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Mestre-Ferrándiz J, Rivero A, Orrico-Sánchez A, Hidalgo Á, Abdalla F, Martín I, Álvarez J, García-Cenoz M, Del Carmen Pacheco M, Garcés-Sánchez M, Zozaya N, Ortiz-de-Lejarazu R. Evaluation of antibody-based preventive alternatives for respiratory syncytial virus: a novel multi-criteria decision analysis framework and assessment of nirsevimab in Spain. BMC Infect Dis 2024; 24:99. [PMID: 38238680 PMCID: PMC10797756 DOI: 10.1186/s12879-024-08988-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/06/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a highly infectious disease that poses a significant clinical and medical burden, as well as social disruption and economic costs, recognized by the World Health Organization as a public health issue. After several failed attempts to find preventive candidates (compounds, products, including vaccines), new alternatives might be available, one being nirsevimab, the first and only option approved for RSV prevention in neonates and infants during their first RSV season. The objective of this study was to develop a novel multi-criteria decision analysis (MCDA) framework for RSV antibody-based preventive alternatives and to use it to assess the value of nirsevimab vs. placebo as a systematic immunization approach to prevent RSV in neonates and infants during their first RSV season in Spain. METHODS Based on a pre-established model called Vaccinex, an ad-hoc MCDA framework was created to reflect relevant attributes for the assessment of current and future antibody-based preventive measures for RSV. The estimated value of nirsevimab was obtained by means of an additive linear model combining weights and scores assigned by a multidisciplinary committee of 9 experts. A retest and three sensitivity analyses were conducted. RESULTS Nirsevimab was evaluated through a novel framework with 26 criteria by the committee as a measure that adds value (positive final estimated value: 0.56 ± 0.11) to the current RSV scenario in Spain, by providing a high efficacy for prevention of neonates and infants. In addition, its implementation might generate cost savings in hospitalizations and to the healthcare system and increase the level of public health awareness among the general population, while reducing health inequities. CONCLUSIONS Under a methodology with increasing use in the health field, nirsevimab has been evaluated as a measure which adds value for RSV prevention in neonates and infants during their first RSV season in Spain.
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Affiliation(s)
| | - Agustín Rivero
- Department of Management, Bioregión de Salud y Bienestar (BioMad), Madrid, Spain
| | - Alejandro Orrico-Sánchez
- Department of Vaccines Research, Fundación Para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
- Catholic University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Álvaro Hidalgo
- Weber Foundation, Madrid, Spain
- Department of Economic Analysis and Finances, University of Castilla-La Mancha, Toledo, Spain
| | - Fernando Abdalla
- Department of Health Affairs and Policy Research, Vivactis Weber, Madrid, Spain.
| | - Isabel Martín
- Department of Primary Care, Rochapea Healthcare Center, Navarra, Spain
| | - Javier Álvarez
- Department of Pediatrics, Hospital Costa del Sol, Málaga, Spain
| | | | | | | | - Néboa Zozaya
- Department of Health Affairs and Policy Research, Vivactis Weber, Madrid, Spain
- Department of Quantitative Methods in Economics and Management, University Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Raúl Ortiz-de-Lejarazu
- National Influenza Centre, School of Medicine, University of Valladolid, Castilla y León, Spain
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2
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Ma C, Li J, Wang N, Wang Y, Song Y, Zeng X, Zheng C, An Z, Rodewald L, Yin Z. Prioritization of Vaccines for Inclusion into China’s Expanded Program on Immunization: Evidence from Experts’ Knowledge and Opinions. Vaccines (Basel) 2022; 10:vaccines10071010. [PMID: 35891174 PMCID: PMC9318118 DOI: 10.3390/vaccines10071010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 02/02/2023] Open
Abstract
Background: Vaccine developers in China have made an increasing number of infectious diseases preventable through vaccination. An appropriate decision-making procedure is necessary for making wise decisions on whether to introduce new vaccines into the Expanded Program on Immunization (EPI). When there are several vaccines that could potentially be considered, a scientifically justifiable mechanism is needed for prioritizing and sequencing vaccines for consideration. Methods: We used a modified Delphi technique (MDT) to develop and refine an indicator system to prioritize vaccines and make policy recommendations concerning their introduction into China’s EPI system. From January through May 2021, thirty-nine experts were recruited and participated in a two-round Delphi survey that was based on a set of candidate indicators obtained through a literature review and reference to the WHO vaccine introduction recommendations. Using the resulting indicator system, we conducted a third consultation with a multi-disciplinary group of experts who scored five program-eligible candidate vaccines to determine prioritization and sequencing for consideration of inclusion into the EPI. Results: Response rates of the thirty-nine experts were 100% and 97.4% across the two rounds. Authority coefficients from rounds one to three were over 0.70, reflecting the high accuracy and reliability of the consultation. Coordination coefficients of importance scores for primary, secondary, and tertiary indicators were 0.486, 0.356, 0.275 in round one, and 0.405, 0.340, and 0.236 in round two. According to the scores from 30 experts using our indicator system, the sequence and scores (1–10 scale, 10 highest) of 5 candidate vaccines were varicella (6.91), meningococcal conjugate AC (6.83), Hib (6.74), influenza (6.56), and EV71 (6.17) vaccines. Conclusions: A modified Delphi technique effectively built a scientific, rational, comprehensive, and systematic indicator system for prioritizing vaccine candidates for consideration of inclusion into the EPI. The rank order will be used by the technical working groups of China’s National Immunization Advisory Committee to sequentially develop and present Evidence-to-Recommendation tables for making policy recommendations.
