Health economic analyses of secondary vaccine effects: a systematic review and policy insights

Thompson, Kimberly M.; Badizadegan, Kamran

doi:10.1080/14760584.2022.2017287

Cited by 4 publications

(7 citation statements)

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“…Given the absence of specific, unbiased evidence of SVEs associated with poliovirus vaccines, however, health economic analyses for polio 27 , 50 and for COVID-19 49 did not include SVEs. A systematic review 51 found that the only published health economic analysis that quantified the use of OPV for potential SVEs did not find health or economic justification for repurposing OPV in the US for COVID-19 49 . Consistent with the findings of the analysis, the US did not reintroduce OPV for COVID-19 51 , and the development, licensure, and use of COVID-19 specific vaccines led to appropriate focus on widespread distribution of COVID-19 vaccines.…”

Section: Full Accounting For Gpei and Polio Financial Investmentsmentioning

confidence: 99%

“…A systematic review 51 found that the only published health economic analysis that quantified the use of OPV for potential SVEs did not find health or economic justification for repurposing OPV in the US for COVID-19 49 . Consistent with the findings of the analysis, the US did not reintroduce OPV for COVID-19 51 , and the development, licensure, and use of COVID-19 specific vaccines led to appropriate focus on widespread distribution of COVID-19 vaccines. In the absence of randomized controlled trials and demonstrated mechanisms of action that document specific effects of polio vaccines on non-polio health endpoints, health economic analysts lack sufficient inputs (e.g., costs, expected magnitudes and duration of effects) to support the inclusion of SVEs for poliovirus vaccines 51 .…”

Section: Full Accounting For Gpei and Polio Financial Investmentsmentioning

confidence: 99%

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Polio health economics: assessing the benefits and costs of polio, non-polio, and integrated activities of the Global Polio Eradication Initiative

Thompson¹,

Kalkowska²,

Badizadegan³

2022

Gates Open Res

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Background: Investments made by countries and donors to support polio eradication and the Global Polio Eradication Initiative (GPEI) over the past 35 years provided financial support for significant health interventions beyond the prevention of polio. Prior economic analyses that sought to quantify the economic benefits of some interventions encountered insufficient data and evidence associated with non-polio-specific activities. The 2022-2026 GPEI Strategic Plan explicitly identified integration and gender equity as funded mandates that must move forward in parallel with polio eradication, but these goals remain vaguely defined from a health economic perspective. Methods: To ensure unambiguous and full accounting for all financial investments in the GPEI, polio eradication, and other desirable objectives, we identify the health economic analysis methods and inputs needed to ensure transparent financial accountability and cost-effective use of funds. Results: Sufficient inputs and methods exist to characterize the health and economic benefits of polio-specific activities, but we identified the need for additional information and method development for some non-polio-specific and cost-sharing activities. Donors who seek to support non-polio-specific objectives as part of the GPEI may want to provide dedicated support financing for which it may be difficult to apply typical health economic criteria and to expect net health and/or net economic benefits. Conclusions: Given the mixture of funding sources provided to the GPEI, which includes support by governments and private donors, we recommend that the GPEI separately account for financial needs that represent necessities for polio eradication from those used for other stated objectives. An added layer of specificity that identifies all funds according to each activity, the accountable party and/or parties, and the associated measurable health or other outcome(s), will enable improved health economic analyses and reporting to donors who seek to track returns on their investments.

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Section: Full Accounting For Gpei and Polio Financial Investmentsmentioning

confidence: 99%

Section: Full Accounting For Gpei and Polio Financial Investmentsmentioning

confidence: 99%

Polio health economics: assessing the benefits and costs of polio, non-polio, and integrated activities of the Global Polio Eradication Initiative

Thompson¹,

Kalkowska²,

Badizadegan³

2022

Gates Open Res

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“…We assumed vaccine cost of $0.15 [0.12-0.19] and $10 [7.5-12.5] and delivery cost of $0.96 [0.56-1.56] and $1.49 [0.90-2.51] for one dose of OPV and COVID-19 vaccine, respectively (Appendix p17). For both vaccines, we assumed a 10% [5][6][7][8][9][10][11][12][13][14][15] wastage rate. For benefit-cost analysis, we applied three sets of VSL estimates following the reference case standardized sensitivity analysis recommendation, extrapolating from the US VSL with Indian GNI per capita in 2019 at $6,920, and used the lowest VSL for the main result (Appendix p24).…”

Section: Input Parametersmentioning

confidence: 99%

“…These non-specific heterologous effects of LAVs—such as the Bacillus Calmette-Guérin (BCG) vaccine against tuberculosis, measles-containing vaccines, and oral polio vaccines (OPV)—have led to reductions in mortality and morbidity by more than can be explained from prevention of the targeted disease alone ( 4 ). Only four studies have undertaken economic analyses that explicitly incorporates the heterologous effects of pathogen-specific vaccines, two of which are relevant in the context of this research ( 5 ). Byberg et al concluded that the heterologous effects were more important in determining cost-effectiveness than the measles-specific effect, while Thompson et al assumed there is insufficient evidence for a non-specific heterologous effect of OPV against COVID-19 in the United States ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

