusion The visualizations presented, albeit open to provide an increasingly complete accounting of the value of vaccination, ensure consistency of approach where comparative judgments are most needed.

Estimating the Fiscal Consequences of National Immunization Programs Using a "Government Perspective" Public Economic Framework.

Infectious diseases can impose considerable mortality and morbidity for children and adult populations resulting in both short- and long-term fiscal costs for government. Traditionally, healthcare costs are the dominant consideration in economic evaluations of vaccines, which likely ignores many costs that fall on governments in relation to vaccine-preventable conditions. In recent years, fiscal health modeling has been proposed as a complementary approach to cost-effectiveness analysis for considering the broader consequences for governments attributed to vaccines. Fiscal modeling evaluates public health investments attributed to treatments or preventive interventions in the case of vaccination, and how these investments influence government public accounts. This involves translating morbidity and mortality outcomes that can lead to disability, associated costs, early retirement due to poor health, and death, which can result in lost tax revenue for government attributed to reduced lifetime productivity. To assess fiscal consequences of public health programs, discounted cash flow analysis can be used to translate how changes in morbidity and mortality influence transfer payments and changes in lifetime taxes paid based on initial health program investments. The aim of this review is to describe the fiscal health modeling framework in the context of vaccines and demonstrate key features of this approach and the role that public economic assessment of vaccines can make in understanding the broader economic consequences of investing in vaccination programs. In this review, we describe the theoretical foundations for fiscal modeling, the aims of fiscal model, the analytical outputs, and discuss the relevance of this framework for evaluating the economics of vaccines.

The role of vaccines in combating antimicrobial resistance

Abstract Vaccination is one of the most effective measures to reduce antimicrobial resistance in both human and animal pathogens. This presentation reviews the multiple pathways by which vaccines may act to reduce resistance: they can prevent infections by focal pathogens, reducing the need to use antibiotics; they can selectively protect against resistant subtypes of a pathogen; they can reduce infections by other pathogen species which are routinely treated with antibiotics (not necessarily appropriately) thus reducing bystander selection; and they could selectively reduce transmission in settings such as hospitals which may have higher proportions of resistant strains. Because vaccines are highly specific to their targeted pathogens, they are much less likely to induce resistance compared to antibiotics. Hence, they can be delivered to large populations as a preventive measure to reduce transmission. The impact of vaccination on resistance has been demonstrated for vaccines against Streptococcus pneumoniae, Haemophilus influenzae type b and influenza. Current and pipeline vaccines against pathogens such as Vibrio cholerae, Escherichia coli, Salmonella typhi, RSV, diarrhoeal viruses and nosocomial bacteria may also have potential to reduce resistance. Economic evaluations of vaccines need to be expanded to capture their benefits in reducing resistance, in order to incentivize development and introduction of the right vaccines. Accurately doing so will require health systems, epidemiological and economic research.

<b>2．Policy Application of Health Technology Assessment</b>：<b>Economic Evaluation of Vaccination </b>

<b>2．Policy Application of Health Technology Assessment</b>：<b>Economic Evaluation of Vaccination </b>

Vaccine Efficacy, Effectiveness, Or Impact: Which One To Choose In Economic Evaluations Of Vaccines?

Vaccine Efficacy, Effectiveness, Or Impact: Which One To Choose In Economic Evaluations Of Vaccines?

Economic evaluation of vaccines in Canada: A systematic review

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.

Economic evaluations of vaccination in China flawed

Economic evaluations of vaccination in China flawed

PIN29 - Economic Evaluation of Vaccination Against Hav in High Risk Population

PIN29 - Economic Evaluation of Vaccination Against Hav in High Risk Population

Economic evaluation of vaccines: specificities and future challenges illustrated by recent European examples

This study reviews the current challenges in the economic evaluation of vaccines with a focus on European countries. In particular, the type of clinical evidence generally available, the impact of discounting for time preference and the use of modeling to derive valid cost–effectiveness assessments are considered. First, the characteristics of evidence for vaccines are discussed, as well as potential difficulties faced when using evidence-based medicine applied to curative drugs to interpret vaccine evidence. Then, discounting is considered and specific examples illustrating issues with different types of discounting are described, taking HPV as the example. Finally, the need for sometimes complex dynamic models for vaccines is explored, and specific types of models are reviewed, keeping into consideration the adage “complex when needed, straightforward if allowed.”

