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. 2021 Aug;24(8):1150-1157.
doi: 10.1016/j.jval.2021.04.1273. Epub 2021 Jun 18.

The CAPACITI Decision-Support Tool for National Immunization Programs

Siobhan Botwright  1 , Birgitte K Giersing  1 , Martin I Meltzer  2 , Anna-Lea Kahn  1 , Mark Jit  3 , Rob Baltussen  4 , Nathalie El Omeiri  5 , Joseph N-M Biey  6 , Kelly L Moore  7 , Praveen Thokala  8 , Jason M Mwenda  9 , Melanie Bertram  1 , Raymond C W Hutubessy  10
Affiliations

The CAPACITI Decision-Support Tool for National Immunization Programs

Siobhan Botwright et al. Value Health. 2021 Aug.

Abstract

Objectives: Immunization programs in low-income and middle-income countries (LMICs) are faced with an ever-growing number of vaccines of public health importance recommended by the World Health Organization, while also financing a greater proportion of the program through domestic resources. More than ever, national immunization programs must be equipped to contextualize global guidance and make choices that are best suited to their setting. The CAPACITI decision-support tool has been developed in collaboration with national immunization program decision makers in LMICs to structure and document an evidence-based, context-specific process for prioritizing or selecting among multiple vaccination products, services, or strategies.

Methods: The CAPACITI decision-support tool is based on multi-criteria decision analysis, as a structured way to incorporate multiple sources of evidence and stakeholder perspectives. The tool has been developed iteratively in consultation with 12 countries across Africa, Asia, and the Americas.

Results: The tool is flexible to existing country processes and can follow any type of multi-criteria decision analysis or a hybrid approach. It is structured into 5 sections: decision question, criteria for decision making, evidence assessment, appraisal, and recommendation. The Excel-based tool guides the user through the steps and document discussions in a transparent manner, with an emphasis on stakeholder engagement and country ownership.

Conclusions: Pilot countries valued the CAPACITI decision-support tool as a means to consider multiple criteria and stakeholder perspectives and to evaluate trade-offs and the impact of data quality. With use, it is expected that LMICs will tailor steps to their context and streamline the tool for decision making.

Keywords: HTA; LMIC; MCDA; decision-support; immunization; priority setting; vaccine.

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Conflict of interest statement

Dr Giersing reported receiving grants to support the development of the CAPACITI decision support tool from World Health Organization during the conduct of the study. Dr Moore reported receiving personal fees from Pfizer and Sanofi Pasteur for service on external advisory boards regarding US-based vaccines, and personal fees for service on an external advisory board regarding US-based influenza vaccine from Seqirus outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.
A summary of the key differences among quantitative, qualitative, and rule-based MCDAs. The CAPACITI decision-support framework (right side) allows the user to follow any of these 3 approaches or to follow a hybrid-based approach. Specific details are in the text. MCDA indicates multi-criteria decision analysis.
Figure 2.
Figure 2.
(A) For quantitative MCDA, the tool produces a visual aid to guide committee discussion around factors driving the total scores. This figure is an illustrative example from a pilot country workshop to compare 3 HPV vaccine products. Workshop participants defined the criteria. Filled circles indicates weight (full circle is higher weight); gray horizontal bars, weighted score; green to red scale, higher scores are green and lower scores are red; navy vertical bars, total score. (B) For quantitative MCDA, there is also an interactive sheet in which the committee can view the effect of changing scores and weights on the final result, to support discussions around confidence to proceed with a recommendation and the impact of data uncertainty or disagreement on weights. This figure is an illustrative example from a pilot country workshop to compare 3 HPV vaccine products, in which the score for the “experience” criterion has been modified to examine the impact of missing data. Navy bars indicate original total score; yellow bars, new total score in the uncertainty analysis; pink text, scores that have been modified in the uncertainty analysis. CTC indicates controlled temperature chain; HPV, human papillomavirus; MCDA, multi-criteria decision analysis.
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