Health Technology Assessment for Vaccines Against Rare, Severe Infections: Properly Accounting for Serogroup B Meningococcal Vaccination's Full Social and Economic Benefits

Abstract

The high price of new generations of vaccines relative to their predecessors has become an important consideration in debates over whether the benefits of the new vaccines justify their costs. An increasingly central line of inquiry in the literature on valuing vaccination surrounds accounting for the full social and economic benefits of vaccination. This paper applies this emerging perspective to the particular case of vaccination against serogroup B meningococcal disease (MenB). We explore key issues involved in health technology assessments of MenB vaccination, which have led to pronounced heterogeneity in evaluation methods and recommendation outcomes across countries such as France, Germany, the US, and the UK. Accounting for typically neglected sources of socioeconomic benefit could potentially impact recommendation and reimbursement decisions. We propose a taxonomy of such benefits built around four dimensions: (i) internalized health benefits, (ii) internalized non-health benefits, (iii) externalized health benefits, and (iv) externalized non-health benefits. This approach offers a systematic, comprehensive evaluation framework that can be used in future assessment of MenB vaccines as well as other health technologies.

Cost-effectiveness of meningococcal vaccination of Norwegian teenagers with a quadrivalent ACWY conjugate vaccine

“…Prevention of severe diseases and especially those affecting young people have a high priority both to the public and other stakeholders. 7 Observations of a high vaccine uptake among the 18-year-olds with out-of-pocket payment in Norway 19 indicate that the acceptability of MCV4 vaccination is high. Introducing MCV4 in the NIP would promote equity in access to health and probably increase the vaccine uptake among Norwegian teenagers, as already observed in regions sponsoring MCV4.…”

“…Experiences from some countries indicate that including a wide range of societal costs in the analysis may be pivotal for the outcome. 6 , 7 By using a healthcare perspective, our model did not capture the costs and burdens of IMD fully, which might have underestimated the benefits of vaccination. However, adhering to the Norwegian government’s recommendation of using a healthcare perspective makes our calculations more applicable for the Norwegian settings.…”

“…6 Fortunately, health technology assessments for publicly financed meningococcal vaccination lean on more than economic evaluations. Other factors include societal preference and acceptability, equity in health 6,7 , and feasibility of the intervention. Unexpected affliction of previously young and healthy individuals induces anxiety in the population and high media uptake.…”

“…Influence of long-term sequelae on the patient, as well as indirect effects on family members and society, are difficult to capture fully. 6 , 7 In addition, the emergence of hypervirulent clones 8 , 9 and unforeseen outbreaks with cases spread over time 10 , 11 also predicts disease burden challenging at a public health level.…”

Monetary Valuation of Children’s Cognitive Outcomes in Economic Evaluations from a Societal Perspective: A Review

“…Childhood immunizations can potentially lead to improvements in adult productivity, which could make certain vaccines more economically attractive [ 27 , 28 , 29 ]. Studies conducted in low- and middle-income countries have reported that the implementation of childhood immunizations was associated with significantly higher educational attainments and children’s cognitive scores [ 30 , 31 , 32 ].…”