Methodological Concerns with Economic Evaluations of Meningococcal Vaccines

The evolution of meningococcal vaccines illustrates nicely the incremental technological process that is common to much medical innovation and particularly appropriate to economic analysis. However, the economic evaluation of vaccines is complicated by several features unique to vaccines, including the possibility of indirect (herd immunity) benefits and the shear breadth of vaccination strategies available to decision makers. As with the vaccines themselves, the modelling approaches applied to the economic evaluation of meningococcal vaccines have evolved to become increasingly complex. Despite such innovation, concerns remain about the quality of economic studies of meningococcal vaccines. This article reviews evaluations of meningococcal vaccine strategies in developed countries and provides recommendations for future work in this area. Four potentially problematic areas in the existing literature are identified - indirect costs, herd immunity, quality of life and comparison programmes - and approaches to these issues are discussed. Recommendations for reporting a 'minimum analysis profile' case are also made. Although comparisons across studies are difficult at best, recent work shows that incorporating the indirect benefits and costs of vaccination substantially improves cost effectiveness.

Economic evaluations of hepatitis B vaccination for developing countries

Economic evaluations, in particular cost–effectiveness, are important determinants for policy makers and stakeholders involved in decision-making for health interventions. Up until now, most evaluations of cost–effectiveness of hepatitis B vaccination have been performed in developed countries. Appropriate health–economic studies on this topic specifically targeted at the developing world are essential in order to justify adding another vaccine into the existing Expanded Program on Immunization in these countries. We present a systematic review of economic evaluations of vaccination against HBV for developing and less-developed countries. Vaccine price, the discount rate, incidence and prevalence of HBV infection were found to be major drivers of cost–effectiveness. Data accuracy and reliability were also major issues, with major potentials for improvement in studies of these countries. The choice between monovalent or combination vaccines (diphteria, tetanus and polio–hepatitis B) poses new challenges to cost–effectiveness analysis. It is concluded that for many developing countries implementation of universal immunization against HBV to reduce the level of endemicity of hepatitis B is an appropriate strategy, and probably cost effective in many settings. Given their limited financial resources, developing countries should properly plan how to achieve this. Further country-specific economic evaluations and related gathering of high-quality data must be conducted in developing countries in order to raise both public awareness of the effectiveness and economic attractiveness of universal immunization against HBV.

Economic evaluation of vaccination against influenza in the elderly: an experience from a population-based influenza vaccination program in Taiwan

Due to viral strains, influenza season, and consultations and admission rates varying from country to country, the continued economic evaluation of influenza vaccination for the elderly people aged 65 years and above is paramount, particularly in areas with dense population. Efficacy and cost-effective analysis of influenza vaccination in reducing all-cause mortality and hospitalization was therefore elucidated based on a prospective and population-based study targeted to 226,997 elderly people aged 65 years and above residing in Taipei county, Taiwan between 1 October 2000 and 31 March 2001. Vaccination against influenza for the elderly persons can lead to a 29% (95% CI: 23–35%) significant reduction of all-cause deaths. Approximately, 20% (95% CI: 9–30%) significant reduction in hospitalization was observed for average-risk group but 4% (95% CI: −4–11%) non-significant reduction for high-risk group. Community-based influenza vaccination program for elderly people aged 65 years and above was demonstrated to be effective in reducing mortality in all elderly people but not significantly in reducing hospitalization. Universal vaccination program for the elderly people seems cost-effective in averting death or gaining life years.

