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Review
. 2017 Aug 31;5(1):1336044.
doi: 10.1080/20016689.2017.1336044. eCollection 2017.

3. How comprehensive can we be in the economic assessment of vaccines?

Baudouin Standaert  1 , Rino Rappuoli  2
Affiliations
Review

3. How comprehensive can we be in the economic assessment of vaccines?

Baudouin Standaert et al. J Mark Access Health Policy. .

Abstract

In two previous papers we argued on current vaccines economic assessment not fully comprehensive when using the incremental cost-utility analysis normally applied for treatments. Many differences exist between vaccines and drug treatments making vaccines economic evaluation more cumbersome. Four challenges overwhelmingly present in vaccines assessment are less important for treatments: requirements for population, societal perspectives, budget impact evaluation, and time focused objectives (control or elimination). Based on this, economic analysis of vaccines may need to be presented to many different stakeholders with various evaluation preferences, in addition to the current stakeholders involved for drugs treatment assessment. Then, we may need a tool making the inventory of the different vaccines health economic assessment programmes more comprehensive. The cauliflower value toolbox has been developed with that aim, and its use is illustrated here with rotavirus vaccine. Given the broader perspectives for vaccine assessment, it provides better value and cost evaluations. Cost-benefit analysis may be the preferred economic assessment method when considering substitution from treatment to active medical prevention. Other economic evaluation methods can be selected (i.e. optimisation modelling, return on investment) when project prioritisation is the main focus considered and when stakeholders would like to influence the development of the healthcare programme.

Keywords: Budget; economic evaluation; incremental cost-effectiveness ratio; societal perspective; vaccines; value assessment.

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Figures

Figure 1.
Figure 1.
Identifying examples of instrumental and inherent (italic) vaccine values by different stakeholder types (payer, population, and prescriber). QoL, quality of life
Figure 2.
Figure 2.
The relationship between health gain and health care expenditures.
Figure 3.
Figure 3.
Shifting the use of vaccines from control to reduction with a shift in budget line.
Figure 4.
Figure 4.
Answering the three critical questions when assessing the full health economic value of a vaccine. QoL, quality of life; QALY, quality-adjusted life-year; DALY, disability-adjusted life-year; ICUA, incremental cost-utility analysis; QoC, quality of care; CBA, cost benefit analysis
Figure 5.
Figure 5.
The health economic Cauliflower Value Toolbox. EPI, epidemiology
Figure 6.
Figure 6.
Aspects of value for a new vaccine to be assessed and combined into an economic evaluation. GDP, Gross domestic product; QoC, quality of care; QoL, quality of life
Figure 7.
Figure 7.
Cost range shift for the vaccine with traditional cost-effectiveness analysis compared with the more extended societal evaluation with the Cauliflower Value Toolbox. ICER, incremental cost-effectiveness ratio; T, threshold; CostI, cost of a new intervention; CEA, cost-effectiveness analysis
See this image and copyright information in PMC

References

    1. Standaert B, Rappuoli R.. The building blocks for a health economic assessment. J Market Access Health Policy. 2017;5:1335162. - PMC - PubMed
    1. Standaert B, Rappuoli R.. How is the economic assessment of vaccines performed today? J Market Access Health Policy. 2017;5:1335163. - PMC - PubMed
    1. Ricciardi W, Toumi M. National immunization therapeutic advisory group: it is time for experience sharing and best practice learning. J Mark Access Health Policy. 2015;3:29276. - PMC - PubMed
    1. Standaert B. Are changes occurring in the perceived value of vaccines? Belgian J Paediatr. 2016;18(4):1–16.
    1. Philip R, Shapiro M, Paterson P, et al. Is it time for vaccination to “Go Viral”? Pediatr Infect Dis J. 2016;35(12):1343–1349. - PubMed

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