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. 2018 Dec 18;115(51):12911-12919.
doi: 10.1073/pnas.1717161115.

Toward economic evaluation of the value of vaccines and other health technologies in addressing AMR

J P Sevilla  1   2 , David E Bloom  3 , Daniel Cadarette  3 , Mark Jit  4   5 , Marc Lipsitch  6   7   8
Affiliations

Toward economic evaluation of the value of vaccines and other health technologies in addressing AMR

J P Sevilla et al. Proc Natl Acad Sci U S A. .

Abstract

We discuss the need to make economic evaluations of vaccines antimicrobial resistance (AMR)-sensitive and ways to do so. Such AMR-sensitive evaluations can play a role in value-for-money comparisons of different vaccines within a national immunization program, or in comparisons of vaccine-centric and non-vaccine-centric technologies within an anti-AMR program. In general terms, incremental cost-effectiveness ratios and rates of return and their associated decision rules are unaltered by consideration of AMR-related value. The decision metrics need to have their various health, cost, and socioeconomic terms disaggregated into resistance-related subcategories, which in turn have to be measured carefully before they are reaggregated. The fundamental scientific challenges lie primarily in quantifying the causal impact of health technologies on resistance-related health outcomes, and secondarily in ascertaining the economic value of those outcomes. We emphasize the importance of evaluating vaccines in the context of other potentially complementary and substitutable nonvaccine technologies. Complementarity implies that optimal spending on each set of interventions is positive, and substitutability implies that the ratio of spending will depend on relative value for money. We exemplify this general point through a qualitative discussion of the complementarities and (especially the) substitutability between pneumococcal conjugate vaccines and antimicrobial stewardship and between research and development (R&D) of a gonorrhea vaccine versus R&D of a gonorrhea antibiotic. We propose a roadmap for future work, which includes quantifying the causal effects of vaccination and other health technologies on short-term and long-term resistance-related outcomes, measuring the health-sector costs and broader socioeconomic consequences of resistance-related mortality and morbidity, and evaluating vaccines in the context of nonvaccine complements and substitutes.

Keywords: antimicrobial resistance; economic evaluation; health technology assessment; immunization; vaccines.

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Conflict of interest statement

Conflict of interest statement: J.P.S. has received personal payments for consulting, speaking, and advisory services to GSK, Pfizer, Merck, the World Health Organization, and the Bill and Melinda Gates Foundation. He is employed at Data for Decisions, a consultancy, where he has performed research for clients including GSK, Merck, and Pfizer. He receives research funding from Sanofi Pasteur MSD through the Harvard T.H. Chan School of Public Health. He did not receive specific funding to work on this paper. D.E.B. has received personal payments from GSK, Merck, Pfizer, and Sanofi-Pasteur for consulting, speaking, research, or advisory services related to the value of vaccination and has also received research funding from the WHO and the Bill and Melinda Gates Foundation. He did not receive any funding to work on this article. M.L. has received consulting income/honoraria from Merck, Pfizer, Affinivax, and Antigen Discovery. He receives research support through Harvard T.H. Chan School of Public Health from Pfizer and PATH.

References

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