Discounting: technical issues in economic evaluations of vaccination

Discounting is a mathematical adjustment permitting a distinct valorization between future and present events. If, purely on economic principles, discounting costs appears logical and difficult to avoid, the discounting of health outcomes is less obvious. Most of analysts use the same constant rate to discount health gains, as for other goods and thus, as for costs. This is one of the prime determinants of the economic value and then attractiveness placed upon the vaccination. The purpose of this article is to explore the state of knowledge concerning discounting and to discuss the main three issues underlying discounting. Our findings suggest that empirical studies on the individuals' time preference specific to vaccination would be of great help to reach consensus.

An economic evaluation of vaccination against hepatitis A for frequent travellers

This paper compares the cost of using inactive Hepatitis A vaccine relative to immunoglobulin as a means of protecting frequent travellers against Hepatitis A. The number of trips to 'at risk' areas is modelled as a Poisson process and results are reported in terms of the discounted gross cost per protected trip over a 10-year period. We find that the expected cost of immunization is lower with immunoglobulin for travellers visiting 'at risk' areas less than five times in 10 years, and lower with Hepatitis A vaccine for those visiting 'at risk' areas more than five times in 10 years.

Economic evaluation of vaccination against influenza in New Zealand.

The objective of this study was to evaluate the costs and benefits of influenza vaccination for the population aged 65 years and over, from the perspectives of individuals and health insurers, government and society. The annual incremental direct medical costs and benefits of influenza vaccination (compared with the nonvaccination, or 'do nothing', option) were evaluated using New Zealand healthcare resource usage and unit cost data [in 1992 New Zealand dollars ($NZ); $NZ1 = $US0.5458, June 1992] applied to cohort studies reported in the literature. The costs and benefits to society as a result of vaccination of people aged 65 years and older (20% of people in this age group are currently vaccinated) were estimated to be: (i) additional direct medical costs of vaccination of $NZ1.42 million [$NZ17.78 per vaccination]; (ii) direct medical costs avoided of $NZ5.35 million ($NZ67.18 per vaccination); and (iii) net benefits of $NZ3.93 million ($NZ49.40 per vaccination). The direct medical costs avoided per dollar cost of vaccination were $NZ1.04 for individuals, $NZ4.69 for government and $NZ3.78 for society as a whole. If the vaccination uptake for this group is increased in 20% increments, the net benefit to society increases by a further $NZ3.93 million per year at each step. If the economic evaluation is extended to include vaccination of at-risk individuals under 65 years of age, net benefits to society increase by 15%. Influenza vaccination for people aged 65 years and over is cost effective from the perspective of society, government and the individual. If the vaccination rate for at-risk individuals in New Zealand could be increased to 60%, the net benefits reported in this study would increase by 200%. However, the costs of promotion and education to achieve this vaccination rate would need to be deducted from the net benefits. Strategies to increase the vaccination rate include altering the cost of vaccinations to the individual, intensifying education and promotion programmes, and changing the mode of delivery.

Is vaccination against hepatitis B efficient? A review of world literature.

We report on the result of a study aimed at assessing the variability of assumptions upon which economic models for the introduction of vaccination against Hepatitis B are based, the conclusions reached and define a minimum set of methodological standards upon which future economic studies on vaccines should be based. We identified 116 published and unpublished works by Medline literature searches, consulting private databases and corresponding with all authors and researchers active in economic evaluation of vaccines. All works were assessed but we included in our review only those which were original economic analyses (90 studies). Principal epidemiological and economic variables were extracted and compared where possible. Rough manipulations were carried out to make the data comparable. We found profound variability on the main parameters of the efficiency equation (disease incidence, costing methods, use of marginal theory, discounting and study time-span, sensitivity analysis and reporting methods). We also found inconsistencies in definition and study design in 38% of a subset of studies. Although we found scarce decision-making impact, we believe that due to uncertain or unclear methodology, few studies reach valid conclusions. In future decisions may be based on biased evidence and scarce resources committed to untested programmes. There is an urgent need to standardise study methods and define a common set of procedures.