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

Abstract

This paper describes how the economic assessment of vaccines is performed today. It discusses why it may be incomplete and explores potential approaches to adjust the analysis to be more comprehensive. Besides helping protect against serious disease, vaccines also help avoid mild disease episodes that may not receive medical attention but which have important societal consequences. They also benefit unvaccinated individuals by reducing disease transmission. Wider societal benefits may extend beyond a decrease in disease incidence, as lower transmission rates reduce the risk of epidemics, which in turn reduces the pressure on healthcare providers, and may improve the quality of care for patients with unrelated diseases. Vaccines also lower the use of antibiotics leading to less pressure on anti-microbial resistance. Conventional ICUA focuses on individual health benefits, like increased survival. Therefore, this approach may not adequately capture the wider vaccination benefits. We discuss differences between treatment and vaccine prevention in the economic assessment, and how ICUA has been adapted to cope with the inconsistencies. Although such adaptations may fulfil the demand of one specific stakeholder, they may not meet the needs of other stakeholders who operate at the societal level, such as ministries other than healthcare, employers, caregivers, and insurers.

Keywords: Budget; cost effectiveness analysis; economic evaluation; societal perspective; vaccines; value assessment.

Figure 1.

Comparison of treatment versus prevention: hypothetical example (a) Assessing the individual quality of life (QoL) gain or loss with prevention and treatment; (b) Impact difference between treatment and prevention at a population level (cohort of 100,000 subjects). QoL, quality of life

Figure 2.

Schematic view of the different levels of vaccine benefit.

Figure 3.

Incremental cost-utility ratio (ICUR) per QALY gained versus intervention cost (CostI) comparing treatment (blue line) versus vaccine (green line). ICUR, incremental cost-utility ratio; CostI, intervention cost; QALY, quality-adjusted life-years. (A) Cost-offset when two treatments are compared; (B) The difference in cost between the cost-neutral point (Cn1) and the cost where the line reaches the threshold (Cm1) for a treatment compared with another treatment; (C) Cost-offset when a vaccine is compared with a treatment; (D) The difference in cost between Cn2 and the cost where the line reaches the threshold (Cm2) for a vaccine compared with a treatment; T, threshold value.