Funding processes for new vaccines: the need for greater understanding of the economic issues

Abstract

Aim Given the changing landscape for the economics of vaccines, this article discusses the nature of economic assessments, the criteria being applied by decision-makers, the available evidence on the cost-effectiveness of the newer vaccines and the methodological and policy issues involved. Subjects and methods We examine the nature of economic assessments, recent evidence on the cost-effectiveness of vaccines as well as the methodological and political issues arising as a consequence of evaluating vaccination programmes from an economic point of view. Results Economic evaluations of vaccination look at (1) different schedules and implementation of a vaccine in national programmes; (2) benefits for high-risk individuals as versus entire populations; (3) healthcare system costs and societal costs incurred as a result of vaccination programmes versus treating disease; (4) life years gained and quality-adjusted life years. Cost-effectiveness studies of vaccination range considerably in the ratios produced owing to the wide variation of vaccination programmes and differing target populations. Nevertheless, vaccination programmes with newer or less widely used vaccines such as as pneumococcal, meningococcal, hepatitis A and influenza vaccines have consistently demonstrated their cost-effectiveness. In practice, however, implementation of vaccination programmes generally precedes the demonstration of their cost-effectiveness Conclusion In the face of growing pressure on health-care resources, vaccines-as other health interventions and products-will have increasingly to demonstrate their costeffectiveness. This poses particular challenges given the specificity of vaccination both as an individual and collective health intervention.

The introduction of policies for human papillomavirus vaccination in Europe

“…This was surprising given vaccination programs, even with newer vaccines, have consistently been demonstrated to be cost effective (Drummond 2008). In contrast to the Netherlands, a number of other countries have approved HPV vaccination based, at least in part, on cost-effectiveness analyses.…”

“…This contrast may reflect methodological differences. The process for approval by the Dutch Drugs Reimbursement System (GVS), including the health economic component, has been specifically designed for drugs (Postma 2008), and standard methods for economic evaluation of drugs may underestimate benefits when applied to vaccines (Postma 2008;Drummond 2008). Subsequently, in March 2008 the Dutch authorities recommended HPV vaccination (Health Council of the Netherlands 2008).…”