Estimating the money flow in the economy attributed to rotavirus disease and vaccination in the Netherlands using a Social Accounting Matrix (SAM) framework

The Knowledge and Application of Economics in Healthcare in a High-Income Country Today: The Case of Belgium

Healthcare is a huge business sector in many countries, focusing on the social function of delivering quality health when people develop illness. The system is essentially financed by public funds based on the solidarity principle. With a large financial outlay, the sector must use economic evaluation methods to achieve better efficiency. The objective of our study was to evaluate and to understand how health economics is used today, taking Belgium as an example of a high-income country. The evaluation started with a historical view of healthcare development and ended with potential projections for its future. A literature review focused on country-specific evaluation reports to identify the health economic methods used, with a search for potential gaps. The first results indicated that Belgium in 2021 devoted 11% of its GDP, 17% of its total tax revenue, and 30% of the national Social Security Fund to health-related activities, totalizing EUR 55.5 billion spending. The main health economic method used was a cost-effectiveness analysis linked to budget impact, assigning reimbursable monetary values to new products becoming available. However, these evaluation methods only impacted at most 20% of the money circulating in healthcare. The remaining 80% was subject to financial regulations (70%) and budgeting (10%), which could use many other techniques of an economic analysis. The evaluation indicated two potentially important changes in health economic use in Belgium. One was an increased focus on budgeting with plans, time frames, and quantified treatment objectives on specific disease problems. Economic models with simulations are very supportive in those settings. The other was the application of constrained optimization methods, which may become the new standard of practice when switching from fee-for-service to pay-per-performance as promoted by value-based healthcare and value-based health management. This economic refocusing to a more constrained approach may help to keep the healthcare system sustainable and affordable in the face of the many future challenges including ageing, climate change, migration, pandemics, logistical limitations, and financial instability.

Fiscal analysis of the pediatric immunization program in Belgium applying a lifetime government perspective framework

OBJECTIVES

A public economic framework was used to explore lifetime government costs and benefits in relation to the Pediatric Immunization Program (PIP) in Belgium based on cases and deaths averted.

METHODS

To estimate changes in net government revenue, we developed a decision-analytic model that quantifies lifetime tax revenues and transfers based on changes in morbidity and mortality arising from Belgium's Pediatric Immunization Program (PIP). The model considered differences in incidence rates with vaccines included in Belgium's PIP: compared with the pre-vaccine era. Changes in deaths and comorbid conditions attributed to PIP on the Belgium 2020 birth cohort were used to estimate gross lifetime earnings changes, tax revenue gains attributed to averted morbidity and mortality avoidance, disability transfer cost savings, and averted special education costs associated with each vaccine.

RESULTS

Vaccinating a single birth cohort according to the PIP gives rise to fiscal gains of €56 million in averted tax revenue loss, €8 million disability savings, and €6 million special education cost-savings. Based on the costs of implementing the PIP, we estimate the fiscal benefit-cost ratio (fBCR) of €2.2 investment return for the government from every €1 invested excluding longevity costs.

CONCLUSIONS

Reducing vaccine-preventable conditions generates tax revenue for the government, providing fiscal justification for sustained immunization investments.

Accounting for Adverse Events Following Immunization in Economic Evaluation: Systematic Review of Economic Evaluations of Pediatric Vaccines Against Pneumococcus, Rotavirus, Human Papillomavirus, Meningococcus and Measles-Mumps-Rubella-Varicella

OBJECTIVES

Economic evaluations of vaccines should accurately represent all relevant economic and health consequences of vaccination, including losses due to adverse events following immunization (AEFI). We investigated to what extent economic evaluations of pediatric vaccines account for AEFI, which methods are used to do so and whether inclusion of AEFI is associated with study characteristics and the vaccine's safety profile.

