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. 2016 Mar;34(3):227-44.
doi: 10.1007/s40273-015-0335-2.

Methods for Health Economic Evaluation of Vaccines and Immunization Decision Frameworks: A Consensus Framework from a European Vaccine Economics Community

Bernhard Ultsch  1 , Oliver Damm  2 , Philippe Beutels  3 , Joke Bilcke  3 , Bernd Brüggenjürgen  4 , Andreas Gerber-Grote  5 , Wolfgang Greiner  2 , Germaine Hanquet  6 , Raymond Hutubessy  7 , Mark Jit  8   9 , Mirjam Knol  10 , Rüdiger von Kries  11 , Alexander Kuhlmann  12 , Daniel Levy-Bruhl  13 , Matthias Perleth  14 , Maarten Postma  15 , Heini Salo  16 , Uwe Siebert  17   18 , Jürgen Wasem  19 , Ole Wichmann  20
Affiliations

Methods for Health Economic Evaluation of Vaccines and Immunization Decision Frameworks: A Consensus Framework from a European Vaccine Economics Community

Bernhard Ultsch et al. Pharmacoeconomics. 2016 Mar.

Abstract

Background: Incremental cost-effectiveness and cost-utility analyses [health economic evaluations (HEEs)] of vaccines are routinely considered in decision making on immunization in various industrialized countries. While guidelines advocating more standardization of such HEEs (mainly for curative drugs) exist, several immunization-specific aspects (e.g. indirect effects or discounting approach) are still a subject of debate within the scientific community.

Objective: The objective of this study was to develop a consensus framework for HEEs of vaccines to support the development of national guidelines in Europe.

Methods: A systematic literature review was conducted to identify prevailing issues related to HEEs of vaccines. Furthermore, European experts in the field of health economics and immunization decision making were nominated and asked to select relevant aspects for discussion. Based on this, a workshop was held with these experts. Aspects on 'mathematical modelling', 'health economics' and 'decision making' were debated in group-work sessions (GWS) to formulate recommendations and/or--if applicable--to state 'pros' and 'contras'.

Results: A total of 13 different aspects were identified for modelling and HEE: model selection, time horizon of models, natural disease history, measures of vaccine-induced protection, duration of vaccine-induced protection, indirect effects apart from herd protection, target population, model calibration and validation, handling uncertainty, discounting, health-related quality of life, cost components, and perspectives. For decision making, there were four aspects regarding the purpose and the integration of HEEs of vaccines in decision making as well as the variation of parameters within uncertainty analyses and the reporting of results from HEEs. For each aspect, background information and an expert consensus were formulated.

Conclusions: There was consensus that when HEEs are used to prioritize healthcare funding, this should be done in a consistent way across all interventions, including vaccines. However, proper evaluation of vaccines implies using tools that are not commonly used for therapeutic drugs. Due to the complexity of and uncertainties around vaccination, transparency in the documentation of HEEs and during subsequent decision making is essential.

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Figures

Fig. 1
Fig. 1
Map of Europe indicating whether results from economic evaluations of vaccines are routinely considered in recommendations, based on [, –14] (asterisk no response from country, country not considered, Malta and Cypress not shown)
Fig. 2
Fig. 2
Flow chart of the systematic literature review
Fig. 3
Fig. 3
Flow chart for model choice adopted from the World Health Organization [4]
Fig. 4
Fig. 4
Decision making continuum, adapted from expert-group discussion. HEE health economic evaluation, MCDA multi-criteria decision analysis
See this image and copyright information in PMC

References

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