2. How is the economic assessment of vaccines performed today?

Journal of Market Access & Health Policy

Rappuoli²

2017

Self Cite

In two previous papers we argued on current vaccines economic assessment not fully comprehensive when using the incremental cost-utility analysis normally applied for treatments. Many differences exist between vaccines and drug treatments making vaccines economic evaluation more cumbersome. Four challenges overwhelmingly present in vaccines assessment are less important for treatments: requirements for population, societal perspectives, budget impact evaluation, and time focused objectives (control or elimination). Based on this, economic analysis of vaccines may need to be presented to many different stakeholders with various evaluation preferences, in addition to the current stakeholders involved for drugs treatment assessment. Then, we may need a tool making the inventory of the different vaccines health economic assessment programmes more comprehensive. The cauliflower value toolbox has been developed with that aim, and its use is illustrated here with rotavirus vaccine. Given the broader perspectives for vaccine assessment, it provides better value and cost evaluations. Cost-benefit analysis may be the preferred economic assessment method when considering substitution from treatment to active medical prevention. Other economic evaluation methods can be selected (i.e. optimisation modelling, return on investment) when project prioritisation is the main focus considered and when stakeholders would like to influence the development of the healthcare programme.

Section: Discussionmentioning

confidence: 89%

Section: Ways Of Moving Forwardmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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3. How comprehensive can we be in the economic assessment of vaccines?

Journal of Market Access & Health Policy

Rappuoli²

2017

Self Cite

“…The number of members under insurance coverage defines the budget made available for investments, and how much they likely want to invest in prevention versus treatment or how much control they want to over infections. In these situations, a CO model can be developed within a specific disease area (influenza, pneumococcal disease, malaria, HPV [36]) or per disease domain (infectious diseases [37], diabetes [38], cancer [39]), when different intervention options exist, precise budgets are known, and the constraints are well specified.…”

Section: Discussionmentioning

confidence: 99%

Constrained Optimization for the Selection of Influenza Vaccines to Maximize the Population Benefit: A Demonstration Project

Appl Health Econ Health Policy

Vlaenderen

Bellinghen

et al. 2019

Self Cite

Background Influenza is an infectious disease causing a high annual economic and public health burden. The most efficient management of the disease is through prevention with vaccination. Many influenza vaccines are available, with varying efficacy and cost, targeting different age groups. Therefore, strategic decision-making about which vaccine to deliver to whom is warranted to improve efficiency. Objective We present the use of a constrained optimization (CO) model to evaluate targeted strategies for providing influenza vaccines in three adult age groups in the USA. Methods CO was considered for identifying an influenza vaccine provision strategy that maximizes the benefits at constrained annual budgets, by prioritizing vaccines based on return on investment. The approach optimizes a set of predefined outcome measures over several years resulting from an increasing investment using the best combination of influenza vaccines. Results Results indicate the importance of understanding the relative differences in benefits for each vaccine type within and across age groups. Scenario and threshold analyses demonstrate the impact of changing budget distribution over time, price setting per vaccine type, and selection of outcome measure to optimize. Conclusion Significant gains in cost efficiency can be realized for a decision maker using a CO model, especially for a disease like influenza with many vaccine options. Testing the model under different scenarios offers powerful insights into maximum achievable benefit overall and per age group within the predefined constraints of a vaccine budget. Electronic supplementary material The online version of this article (10.1007/s40258-019-00534-y) contains supplementary material, which is available to authorized users.

“…It then reviews the stakeholder list with the focus on the specific benefits sought by each [7,[14][15][16][17]. This is followed by a range of analysis methods for measuring those gains, where we briefly describe how we came to our current findings [18]. In the discussion section, we give examples of the use of a combination of different methods to inform different decision-makers about the full economic value of vaccines.…”

Section: Introductionmentioning

confidence: 99%

How to assess for the full economic value of vaccines? From past to present, drawing lessons for the future

Journal of Market Access & Health Policy

Sauboin

DeAntonio³

et al. 2020

Self Cite

Background:Cost-effectiveness analysis (CEA) is the economic analysis method most commonly applied today in the context of replacing one treatment with a new one in a developed healthcare system to improve efficiency. CEA is often requested by local healthcare decisionmakers to grant reimbursement.New preventative interventions, such as new vaccines, may however have much wider benefits inside and outside healthcare, when compared with treatment. These additional benefits include externalities on indirect clinical impact, reallocation of specific healthcare resources, improved quality of care, better productivity, better disease control, better fiscal revenues, and others. But these effects are sometimes difficult to integrate into a meaningful CEA result. They may appear as specific benefits for specific stakeholders, other than the stakeholders in healthcare.Objective: Based on a historical view about the application of economic assessments for vaccines our objective has been to make the inventory of who was/is interested in knowing the economic value of vaccines, in what those different stakeholders are likely to see the benefit from their perspective and how were/are we able to measure those benefits and to report them well. Results: The historical view disclosed a limited interest in the economic assessment of vaccines at start, more than 50 years ago, that was comparable to the assessment of looking for more efficiency in new industries through optimization exercises. Today, we are exposed to a very rich panoply of different stakeholders (n= 16). They have their specific interest in many different facets of the vaccine benefit of which some are well known in the conventional economic analysis (n=9), but most outcomes are hidden and not enough evaluated and reported (n=26). Meanwhile we discovered that many different methods of evaluation have been explored to facilitate the measurement and reporting of the benefits (n=18). Conclusion: Our recommendation for future economic evaluations of new vaccines is therefore to find the right combination among the three entities of stakeholder type selection, outcome measure of interest for each stakeholder, and the right method to apply. We present at the end examples that illustrate how successful this approach can be.