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Affiliation(s)
- Chao Ma
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Junhong Li
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Nan Wang
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai 201204, China;
| | - Yamin Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Yudan Song
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Xiang Zeng
- Zhuhai Center for Disease Control and Prevention, Zhuhai 519000, China;
- Chinese Field Epidemiology Training Program (CFETP), Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Canjun Zheng
- Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 100050, China;
| | - Zhijie An
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Lance Rodewald
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Zundong Yin
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
- Correspondence:
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3
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Luyten J, Beutels P, Vandermeulen C, Kessels R. Social preferences for adopting new vaccines in the national immunization program: A discrete choice experiment. Soc Sci Med 2022; 303:114991. [PMID: 35594739 DOI: 10.1016/j.socscimed.2022.114991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 04/17/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Abstract
Governments regularly have to decide whether new vaccines should be adopted in their national immunization program. These choices imply complex trade-offs of epidemiological, medical and socio-economic criteria. We investigated how the population in Flanders (Belgium) wants their government to set vaccine-funding priorities. In December 2019, we executed a discrete choice experiment in a sample of the Flemish population (N = 1636). In total, we analysed 16 360 choices between vaccines competing for funding, described in terms of eight characteristics. Using a panel mixed logit model, we quantified the relative importance of each characteristic and investigated differences in preferences across respondent groups. The observed vaccine priorities were different from those that would be identified through cost-effectiveness analysis. People valued the health impact from infectious diseases differently than their weight expressed in QALYs would suggest. Mortality and frequently occurring mild illness were valued higher, whereas lasting morbidity received lower weight. Contribution of the vaccine to disease eradication and uncertainty in vaccine effectiveness were both highly influential factors. Health equity impact was also important whereas the economic impact of the disease did not matter at all. Our results can be used to incorporate public values into vaccine decision-making.
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Affiliation(s)
- Jeroen Luyten
- KU Leuven, Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, Kapucijnenvoer 35, 3000, Leuven, Belgium.
| | - Philippe Beutels
- University of Antwerp, Centre for Health Economics Research & Modelling Infectious Diseases, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Corinne Vandermeulen
- KU Leuven, Environment and Health, Department of Public Health and Primary Care, Kapucijnenvoer 35, 3000, Leuven, Belgium
| | - Roselinde Kessels
- Maastricht University, Department of Data Analytics and Digitalization, PO Box 616, 6200 MD, Maastricht, The Netherlands; University of Antwerp, Department of Economics, City Campus, Prinsstraat 13, 2000, Antwerp, Belgium
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McCormick BJJ, Waiswa P, Nalwadda C, Sewankambo NK, Knobler SL. SMART Vaccines 2.0 decision-support platform: a tool to facilitate and promote priority setting for sustainable vaccination in resource-limited settings. BMJ Glob Health 2021; 5:bmjgh-2020-003587. [PMID: 33239338 PMCID: PMC7689585 DOI: 10.1136/bmjgh-2020-003587] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 11/06/2022] Open
Abstract
In resource-constrained environments, priority setting is critical to making sustainable decisions for introducing new and underused vaccines and choosing among vaccine products. Donor organisations and national governments in low-income and middle-income countries (LMICs) recognise the need to support prioritisation of vaccine decisions driven by local health system capacity, epidemiology and financial sustainability. Successful efforts have supported the establishment of National Immunisation Technical Advisory Groups (NITAGs) to undertake evidence-informed decision making (EIDM) in LMICs. Now, attention is increasingly focused on supporting their function to leverage local expertise and priorities. EIDM and priority-setting functions are complex and dynamic processes. Here, we report a pilot of a web-based decision-support tool. Applying tenets of multicriteria decision analysis, SMART Vaccines 2.0 supported transparent, reproducible and evidence-informed priority setting with an easy-to-use interface and shareable outputs. The pilot was run by the Uganda NITAG who were requested by the Ministry of Health (MOH) in 2016 to produce recommendations on the prioritised introduction of five new vaccines. The tool was acceptable to the NITAG and supported their recommendations to the MOH. The tool highlighted sensitivity in the prioritisation process to the inherent biases of different stakeholders. This feature also enabled examination of the implications of data uncertainty. Feedback from users identified areas where the tool could more explicitly support evidence-to-recommendation frameworks, ultimately informing the next generation of the platform, PriorityVax. Country ownership and priority setting in vaccine decisions are central to sustainability. PriorityVax promotes auditable and rigorous deliberations; enables and captures the decision matrix of users; and generates shareable documentation of the process.
