Is the gap between micro- and macroeconomic assessments in health care well understood? The case of vaccination and potential remedies

Figures & data

Fig. 1. Communicable diseases and the economy.

Table 1. Micro- and macroeconomic methods for evaluating vaccine indirect costs

	Microeconomic methods			Macroeconomic methods	Combined micro- & macro
Characteristics	Cost of illness – CEA	Indirect	Contingent valuation	Econometric	CGE models
Scope of evaluation	Technical efficiency of alternative health care interventions	Societal loss associated with disease prevention	Societal preferences for disease prevention and the relative importance of its attributes	Statistical association of communicable disease epidemiology with GDP or GDP per capita	Cross-sectorial microeconomic and macroeconomic impact of disease prevention
Evidence and analysis needs	Decision analytic modeling combining epidemiological data, resource use and unit costs; absenteeism, and presenteeism (optional)	Cohort modeling of epidemiological data, wages, absenteeism, and presenteeism	Survey collection and analysis methods	Econometric models to model retrospective panel data for GDP, epidemiology and a set of control variables	Sectorial matrix CGE models to simulate the consequence of disease on economic behaviors and productivity
Vaccinations’ benefit	Reduction of mortality and morbidity; Improvement of Patient quality of life; Prevention of health care costs; productivity gains and care-giving needs reduction	Reduction of sick-days; Increase of productivity while at work; Increase in total productive life years; increase in education levels achieved and lifetime education-specific earnings	Vaccinations are associated with positive WTP for preventing disease	Vaccination benefit can be quantified if vaccination variables are included in the model and vaccination data available	Change of economic behavior patterns projected/ investment choices
Decision criterion	ICERs in terms of cost/LY or QALY or DALY gained or cases averted	Inclusion in CEA or CBA	NPV: WTP for prevention of disease minus the cost of vaccination	Statistical relationship between GDP and vaccination	GDP impact of disease prevention; income, productivity gain, income distribution
Incorporation of broader consequences	Optional inclusion of absenteeism and presenteeism evaluations for the individual and the firm	Absenteeism and presenteeism evaluations for the individual and the firm; Quantification of the statistical and fiscal value of future cohorts (demographical changes); May link education outcomes with lifetime earnings	Depending on the survey design it may assess intangible elements that influence individuals’ decisions	Retrospective analysis implicitly captures all levels	Projections of the macroeconomic consequences are based on assumptions or data relating to broader consequences
Policy relevance/utility	Efficient allocation of resources within the health care budget	Comprehensive estimate of the economic surplus produced for the society	Identify societally preferred health policies	Ad-hoc assessment of cross –country macroeconomic association between the disease and the GDP; Cross-country best practice identifications	Cross-sectorial allocation of funding; Public investment appraisals