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. 2024 Jul 15;12(7):773.
doi: 10.3390/vaccines12070773.

Capturing the Value of Vaccination within Health Technology Assessment and Health Economics-Practical Considerations for Expanding Valuation by Including Key Concepts

Eliana Biundo  1 , Mariia Dronova  2 , Annie Chicoye  3 , Richard Cookson  4 , Nancy Devlin  5 , T Mark Doherty  1 , Stephanie Garcia  1 , Antonio J Garcia-Ruiz  6 , Louis P Garrison  7 , Terry Nolan  5 , Maarten Postma  8   9   10 , David Salisbury  11 , Hiral Shah  1 , Shazia Sheikh  1 , Richard Smith  12 , Mondher Toumi  13 , Jurgen Wasem  14 , Ekkehard Beck  1
Affiliations

Capturing the Value of Vaccination within Health Technology Assessment and Health Economics-Practical Considerations for Expanding Valuation by Including Key Concepts

Eliana Biundo et al. Vaccines (Basel). .

Abstract

Following the development of a value of vaccination (VoV) framework for health technology assessment/cost-effectiveness analysis (HTA/CEA), and identification of three vaccination benefits for near-term inclusion in HTA/CEA, this final paper provides decision makers with methods and examples to consider benefits of health systems strengthening (HSS), equity, and macroeconomic gains. Expert working groups, targeted literature reviews, and case studies were used. Opportunity cost methods were applied for HSS benefits of rotavirus vaccination. Vaccination, with HSS benefits included, reduced the incremental cost-effectiveness ratio (ICER) by 1.4-50.5% (to GBP 11,552-GBP 23,016) depending on alternative conditions considered. Distributional CEA was applied for health equity benefits of meningococcal vaccination. Nearly 80% of prevented cases were among the three most deprived groups. Vaccination, with equity benefits included, reduced the ICER by 22-56% (to GBP 7014-GBP 12,460), depending on equity parameters. Macroeconomic models may inform HTA deliberative processes (e.g., disease impact on the labour force and the wider economy), or macroeconomic outcomes may be assessed for individuals in CEAs (e.g., impact on non-health consumption, leisure time, and income). These case studies show how to assess broader vaccination benefits in current HTA/CEA, providing decision makers with more accurate and complete VoV assessments. More work is needed to refine inputs and methods, especially for macroeconomic gains.

Keywords: economic evaluation; efficiency; health equity; health systems strengthening; macroeconomic; vaccination.

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Conflict of interest statement

Eliana Biundo, Mark Doherty, Hiral Shah, and Stéphanie Garcia are employed by GSK. Eliana Biundo, Ekkehard Beck, Hiral Shah, Mark Doherty, Stéphanie Garcia and Shazia Sheikh hold financial equities in GSK. Ekkehard Beck and Shazia Sheikh were employed by GSK and hold financial equities in it. Ekkehard Beck is employed by Moderna. Mariia Dronova is an employee of Putnam PHMR (previously Creativ-Ceutical), which received funding from GSK. Annie Chicoye received funding from GSK during the conduct of this study. She was also a member of the Advisory Board for this study, established by GSK, and was paid an honorarium for her input. Nancy Devlin, Jürgen Wasem, Lou Garrisson, Richard Cookson, Mondher Toumi, and Maarten Postma were all members of the Advisory Board for this study, established by GSK, and were paid an honorarium for their input. Richard Cookson has also received consultancy fees for related work advising Genentech on general equity methods. Antonio J. Garcia-Ruiz received funding from GSK during the conduct of this study. He also received grants and/or consulting fees and/or honoraria from Sanofi Pasteur, UCB, CHIESI, the Official College of Physicians, the Sociedade Galega de Neuroloxía, the Foundation for Progress and Health (Andalusian Regional Government), the Department of Health, the Regional Government of Extremadura, the Ministry of Science and Innovation of Spain, the Spanish Confederation of Housewives, the Consumers and Users Organisations (CEACCU), the Royal Academy of Medicine and Surgery of Eastern Andalusia, the University of Granada, Alicante, Seville, Seville, Basque Country and Pompeu Fabra, and the regional government outside of this work. Terry Nolan was a member and co-chair of the Advisory Board for this study, established by GSK, and was paid an honorarium for his input. He received consulting fees and/or honoraria from AstraZeneca, Merck, Seqirus, Sanofi Pasteur and GSK, as well as personal payment for participation in other advisory boards, not related to this study, from Clover, Zeria and the Serum Institute of India. He is an expert in the Victorian State Government advisory group on COVID-19 vaccine roll-out, outside of this submitted work. His institution received grants from GSK, Sanofi Pasteur, Janssen, Seqirus, and the Serum Institute of India outside of this work. Maarten Postma received grants and/or consulting fees and/or honoraria from the Foundation for Progress and Health (Andalusian Regional Government), the Department of Health, the Regional Government of Extremadura, the Ministry of Science and Innovation of Spain, the Spanish Confederation of Housewives, the Consumers and Users Organisations (CEACCU), the Royal Academy of Medicine and Surgery of Eastern Andalusia, the University of Granada, Alicante, Seville, Seville, Basque Country and Pompeu Fabra, and the regional government outside of this work. David Salisbury was a member and co-chair of the Advisory Board for this study, established by GSK, and was paid an honorarium for his input. He has received consulting fees and/or honoraria, unrelated to this study, from AstraZeneca, Clover, GSK, Janssen, Pfizer, Sanofi Pasteur, and Seqirus. Nancy Devlin, Hiral Shah, Shazia Sheikh, Jürgen Wasem, Richard Smith, Mondher Toumi, Jurgen Wasem, and Maarten Postma were all members of the Advisory Board for this study, established by GSK, and were paid an honorarium for their input. All authors declare no other financial or non-financial relationships or activities.

Figures

Figure 1
Figure 1
Assessing vaccination impact in health systems with constrained versus normal utilisation. DRG: diagnosis related group; Flu: influenza; HCP: healthcare professional; RSV: respiratory syncytial virus; VPD: vaccine-preventable disease.
Figure 2
Figure 2
Staircase of health inequality impact [Based on a figure developed by Cookson and Love-Koh, Centre for Health Economics, University of York]. * Health loss due to intervention costs: scarce resources would otherwise be used to improve health in other ways.
Figure 3
Figure 3
Equity-efficiency impact plane. NE: north-east; NW: north-west; SE: south-east; SW: south-west (based on [37]).
Figure 4
Figure 4
(a) MenB cases prevented across equity strata and (b) the impact of including equity benefits on cost-effectiveness. ICER: incremental cost-effectiveness ratio; IMDQ: index of multiple deprivation quintile; MenB: MenB-related cases of invasive meningococcal disease; QAF: quality-of-life adjustment factor; QALY: quality-adjusted life-year.
Figure 5
Figure 5
Illustrative diagram of the different elements that could be included in a CGE model and links with microeconomic CEA models. CEA: cost-effectiveness analysis; CGE: computable general equilibrium.
See this image and copyright information in PMC

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