METHODS

A systematic literature search (MEDLINE, EMBASE, Cochrane Systematic Reviews and Trials, Database of the Centre for Reviews and Dissemination of the University of York, EconPapers, Paediatric Economic Database Evaluation, Tufts New England Cost-Effectiveness Analysis Registry, Tufts New England Global Health CEA, International Network of Agencies for Health Technology Assessment Database) was performed for economic evaluations published between 2014 and 29 April 2021 (date of search) pertaining to the five groups of pediatric vaccines licensed in Europe and the United States since 1998: the human papillomavirus (HPV) vaccines, the meningococcal vaccines (MCV), the measles-mumps-rubella-varicella (MMRV) combination vaccines, the pneumococcal conjugate vaccines (PCV) and the rotavirus vaccines (RV). Rates of accounting for AEFI were calculated, stratified by study characteristics (e.g., region, publication year, journal impact factor, level of industry involvement) and triangulated with the vaccine's safety profile (Advisory Committee on Immunization Practices [ACIP] recommendations and information on safety-related product label changes). The studies accounting for AEFI were analyzed in terms of the methods used to account for both cost and effect implications of AEFI.

RESULTS

We identified 112 economic evaluations, of which 28 (25%) accounted for AEFI. This proportion was significantly higher for MMRV (80%, four out of five evaluations), MCV (61%, 11 out of 18 evaluations) and RV (60%, nine out of 15 evaluations) compared to HPV (6%, three out of 53 evaluations) and PCV (5%, one out of 21 evaluations). No other study characteristics were associated with a study's likelihood of accounting for AEFI. Vaccines for which AEFI were more frequently accounted for also had a higher frequency of label changes and a higher level of attention to AEFI in ACIP recommendations. Nine studies accounted for both the cost and health implications of AEFI, 18 studies considered only costs and one only health outcomes. While the cost impact was usually estimated based on routine billing data, the adverse health impact of AEFI was usually estimated based on assumptions.

DISCUSSION

Although (mild) AEFI were demonstrated for all five studied vaccines, only a quarter of reviewed studies accounted for these, mostly in an incomplete and inaccurate manner. We provide guidance on which methods to use to better quantify the impact of AEFI on both costs and health outcomes. Policymakers should be aware that the impact of AEFI on cost-effectiveness is likely to be underestimated in the majority of economic evaluations.

The Value of Rotavirus Vaccination in Europe: A Call for Action

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has pushed many healthcare systems into crisis. High vaccine coverage amongst children reduces emergency room presentations, hospital admissions and deaths due to vaccine-preventable diseases, freeing up healthcare resources including polymerase chain reaction testing for patients with SARS-CoV-2. In Europe, rotavirus gastroenteritis leads to 75,000-150,000 hospitalisations and up to 600,000 medical encounters annually. Nevertheless, in 2022, only 18 countries in Europe (out of 38) have a publicly funded routine universal mass immunisation programme against rotavirus gastroenteritis. Evidence available in the last few years re-emphasises that rotavirus vaccines currently available in Europe are highly effective, preventing up to 96% of rotavirus-related hospitalisations in children less than 1 year of age (potentially 72,000-144,000 hospitalisations Europe-wide). Long-term surveillance indicates that rotavirus vaccination does not result in an overall increase in intussusception. On the contrary, increasing evidence suggests an overall reduction in intussusception in the first 12 months of life when early, high rotavirus vaccine coverage is achieved. Prevention of rotavirus gastroenteritis has marked positive impacts on parental wages and government tax revenue, with benefits extending across the whole economy. In the SARS-CoV-2 pandemic setting there is a new imperative to achieve high levels of paediatric vaccination against vaccine-preventable diseases, including rotavirus gastroenteritis. The introduction of rotavirus universal mass vaccination can be expected to reduce the number of preventable illnesses, hospitalisations and deaths caused by rotavirus gastroenteritis. Reducing vaccine-preventable diseases is particularly urgent at this time when healthcare systems are preoccupied and overwhelmed with SARS-CoV-2. Graphical abstract available for this article.

