Towards a more comprehensive approach for a total economic assessment of vaccines?

Figures & data

Figure 1. Classification of prevention.

Table 1. Vaccination extends beyond vaccine availability.

Activities	Process handling options
Registration	Central (FDA-EMA) /local	List cost/market cost/reference cost	Clinical dossier (plus economic)	+ Local data	Access to pharmacy or to GPs	Full value/ICUA
Acquisition	Tender	Reimbursement	Co-payment	Out-of-pocket	Mixed	Private
Stockpiling	Warehouse	Wholesaler	Pharmacist	Local vaccine clinics	GP level
Transport	Cold-chain requirement	Bulk transport (by ship, aeroplane, trucks)	Local transport (by cars, motorbikes, horses, on foot)	New techniques, e.g., drones
Administration	Private clinics	Public vaccination centres	Organised school programmes
Waste management	Organised through pharmacies

EMA, European Medicine Agency; FDA, Food and Drug Administration; GP, general practitioner, ICUA, incremental cost–utility analysis.

Table 2. Summary of the differences between vaccines and drug treatment.

Product (9)	People/healthcare (11)	Finance/budget (8)
Objective	Target group	Financial
Safety	Environment	Budget
Efficacy	Impact	Purchasing
Outcome measures	Access	Investment
Reactivity	Societal	Market type
Duration	Organisation	Third-party payer
Switch	Evaluation	Risk-sharing programmes
Focus	Monitoring	Decision-making
Production	Acceptance
	At-risk
	Information

Figure 2. Positioning an HTA programme within healthcare.

BI, budget impact; HE, health economics; HTA, health technology assessment; RCT, randomised controlled trial.

Adapted from Luce et al., 2010 [36].

Table 3. Programme of the National Immunisation Technical Advisory Group (NITAG) as developed in the Netherlands.

The role of NITAG	Preventing public risk
	Creating equal access
The function of NITAG
Customer	Defining:  • disease burden  • therapeutic options  • higher risk for fatality  • risk groups who cannot protect themselves
Product	Defining:  • effectiveness   • real-life protection gained from vaccination   • adverse effects assessment  • acceptability   • efficiency (cost, technical, social)  • urgency

Table 4. Value assessment in economic evaluations.

Open Market Cost=Value Payer = Consumer		Non-market Cost≠Value Payer ≠ Consumer
Demand/Supply		Cost-Benefit Analysis		Cost-Effectiveness Analysis
		Investment cost	Willingness to pay		Preference
			Direct	Indirect	Unscored			Pre-scored
					Certainty (value)		Uncertainty (utility)	Multi-attribute health status (questionnaire)
Intrinsic	Cost of goods	Human capital approach	Revealed Consumer behaviour Travel cost method Hedonic pricing method	Stated Survey Contingent valuation method Discrete choice experiment	Scaling	Rating scale Category scaling Visual analogue scale Ratio scaling		Quality of well-being EQ-5D Short Form 6D Health utility index
Instrumental	What it is used for
Inherent	Brand-specific				Choice	Time trade-off Paired comparison Equivalence Person trade-off	Standard gamble

EQ-5D, EuroQol of life five dimensions questionnaire.

Figure 3. Additional value characteristics and gains with vaccines.

QALY, quality-adjusted life-year; QoC, quality of care; AMR, antimicrobial resistance.

Table 5. Ranking different interventions in function of incremental QALY analysis or incremental cost–utility ratio for their selection with a threshold and/or a budget limitation (hypothetical case).

Intervention	Cost	QALYs	ICUA	Ranking	Incremental cost	Incremental QALYs	ICUR	Ranking	≤ threshold 500/QALY	Incremental budget	≤ Total budget 250,000
A	50,000	500	100	2
B	70,000	900	78	1	20,000	400	50	1	X	70,000	X
C	150,000	1,050	143	3	100,000	550	182	2	X	220,000	X
D	300,000	950	316	4	250,000	450	556	4
E	350,000	1,100	318	5	300,000	600	500	3	X	570,000

ICUA, incremental cost–utility analysis; ICUR, incremental cost–utility ratio; QALY, quality-adjusted life-year.

Figure 4. Incremental analysis (Line A) versus other threshold options (minimum health gain to be achieved – Line B, and individual level – Line C).

Figure 5. The relative change in cost- or quality-adjusted life-year difference on the incremental cost–utility ratio result.

ICUR, incremental cost–utility ratio; QALY, quality-adjusted life-year.

Luce BR, Drummond M, Jonsson B, et al. EBM, HTA, and CER: clearing the confusion. Milbank Q. 2010;88(2):256–276.

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