Do current cost-effectiveness analyses reflect the full value of childhood vaccination in Europe?

Abstract

E conomic evaluation of vaccinationprograms can be challenging and does not always fully capture the benefits provided. Reasons for this include the difficulties incurred in accurately capturing the health and economic impact of infectious diseases and how different diseases may interact with each other. Rotavirus infection, for example, peaks at a similar time than other infectious diseases, such as RSV and influenza, which can cause hospital overcrowding and disruption, and may pose a risk to more vulnerable children due to limited availability of isolation facilities. Another challenge, specific to evaluating childhood vaccination, is that QoL cannot be accurately measured in children due to a lack of validated instruments. Childhood diseases also incur a care giver burden, due to the need for parents to take time off work, and this is important to consider. Finally, for diseases such as RVGE, cost-effectiveness analyses in which longer time horizons are considered may not reflect the shortterm benefits of vaccination. Further quantification of the economic impact of childhood diseases is thus required to fully highlight the true benefits of childhood vaccination that may be realized. Herein we explore the limitations of existing economic evaluations for childhood vaccination, and how economic analyses could be better adapted in future.

Assessing the Costs and Cost-Effectiveness of Genomic Sequencing

“…Depending on what is being studied, analyses may include additional costs both within and outside of the health care system. These expenditures may include patient co-pays for physician visits, testing or treatments [ 47 ], time off from work for health care appointments [ 48 ], potential life and disability insurance complications [ 49 ], and genetic testing of other family members [ 24 ]. What costs to include and omit depends on the perspective of the analysis.…”

Sources and Characteristics of Utility Weights for Economic Evaluation of Pediatric Vaccines: A Systematic Review

“…The methods used to obtain values for HSs can affect the conclusions drawn about the cost-effectiveness of health care interventions, including vaccines, because several studies have shown that different methods lead to different utility weights [10][11][12]. Although measuring and valuing health is a complex task in adults, it is perhaps even more conceptually and methodologically demanding in children [13][14][15], and the appraisal of vaccines in pediatric populations is particularly challenging, as highlighted recently by Bruggenjurgen et al [16]. Although previous reviews have examined the generation and use of utility weights in pediatric populations in general [6,9], none has focused specifically on the use of utility weights for HSs associated with infectious diseases and their use in economic evaluations of vaccines to prevent those diseases.…”

The intangible benefits of vaccination – what is the true economic value of vaccination?

“…In temperate climates, rotavirus gastro-enteritis (RVGE) coincides with other common childhood epidemics, causing more than 40% of the total burden of infant hospitalisations (i.e., respiratory syncytial virus, influenza) occurring over the same seasonal period, leading to the so-called ‘winter chaos’ ( 15 ). Coincidence of these epidemics places healthcare systems under pressure, causing an increased risk of nosocomial infections from periodic overcrowding, resulting in additional cases, adverse events, understaffing, lack of beds due to extended hospital stays, and closure of wards to new admissions ( 16 – 18 ). Additional costs resulting from the coincidence of RVGE with other infections are likely to occur in a number of areas that may not be fully captured in cost-effectiveness analyses.…”

“…Additional costs resulting from the coincidence of RVGE with other infections are likely to occur in a number of areas that may not be fully captured in cost-effectiveness analyses. Furthermore, the increased burden on hospital capacity can put pressure on staff, affecting their ability to deliver high-quality care to children or delaying planned surgeries for other children ( 18 ). Post-vaccination surveillance data have shown a delay in the onset of RVGE epidemics, leading to a reduction in the overall numbers of cases and in the epidemiological overlap, which may decrease workload pressures.…”