Methodological Concerns with Economic Evaluations of Meningococcal Vaccines

Abstract

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.

Cost-effectiveness of vaccination against meningococcal B among Dutch infants

“…13 Although the indirect costs of death could be estimated, they were not used in the numerator for calculating ICERs to prevent possible double counting. 25 Additional indirect costs (and traveling and higher administration costs) for vaccinations outside the current national immunization schedule were also taken into account. A vaccine price of €40 per dose was assumed in the base-case, based on vaccines previously introduced in developed countries.…”

“…To assess the effect of herd protection on the cost-effectiveness, a transmission dynamic model should be used. 25 On the other hand, we assumed that one vaccine dose at the age of 12 y would be sufficient to induce protective immunity in children that previously received multiple vaccine doses in the routine infant immunization program. If two doses are needed to induce a robust immune response at this age, we may have overestimated the cost-effectiveness of this booster dose at 12 y of age.…”

Cost-Effectiveness Analysis of a Universal Infant Immunization Program with Meningococcal C Conjugate Vaccine in Brazil

“…The existence of a vaccine to prevent MD generates strong demands from the population and health-care workers for its introduction into the NIPs. These ethical concerns play a key role in decision making and are not part of a cost-effectiveness analysis [35]. Table 1.…”

“…Assuming that universal childhood vaccination is able to avoid epidemics, not including these costs, biases the results of the analyses against the vaccination program [35]. Only two economic evaluations of the MenCC vaccine reported in the literature, however, sought to introduce epidemic outbreaks in their analysis [32,37].…”

“…The inclusion of indirect costs significantly improves the chances of demonstrating the cost-effectiveness of the MenCC vaccine because indirect costs related to patient productivity losses may exceed direct medical costs by a factor of Ն2 when calculated by the human capital approach [35]. Because our decision analysis model followed one birth cohort for 10 years, the indirect costs included in the analysis were restricted to work time lost by mothers due to caregiving and calculated using average salary rates.…”