PRM22 The Headroom Method of Early Economic Evaluation of Medical Devices: A Useful Tool for Device Developers?

Abstract

OBJECTIVES: During the last decade, with the arrival of new innovative vaccines, there was a huge increase in the number of papers on economic evaluation of vaccination programmes. Our study had a 3-fold objective: 1) Appraise available methodological papers dealing with specificities of vaccines in term of health economics; 2) Illustrate the impact of each issue in term of decision-making process with concrete examples; and 3) Identify futures challenges. METHODS: A comprehensive literature search was conducted to identify methodological papers dealing with specificities of economic evaluations of vaccines. Each issue was illustrated with concrete examples of cost-effectiveness analyses recently performed for HPV vaccines, or pneumococcal diseases. RESULTS: Except guidelines issued in 2008 by the WHO and a few general papers, most of methodological papers focused on modelling techniques and showed a trend in using more and more sophisticated methods (e.g. calibration). Several papers highlighted the need for having strong dynamic transmission models of infectious diseases to evaluate appropriately the cost-effectiveness of vaccination programmes. Other papers focused on the issue of discounting, and showed the extreme impact of discounting for some vaccines given this long-term assessment, possibly warranting an alternative method of discounting for vaccines. Fewer papers highlighted the different type of clinical evidence compared with curative pharmaceutical drugs, in particular the need to model immunological responses into clinical endpoints of disease and short-term efficacy into long-term effectiveness. Although there is an increasing level of expertise in the field, other important issues such as the choice of realistic assumptions (coverage rates or vaccine prices) and the inclusion of externalities (i.e. changes in the epidemiology of the infection) are not well analysed. CONCLUSIONS: It is important for decision makers to keep in mind the above vaccine specificities when they assess the cost-effectiveness of new vaccination programmes in order to provide relevant conclusions.

Scanning the horizon: a systematic literature review of methodologies

“…Here, participants prioritise, or purchase, a limited number of signals which then accrue a ‘price’ that can ultimately be used to prioritise those of greatest value 35. Controls are possible to counteract the possibility of scoring fatigue 52…”