A guideline for economic evaluations of vaccines and immunization programs in China

Figures & data

Table 1. Ten Items for economic evaluations of vaccines and background in China.

Aspect	Background in China
Study perspectives	Both NIP vaccines and non-NIP vaccines exist in China.
	NIP vaccines are completely financed by governments fiscal fund, and non-NIP vaccines are self-paid.
	Public health insurance does not cover vaccines or immunizations.
Comparator strategies	More new vaccines have been introduced into China.
	Coverage rates of NIP vaccines in China are fairly high, but those of non-NIP vaccines are diverse.
	Comparator vaccination strategies for NIP and non-NIP vaccines may be different.
Analysis types	Very few economic evaluations of vaccines in China justified the analysis types used.
	Vaccination in China was not compared with non-vaccine intervention.
	More funds and resources are needed in China to expand NIP.
Model choices	Static models are often used in China, even if dynamic models are more appropriate.
	No justification of model choices was made.
	A few economic evaluations of vaccines in China have used dynamic models.
Costing approaches	The micro costing has more advantages than the macro costing
	Macro costing approach are commonly used in economic evaluations of vaccines in China.
	Major components of vaccination programs were often not included.
Utility measures	Utility measures, such as QALY and DALY, were often not reported in economic evaluations of vaccines in China.
	Utility measures of vaccine-preventable diseases are often from other countries instead of China.
	Very few economic evaluations of vaccines in China used DALY.
Discounting	Both uniform and differential discounting are mythologically sound in international guidelines.
	Health outcomes may or may not be discounted.
	China has higher interest rates and economic growth rates than other countries, which may affect discounting rates.
Uncertainty	Uncertainty is related to methodological choices, model structure, and values of parameters.
	Economic evaluations of vaccines in China used sensitivity analyses to account for uncertainty.
	Univariate sensitivity analyses of parameter values were often used.
Equity	Coverage rates of vaccines are diverse in terms of urban-rural, provincial, and different socioeconomic population groups in China
	The coverage rates of non-NIP vaccines are relatively low.
	Burdens of infectious diseases are higher in western and less-developed provinces, where vaccination could be more cost-effective.
	Very few economic evaluations of vaccines in China consider equity.
Evaluation purposes	NIP and non-NIP vaccines are related to budget and funding, so immunization policy-making in China is also an economic issue.
	Very few economic evaluations of vaccines were carried out to inform NIP policies in China.
	Some provinces and cities made policies of free non-NIP vaccines to eligible people without economic evidence.

Table 2. Recommendations for economic evaluations of vaccines in China.

Aspect	Recommendation in China
Study perspectives	Study perspectives are reported as early as possible.
	Societal perspective should be taken.
	Results from other perspectives, such as governments, employers, and individuals, may also be reported.
Comparator strategies	For NIP vaccines, no vaccination and vaccination in NIP can be compared.
	For non-NIP vaccines, both no vaccination and keeping as non-NIP vaccines are comparators to introducing them into NIP.
	Coverage rates of NIP vaccines in China are more than 95%
	Coverage rates of non-NIP vaccines at the national level are very diverse.
Analysis types	Cost-utility analyses are recommended.
	Incremental cost-utility ratios (ICUR) should be reported.
	The threshold prices of cost-utility vaccines should be provided.
Model choices	Model choices should be justified.
	More dynamic models are recommended to be used appropriately.
Costing approaches	Micro costing approach is more preferable to macro costing approach.
	Full costing instead of only incremental costing should be measured.
	The component of indirect costs for patients and care givers should be included.
	Costs by different bearers and sources should be disaggregated.
	Human capital method is recommended for cost of productivity and life losses.
	Unit prices and costs should be reported.
Utility measures	QALY is preferred for economic evaluation of vaccines in China.
	DALY may be used only if QALY is not available.
	A country-specific threshold value of 1 QALY can be 1 GDP per capita in the study year.
	China should try to make own QALY and/or HR-QOL of vaccine-preventable diseases for Chinese populations.
Discounting	Health outcomes should be discounted.
	Uniform discounting instead of differential discounting is recommended.
	A discounting rate of 5% is suggested as the base case, which reflects higher real interest rates and/or economic growth rates in China.
	Sensitivity analyses many employ discounting rates of 3% and 8%.
Uncertainty	Potential types and sources of uncertainty should be well justified.
	Scenario analyses are recommended for methodological uncertainty.
	Probabilistic sensitivity analyses are recommended to account for uncertainty of model structure and/or parameter values.
	Uncertainty of vaccine prices, indirect costs, and morbidity/mortality of infectious diseases prevented are particularly assessed.
Equity	Equity should carefully be taken account for in economic evaluations of non-NIP vaccines in China.
	Economic evaluations of vaccines at the national level are suggested to estimate provincial burdens of vaccine-preventable diseases and provincial economic impacts of vaccinations.
	Economic evaluations of vaccines can also be carried by rural-urban and income levels, which significantly affects coverage rates of non-NIP vaccines.
Evaluation purposes	Economic evaluations of vaccines should be applied to sort non-NIP vaccines to be included into NIP in China.
	It is recommended that health economists are involved in an economic-related vaccine or immunization programs from the inception in China.
	Adjusting the NIP vaccine types and/or vaccine procedures also needs health economic evaluations.