A systematic review of economic evaluations of vaccines in Middle East and North Africa countries: is existing evidence good enough to support policy decision-making?

ABSTRACT

Introduction

A vaccine introduction process should be systematic and transparent and take into account many factors, including cost-effectiveness evidence. This study aimed to assess quantity, characteristic, and quality of economic evaluation (EE) studies on vaccines performed in Middle East and North Africa (MENA) countries.

Areas covered

PubMed and Scopus electronic databases were searched since inception to December 2019 to identify published EE studies of vaccines, which were conducted in the 26 MENA countries. Methodological quality of the included studies was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.

Expert opinion

Of the 616 studies identified, 46 were included in the review. Most studies (65%) were conducted in Iran, Israel, and Turkey. The most commonly evaluated vaccines were rotavirus vaccine (n = 15; 33%), human Papillomavirus vaccine (n = 8; 17%), and pneumococcal vaccine (n = 7; 15%). We classified 5 (11%), 27 (59%), 12 (26%), and 2 (4%) studies as excellent, good, moderate, and poor quality, respectively. There were limited cost-effectiveness evidences in the region. It is imperative to have local guidelines on good practice and reporting, availability of local data, and funding sources to improve quantity and quality of EE studies of vaccines in the region, thereby, facilitating transparent and consistent decision-making processes.

KEYWORDS:

• CHEERS
• cost
• decision-making
• economic evaluation
• immunization
• mena
• vaccines

Article highlights

• Only 46 studies on economic evaluation of vaccines were identified from 26 MENA countries.

• There is a wide variation in terms of the number of studies in the region. Studies from three countries (i.e. Iran, Israel, and Turkey) accounted for two-third of the total studies in the region. Meanwhile, 12 countries did not have any publication on the economic evaluation of vaccines.

• About two-third of the studies were rated as good to excellent quality.

• Only seven studies (15%) were funded by governmental/academic institutions

• All studies adopted utility data from other countries outside the region

Notes on contribution

All authors attest they meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship. All authors contributed to the study conception and design. Data extraction and analysis were performed by Mouaddh Abdulmalik Nagi, Chaisiri Luangsinsiri, and Montarat Thavorncharoensap. The first draft of the manuscript was written by Mouaddh Abdulmalik Nagi. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Acknowledgments

This work was part of the training of Mouaddh Abdulmalik Nagi at Social, Economic and Administrative pharmacy graduate program at Mahidol University. The author would like to gratefully acknowledge Health Technology Assessment international (HTAi), Alberta- Canada and Mahidol University for their generous support of this training. The findings, interpretations and conclusions expressed in this article do not necessarily reflect the views of the aforementioned supporting agencies.

Data availability statement

The datasets generated during and/or analyzed during the current study are available upon reasonable request.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Ethical approval

Ethical approval is not required for this study since it does not include human subjects.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This paper was not funded.