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Cost-Effectiveness Analyses of Vaccination Programmes

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  • Sun-Young Kim
  • Sue Goldie

Abstract

Cost effectiveness is becoming an increasingly important factor for stakeholders faced with decisions about adding a new vaccine into national immunization programmes versus alternative use of resources. Evaluating cost effectiveness, taking into account the relevant biological, clinical, epidemiological and economic factors of a vaccination programme, generally requires use of a model. This review examines the modelling approaches used in cost-effectiveness analyses (CEAs) of vaccination programmes. After overviewing the key attributes of models used in CEAs, a framework for categorising theoretical models is presented. Categories are based on three main attributes: static/dynamic; stochastic/deterministic; and aggregate/individual based. This framework was applied to a systematic review of CEAs of all currently available vaccines for the period of 1976 to May 2007. The systematic review identified 276 CEAs of vaccination programmes. The great majority (83%) of CEAs were conducted in the setting of high-income countries. Only a few vaccines were widely studied, with 57% of available CEAs being focused on the varicella, influenza, hepatitis A, hepatitis B or pneumococcal vaccine. Several time trends were evident, indicating that the number of vaccine CEAs being published is increasing; the main health outcome measures are moving away from the number of cases prevented towards quality-adjusted and unadjusted life-years gained, and more complex models are beginning to be used. The modelling approach was often not adequately described. Of the 208 CEAs that could be categorized according to the framework, around 90% were deterministic, aggregate-level static models. Although a dynamic transmission model is required to account for herd-immunity effects, only 23 of the CEAs were dynamic. None of the CEAs were individual based. To improve communication about the cost effectiveness of vaccination programmes, we believe the first step is for analysts to be more transparent with each other. A clear description of the model type using consistent terminology and justification for the model choice must begin to accompany all CEAs. As a minimum, we urge modellers to provide an explicit statement about the following attributes: static/dynamic; stochastic/deterministic; aggregate/individual based; open/closed. Where relevant, time intervals (discrete/continuous) and (non)linearity should also be described. Enhanced methods of assessing model performance and validity are also required. Our results emphasize the need to improve modelling methods for CEAs of vaccination programmes; specifically, model choice, construction, assessment and validation. Copyright Adis Data Information BV 2008

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  • Sun-Young Kim & Sue Goldie, 2008. "Cost-Effectiveness Analyses of Vaccination Programmes," PharmacoEconomics, Springer, vol. 26(3), pages 191-215, March.
    • Handle: RePEc:spr:pharme:v:26:y:2008:i:3:p:191-215
    DOI: 10.2165/00019053-200826030-00004
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    2. van Ackere, Ann & Schulz, Peter J., 2020. "Explaining vaccination decisions: A system dynamics model of the interaction between epidemiological and behavioural factors," Socio-Economic Planning Sciences, Elsevier, vol. 71(C).
    3. Olivier Ethgen & Baudouin Standaert, 2012. "Population–versus Cohort–Based Modelling Approaches," PharmacoEconomics, Springer, vol. 30(3), pages 171-181, March.
    4. Greg Plosker, 2011. "Rotavirus Vaccine RIX4414 (Rotarix™)," PharmacoEconomics, Springer, vol. 29(11), pages 989-1009, November.
    5. Kjell Arne Johansson & Solomon Tessema Memirie & Clint Pecenka & Dean T Jamison & Stéphane Verguet, 2015. "Health Gains and Financial Protection from Pneumococcal Vaccination and Pneumonia Treatment in Ethiopia: Results from an Extended Cost-Effectiveness Analysis," PLOS ONE, Public Library of Science, vol. 10(12), pages 1-16, December.
    6. Andrija S Grustam & Nasuh Buyukkaramikli & Ron Koymans & Hubertus J M Vrijhoef & Johan L Severens, 2019. "Value of information analysis in telehealth for chronic heart failure management," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-23, June.
    7. Sun-Young Kim & Sue J. Goldie & Joshua A. Salomon, 2010. "Exploring Model Uncertainty in Economic Evaluation of Health Interventions: The Example of Rotavirus Vaccination in Vietnam," Medical Decision Making, , vol. 30(5), pages 1-28, September.
    8. Zsifkovits, Martin & Zsifkovits, Johannes & Pickl, Stefan W., 2016. "Simulating healthcare quality innovation based on a novel medical treatment: The case of Hepatitis-C in Europe," Technological Forecasting and Social Change, Elsevier, vol. 113(PB), pages 454-459.
    9. Lieven Annemans & Vanessa Rémy & James Oyee & Nathalie Largeron, 2009. "Cost-Effectiveness Evaluation of a Quadrivalent Human Papillomavirus Vaccine in Belgium," PharmacoEconomics, Springer, vol. 27(3), pages 231-245, March.
    10. Anna K. Lugnér & Sido D. Mylius & Jacco Wallinga, 2010. "Dynamic versus static models in cost‐effectiveness analyses of anti‐viral drug therapy to mitigate an influenza pandemic," Health Economics, John Wiley & Sons, Ltd., vol. 19(5), pages 518-531, May.
    11. Anthony Newall & Mark Jit & Philippe Beutels, 2012. "Economic Evaluations of Childhood Influenza Vaccination," PharmacoEconomics, Springer, vol. 30(8), pages 647-660, August.
    12. Joke Bilcke & Philippe Beutels, 2009. "Reviewing the Cost Effectiveness of Rotavirus Vaccination," PharmacoEconomics, Springer, vol. 27(4), pages 281-297, April.

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