One vaccine to counter many diseases? Modeling the economics of oral polio vaccine against child mortality and COVID-19

Chang

Aaby

Avidan

et al. 2022

Front. Public Health

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IntroductionRecent reviews summarize evidence that some vaccines have heterologous or non-specific effects (NSE), potentially offering protection against multiple pathogens. Numerous economic evaluations examine vaccines' pathogen-specific effects, but less than a handful focus on NSE. This paper addresses that gap by reporting economic evaluations of the NSE of oral polio vaccine (OPV) against under-five mortality and COVID-19.Materials and methodsWe studied two settings: (1) reducing child mortality in a high-mortality setting (Guinea-Bissau) and (2) preventing COVID-19 in India. In the former, the intervention involves three annual campaigns in which children receive OPV incremental to routine immunization. In the latter, a susceptible-exposed-infectious-recovered model was developed to estimate the population benefits of two scenarios, in which OPV would be co-administered alongside COVID-19 vaccines. Incremental cost-effectiveness and benefit-cost ratios were modeled for ranges of intervention effectiveness estimates to supplement the headline numbers and account for heterogeneity and uncertainty.ResultsFor child mortality, headline cost-effectiveness was $650 per child death averted. For COVID-19, assuming OPV had 20% effectiveness, incremental cost per death averted was $23,000–65,000 if it were administered simultaneously with a COVID-19 vaccine <200 days into a wave of the epidemic. If the COVID-19 vaccine availability were delayed, the cost per averted death would decrease to $2600–6100. Estimated benefit-to-cost ratios vary but are consistently high.DiscussionEconomic evaluation suggests the potential of OPV to efficiently reduce child mortality in high mortality environments. Likewise, within a broad range of assumed effect sizes, OPV (or another vaccine with NSE) could play an economically attractive role against COVID-19 in countries facing COVID-19 vaccine delays.FundingThe contribution by DTJ was supported through grants from Trond Mohn Foundation (BFS2019MT02) and Norad (RAF-18/0009) through the Bergen Center for Ethics and Priority Setting.

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“…Some early proponents of OPV cessation continue to suggest urgency (John, 2004; John & Dharmapalan, 2022), while others argue that OPV use should continue indefinitely and GPEI should abandon the objective of eradication of all poliovirus transmission (Chumakov et al., 2021, 2007). Recently, some studies supported continued use of OPV due to potential benefits of secondary vaccine effects (Aaby et al., 2004; Chumakov et al., 2020; Joffe et al., 2021), although other studies highlighted the uncertainty about these effects and any associated health–economic implications (Thompson & Badizadegan, 2022; Thompson et al., 2021a, 2021c).…”

Section: Introductionmentioning

confidence: 99%

Coordinated global cessation of oral poliovirus vaccine use: Options and potential consequences

Kalkowska¹,

Wassilak

Wiesen

et al. 2023

Risk Analysis

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Due to the very low, but nonzero, paralysis risks associated with the use of oral poliovirus vaccine (OPV), eradicating poliomyelitis requires ending all OPV use globally. The Global Polio Eradication Initiative (GPEI) coordinated cessation of Sabin type 2 OPV (OPV2 cessation) in 2016, except for emergency outbreak response. However, as of early 2023, plans for cessation of bivalent OPV (bOPV, containing types 1 and 3 OPV) remain undefined, and OPV2 use for outbreak response continues due to ongoing transmission of type 2 polioviruses and reported type 2 cases. Recent development and use of a genetically stabilized novel type 2 OPV (nOPV2) leads to additional potential vaccine options and increasing complexity in strategies for the polio endgame. Prior applications of integrated global risk, economic, and poliovirus transmission modeling consistent with GPEI strategic plans that preceded OPV2 cessation explored OPV cessation dynamics and the evaluation of options to support globally coordinated risk management efforts. The 2022–2026 GPEI strategic plan highlighted the need for early bOPV cessation planning. We review the published modeling and explore bOPV cessation immunization options as of 2022, assuming that the GPEI partners will not support restart of the use of any OPV type in routine immunization after a globally coordinated cessation of such use. We model the potential consequences of globally coordinating bOPV cessation in 2027, as anticipated in the 2022–2026 GPEI strategic plan. We do not find any options for bOPV cessation likely to succeed without a strategy of bOPV intensification to increase population immunity prior to cessation.

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Health economic analyses of secondary vaccine effects: a systematic review and policy insights

Cited by 4 publications

References 97 publications

Polio health economics: assessing the benefits and costs of polio, non-polio, and integrated activities of the Global Polio Eradication Initiative

Polio health economics: assessing the benefits and costs of polio, non-polio, and integrated activities of the Global Polio Eradication Initiative

One vaccine to counter many diseases? Modeling the economics of oral polio vaccine against child mortality and COVID-19

Coordinated global cessation of oral poliovirus vaccine use: Options and potential consequences

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