Economic Evaluation of Vaccines: Belgian Reflections on the Need for a Broader Perspective

Abstract

The standard framework of economic evaluation of health programs, which is increasingly used for policy funding decisions, is insufficiently equipped to reflect the full range of health and economic benefits conferred by vaccines and thus undervalues vaccination.Methods: In 2019, a group of Belgian health economic and clinical experts, supported by 2 senior international vaccination experts (1 American, 1 Belgian), convened 4 roundtable meetings to highlight which particular value elements of vaccination remain neglected in economic evaluations.Results: They concluded that the standard economic evaluation framework fails to reflect the full value of vaccination with respect to prevention of complications linked to some vaccine-preventable diseases, health gains for caregivers, herd effects, changes in exposure to and distribution of serotypes, the effect on antimicrobial resistance, productivity gains for caregivers and patients, and the distributive implications of vaccination programs.Conclusions: Here, suggestions are made regarding how these shortcomings can be addressed in future economic evaluations of vaccines and how a more level playing field between vaccines and other health programs can be created.

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

“…The need for a broader perspective when evaluating vaccines has been recognised in a European consensus guideline [14] , an ISPOR Special Task Force Panel Report [5] , and WHO guidelines [15] . The support for a broader perspective has also been argued for in several publications during recent years [4] , [6] , [16] , [17] . This is also in line with a general trend in support for a wider perspective in health economic evaluations.…”

Critical Reflections on Reimbursement and Access of Advanced Therapies

“…Although accounting for the characteristics of advanced therapies runs the risk that these products are treated in a different way from a health economic perspective than other medicines, there have been numerous calls from various stakeholders in multiple countries to apply specific considerations to the reimbursement and market access of advanced therapies ( van Overbeeke et al, 2021 ). This is similar to the way that other types of innovative medicines such as (ultra-)orphan drugs ( Nestler-Parr et al, 2018 ), antibiotics ( Simoens and Spriet, 2020 ), or vaccines ( Annemans et al, 2021 ) may receive special attention in value assessment and reimbursement.…”

Towards a Broader Assessment of Value in Vaccines: The BRAVE Way Forward

“…Experts noted that this includes impacts related to vaccine-preventable diseases, and the complications and long-term sequalae that may arise from them. It may also include non-specific benefits relating to heterologous immune stimulation [ 20 ]…”