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Affiliation(s)
- Benjamin J J McCormick
- Division of International Epidemiology and Population Studies, Fogarty International Center, Bethesda, Maryland, USA
| | - Peter Waiswa
- School of Public Health, Makerere University, Kampala, Uganda.,International Health, Dept of Public Health Sciences (IHCAR), Karolinska Institutet, Stockholm, Sweden
| | | | - Nelson K Sewankambo
- Uganda National Academy of Sciences, Kampala, Uganda.,School of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Stacey L Knobler
- Division of International Epidemiology and Population Studies, Fogarty International Center, Bethesda, Maryland, USA .,Sabin Vaccine Institute, Washington, District of Columbia, USA
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5
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Suwantika AA, Purwadi FV, Zakiyah N, Puspitasari IM, Abdulah R, Diantini A, Boersma C, Postma MJ. Multi-criteria decision analysis to prioritize the introduction of new vaccines in Indonesia by using the framework of the strategic multi-attribute ranking tool for vaccines (SMART vaccines). Expert Rev Vaccines 2021; 20:83-91. [PMID: 33428502 DOI: 10.1080/14760584.2021.1874926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Decision-making processes regarding new vaccine prioritizations are complex. The objective of this study was to prioritize the introduction of new vaccines in Indonesia.Methods: A multi-criteria decision analysis (MCDA) was applied in this study. A preliminary data collection form was developed to collect country-specific data in relation to 30 pre-defined attributes. In particular, an open-ended questionnaire was conducted among targeted respondents from global level, national level and vaccine manufacturers, which were involved in the financial flows of new vaccine procurement in Indonesia. For setting new vaccines priorities, targeted respondents were asked to assign weight on 10 selected criteria.Results: Top 3 attributes with the highest weight from respondents were premature deaths averted per year, incident cases prevented per year, and cost-effectiveness. Applying criteria scores and weight assessment, the result showed that PCV, rotavirus, HPV, and JE would be on the 1st, 2nd, 3rd, and 4th rank for setting new vaccine priority in Indonesia. There was a significant difference score (p value <0.05) between all these vaccines.Conclusions: PCV, rotavirus and HPV vaccines should be more prioritized than JE vaccine. This ranking is in line with the WHO's priority list, which potentially illustrates the validity and usefulness of our MCDA-approach.
