Economic Evaluation of Vaccination Programmes
The methods that have been used to estimate the clinical and economic impact of vaccination programmes are not always uniform, which makes it difficult to compare results between economic analyses. Furthermore, the relative efficiency of vaccination programmes can be sensitive to some of the more controversial aspects covered by general guidelines for the economic evaluation of healthcare programmes, such as discounting of health gains and the treatment of future unrelated costs. In view of this, we interpret some aspects of these guidelines with respect to vaccination and offer recommendations for future analyses.
These recommendations include more transparency and validation, more careful choice of models (tailored to the infection and the target groups), more extensive sensitivity analyses, and for all economic evaluations (also nonvaccine related) to be in better accordance with general guidelines.
We use these recommendations to interpret the evidence provided by economic evaluation applied to viral hepatitis vaccination. We conclude that universal hepatitis B vaccination (of neonates, infants or adolescents) seems to be the most optimal strategy worldwide, except in the few areas of very low endemicity, where the evidence to enable a choice between selective and universal vaccination remains inconclusive. While targeted hepatitis A vaccination seems economically unattractive, universal hepatitis A vaccination strategies have not yet been sufficiently investigated to draw general conclusions.
The Viral Hepatitis Prevention Board (VHPB) organised the meeting in Istanbul, Turkey. Participants in the meeting, and subscribers to the consensus statement: Antoñanzas F, Universidad De La Rioja, Spain; Badur S, University of Istanbul, Turkey; Beutels Ph, University of Antwerp, Belgium; Bonanni P, University of Florence, Italy; Carlson J, European Commission, Luxembourg; De la Torre J, Ministry of Health, Spain; De Wit GA, National Institute of Public Health and the Environment, The Netherlands; Edmunds WJ, Public Health Laboratory Service and City University, UK; Evans D, World Health Organization, Switzerland; Feilden R, FBA Health Systems Analysts, UK; Fendrick AM, University of Michigan, USA; Ginsberg GM, Ministry of Health, Israel; Glick HA, University of Pennsylvania, USA; Grob P, University of Zurich, Switzerland; Hallauer J, Gesundheitssystemforschung Universitätsklinikum Charité Berlin, Germany; Kane M, Bill and Melinda Gates Children Vaccine Programme, USA; Mast E, World Health Organization, Switzerland; Meheus A, University of Antwerp, Belgium; Péchevis M, CEMKA, France; Roure C, Institut Pasteur, France; Shouval D, Hadassah University Hospital, Israel; Van Damme P, University of Antwerp, Belgium; Van Doorslaer E, Erasmus University Rotterdam, The Netherlands; van Hout B, University of Utrecht, The Netherlands.
The VHPB is sponsored by educational grants from the pharmaceutical industry, several universities in Europe and other institutions and has strict operational and scientific independence (http://www.vhpb.org).
None of the authors received any financial compensation, other than for travel and accommodation during the meeting.
- 3.Edmuns WJ. Universal or selective immunisation against hepatitis B virus in the United Kingdom? A review of recent cost-effectiveness studies. Commun Dis Public Health 1998; 1 (4): 221–8Google Scholar
- 5.Anderson RM, May RM. Infectious diseases of humans — dynamics and control. Oxford: Oxford University Press 1991Google Scholar