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Affiliation(s)
- Auliya A Suwantika
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia.,Center for Health Technology Assessment, Universitas Padjadjaran, Bandung, Indonesia
| | - Febby V Purwadi
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Neily Zakiyah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Irma M Puspitasari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Ajeng Diantini
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Cornelis Boersma
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maarten J Postma
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia.,Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands.,Unit of PharmacoTherapy, -Epidemiology & -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
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6
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Zozaya González N, Alcalá Revilla B, Arrazola Martínez P, Chávarri Bravo JR, Cuesta Esteve I, García Rojas AJ, Martinón-Torres F, Redondo Margüello E, Rivero Cuadrado A, Tamames Gómez S, Villaseca Carmena J, Hidalgo-Vega A. Pathway towards an ideal and sustainable framework agreement for the public procurement of vaccines in Spain: a multi-criteria decision analysis. Hum Vaccin Immunother 2020; 16:2873-2884. [PMID: 32243235 PMCID: PMC7733903 DOI: 10.1080/21645515.2020.1732164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Objective: To advance the development of an ideal and sustainable framework agreement for the public procurement of vaccines in Spain, and to agree on the desirable award criteria and their relative weight. Methods: A multidisciplinary committee of seven health-care professionals and managers developed a partial multi-criteria decision analysis to determine the award criteria that should be considered and their specific weights for the public procurement of routine vaccines and seasonal influenza vaccines, considering their legal viability. A re-test of the results was carried out. The current situation was analyzed through 118 tender specifications and compared to the ideal framework. Results: Price is the prevailing award criterion for the public procurement of both routine (weighting of 60% versus 40% for all other criteria) and influenza (36% versus 64%) vaccines. Ideally, 22 criteria should be considered for routine vaccines, grouped and weighted into five domains: efficacy (weighting of 29%), economic aspects (27%), vaccine characteristics (22%), presentation form and packaging (13%), and others (9%). Per criteria set, price was the most important criterion (22%), followed by effectiveness (9%), and composition/formulation (7%). Regarding influenza vaccines, 20 criteria were selected, grouped, and weighted: efficacy (29%), economic aspects (25%), vaccine characteristics (20%), presentation form and packaging (16%), and others (11%). Per criteria set, price was also the most relevant criterion (19%), followed by composition/formulation (8%), and effectiveness (8%). Conclusions: Contrary to the current approach, technical award criteria should prevail over economic criteria in an ideal and sustainable framework agreement for the public procurement of vaccines.
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Affiliation(s)
- N Zozaya González
- Health Economics Department, Weber , Madrid, Spain.,University of Las Palmas de Gran Canaria , Las Palmas, Spain
| | - B Alcalá Revilla
- Servicio de Medicina Preventiva, Hospital Universitario 12 de Octubre , Madrid, Spain
| | | | - J R Chávarri Bravo
- Unidad de Vacunas, Subdirección de Salud Pública de Zaragoza , Zaragoza, Spain
| | | | - A J García Rojas
- Servicio de Pediatría, Hospital Clínico Universitario de Santiago de Compostela, Genetics, Vaccines and Pediatrics Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela
| | - F Martinón-Torres
- Centro de Salud Internacional Ayuntamiento de Madrid, Grupo de Trabajo de Actividades Preventivas de la Sociedad Española de Médicos de Atención Primaria
| | | | - A Rivero Cuadrado
- Servicio de Epidemiología, Dirección General de Salud Pública de la Junta de Castilla y León
| | | | - J Villaseca Carmena
- Servicio de Medicina Preventiva, Hospital Universitario 12 de Octubre , Madrid, Spain
| | - A Hidalgo-Vega
- Departamento de Fundamentos de Análisis Económico, Universidad de Castilla la Mancha
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7
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Luyten J, Kessels R, Vandermeulen C, Beutels P. Value Frameworks for Vaccines: Which Dimensions Are Most Relevant? Vaccines (Basel) 2020; 8:E628. [PMID: 33126454 PMCID: PMC7712404 DOI: 10.3390/vaccines8040628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/14/2020] [Accepted: 10/22/2020] [Indexed: 11/20/2022] Open
Abstract
In addition to more narrow criteria such as safety, effectiveness and cost-effectiveness, vaccines can also be evaluated based on broader criteria such as their economic impact, contribution to disease eradication objectives, caregiver aspects, financial protection offered, equity or social acceptability. We summarize a survey executed in a sample of the population (n = 1000) in Flanders, Belgium, in which we investigated support for using these broader criteria to evaluate vaccines for funding decisions. By means of both favourable and unfavourable framings of a hypothetical vaccine across 40 value dimensions, we find support for the view that people indeed consider a broad range of medical and socio-economic criteria relevant. Several of these are not incorporated in standard evaluation frameworks for vaccines. The different results we find for different framings highlight the importance of developing a consistent a priori value framework for vaccine evaluation, rather than evaluating vaccines on an ad hoc basis.
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Affiliation(s)
- Jeroen Luyten
- KU Leuven, Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, Kapucijnenvoer 35, PO 7001, 3000 Leuven, Belgium
| | - Roselinde Kessels
- Department of Data Analytics and Digitalization, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
- Department of Economics, City Campus, University of Antwerp, Prinsstraat 13, 2000 Antwerp, Belgium
| | - Corinne Vandermeulen
- KU Leuven, Department of Public Health and Primary Care, Leuven University Vaccinology Centre, Kapucijnenvoer 35, PO 7001, 3000 Leuven, Belgium;
| | - Philippe Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium;
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Archer RA, Kapoor R, Isaranuwatchai W, Teerawattananon Y, Giersing B, Botwright S, Luttjeboer J, Hutubessy RCW. 'It takes two to tango': Bridging the gap between country need and vaccine product innovation. PLoS One 2020; 15:e0233950. [PMID: 32520934 PMCID: PMC7286512 DOI: 10.1371/journal.pone.0233950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 05/15/2020] [Indexed: 11/23/2022] Open
Abstract
Background Despite a growing global commitment to universal health coverage, considerable vaccine coverage and uptake gaps persist in resource-constrained settings. One way of addressing the gaps is by ensuring product innovation is relevant and responsive to the needs of these contexts. Total Systems Effectiveness (TSE) framework has been developed to characterize preferred vaccine attributes from the perspective of country decision-makers to inform research and development (R&D) of products. A proof of concept pilot study took place in Thailand in 2018 to examine the feasibility and usefulness of the TSE approach using a rotavirus hypothetical test-case. Methods The excel-based model used multiple-criteria decision analysis (MCDA) to compare and evaluate five hypothetical rotavirus vaccine products. The model was populated with local data and products were ranked against decision criteria identified by Thai stakeholders. A one-way sensitivity analysis was performed to identify criteria that influenced vaccine ranking. Self-assessment forms were distributed to R&D stakeholders on the usability of the approach and were subsequently analysed. Results The model identified significant parameters that impacted on MCDA rankings. Self-assessment forms revealed that TSE was perceived as being able to encourage closer collaboration between country decision makers and vaccine developers. Conclusions The pilot study demonstrates that it is feasible to use an MCDA approach to elicit stakeholder preferences and determine influential parameters to help identify the preferred product characteristics for R&D from the perspective of country decision-makers. It found that TSE can help steer manufacturers to develop products that are better aligned with country need. Findings will guide further development of the TSE concept.
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Affiliation(s)
- Rachel A. Archer
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
- * E-mail:
| | - Ritika Kapoor
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Birgitte Giersing
- Immunization, Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
| | - Siobhan Botwright
- Immunization, Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
| | - Jos Luttjeboer
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Asc Academics, Groningen, The Netherlands
| | - Raymond C. W. Hutubessy
- Immunization, Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
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9
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de Waure C, Boccalini S, Bonanni P, Amicizia D, Poscia A, Bechini A, Barbieri M, Capri S, Specchia ML, Di Pietro ML, Arata L, Cacciatore P, Panatto D, Gasparini R. Adjuvanted influenza vaccine for the Italian elderly in the 2018/19 season: an updated health technology assessment. Eur J Public Health 2019; 29:900-905. [PMID: 30929026 PMCID: PMC6761839 DOI: 10.1093/eurpub/ckz041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The elderly, defined here as subjects aged ≥ 65 years, are among at-risk subjects for whom annual influenza vaccination is recommended. For the 2018/19 season, three vaccine types are available for the elderly in Italy: trivalent inactivated vaccine (TIV), adjuvanted TIV (aTIV) and quadrivalent inactivated vaccines (QIV). No health technology assessment (HTA) of seasonal influenza vaccination in the elderly has previously been conducted in Italy. METHODS An HTA was conducted in 2017 to analyze the burden of influenza illness, the characteristics, efficacy, safety and cost-effectiveness of available vaccines and the related organizational and ethical implications. This was then contextualized to the 2018/19 influenza season. Comprehensive literature reviews/analyses were performed and a static mathematical model developed in order to address the above issues. RESULTS In Italy, influenza is usually less common in the elderly than in other age-classes, but the burden of disease is the highest; >10% of infected elderly subjects develop complications, and about 90% of all influenza-related deaths occur in this age-class. All available vaccines are effective, safe and acceptable from an ethical standpoint. However, aTIV has proved more immunogenic and effective in the elderly. Furthermore, from the third payer's perspective, aTIV is highly cost-effective and cost-saving in comparison with TIV and QIV, respectively. Nevertheless, vaccination coverage needs to be improved. CONCLUSIONS According to this HTA, aTIV appeared the vaccine of choice in the elderly. HTA should be reapplied whenever new relevant data become available.
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Affiliation(s)
- Chiara de Waure
- Institute of Public Health - Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Sara Boccalini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Daniela Amicizia
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Andrea Poscia
- Institute of Public Health - Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angela Bechini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Marco Barbieri
- Centre for Health Economics, University of York, York, UK
| | - Stefano Capri
- School of Economics and Management, Cattaneo LIUC University, Castellanza, Italy
| | - Maria Lucia Specchia
- Institute of Public Health - Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Luisa Di Pietro
- Institute of Public Health - Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lucia Arata
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Pasquale Cacciatore
- Institute of Public Health - Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
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