Impact Study on Social Accounting Matrix by Intrabusiness Analysis

According to the current concerns about social welfare and environmental protection, integrated in a model assimilated to intrabusiness relations, our research started from the analysis of the initial model SAM, which will be transformed in order to develop the SAMI model under six research objectives. The need of improving SAM matrix started to connect it directly to the regional economic systems and continued to a new approach on Input-Output Analysis. Nowadays, SAM describes the intraregional connections between regional economic actors using the role of different income categories. Moreover, SAM can quantify different regional multipliers. All deficiencies previously identified in connection to SAM model have been reviewed and resolved within the proposed SAMI model by the authors of this paper. The purpose of this research is the launch of an absolutely new mathematical model (SAMI) and its practical testing at regional level. This model is able to systematize the links between the local and regional businesses, under the matrix (SAMI) flow, for all kinds of companies and to assist the regional decision, as well. Czamanski was not able to escape from the input-output prison's approach. This is why he continued to use the linear interdependencies between the industries, economic sectors and economic actors. The income is able only to approximate the individuals and other economic actors' welfare. If the increase in the average and aggregate income is doubled by an unfair distribution of income in two countries which have the same average income, the effects on welfare vary a lot. A relatively similar effect comes from the government policy differences in income distribution and redistribution.

Macroeconomic lockdown and SMEs: the impact of the COVID-19 pandemic in Spain

Abstract

The relative importance of small- and medium-sized enterprises (SMEs) and large firms is a recurrent topic in the small business economics literature. This paper presents a real and financial social accounting matrix (FSAM) capable of distinguishing the direct and indirect effects that are transferred from micro-, small, medium, and large firms to the rest of the economy. We use the hypothetical extraction method (HEM) to explore the sequence of reactions associated with shocks that arise from the COVID-19 lockdown. Using a structural model for the Spanish economy, we identify the role of different firm size categories in the aggregate gross domestic product (GDP). Our results allow us to reconcile the mixed narrative that accompanies the evaluation of the role played by these categories in economic activity by revealing that both SMEs and large firms are important for supporting economic activity. In particular, SMEs help explain 43% of the income and two-thirds of the unemployment decline caused by the COVID-19 pandemic. Our findings also show the importance of conditioning SME industrial policy to sectoral analysis.

Plain English summary

The effects of the macroeconomic lockdown and its transmission to the rest of the economy differ by firm size and across sectors. Using the Spanish context for micro-, small, medium, and large firms, we distinguish the direct and indirect effects caused by the COVID-19 pandemic. The main implications are the following: (1) Research: results emphasize that SMEs and large firms are both important to support economic activity but, in order to account for the relative effects on SMEs, it is crucial to consider the specific sector that receives the disruption. 2) Policy: SMEs are an important focus of business support policies within the EU. According to our estimations, disruptions in SMEs produce larger reductions in demand. These results could support credit policies for SMEs with a strong impact on the aggregate economy due to their greater productive and financial linkages with the domestic economy.

Estimating the Fiscal Consequences of National Immunization Programs Using a "Government Perspective" Public Economic Framework

Infectious diseases can impose considerable mortality and morbidity for children and adult populations resulting in both short- and long-term fiscal costs for government. Traditionally, healthcare costs are the dominant consideration in economic evaluations of vaccines, which likely ignores many costs that fall on governments in relation to vaccine-preventable conditions. In recent years, fiscal health modeling has been proposed as a complementary approach to cost-effectiveness analysis for considering the broader consequences for governments attributed to vaccines. Fiscal modeling evaluates public health investments attributed to treatments or preventive interventions in the case of vaccination, and how these investments influence government public accounts. This involves translating morbidity and mortality outcomes that can lead to disability, associated costs, early retirement due to poor health, and death, which can result in lost tax revenue for government attributed to reduced lifetime productivity. To assess fiscal consequences of public health programs, discounted cash flow analysis can be used to translate how changes in morbidity and mortality influence transfer payments and changes in lifetime taxes paid based on initial health program investments. The aim of this review is to describe the fiscal health modeling framework in the context of vaccines and demonstrate key features of this approach and the role that public economic assessment of vaccines can make in understanding the broader economic consequences of investing in vaccination programs. In this review, we describe the theoretical foundations for fiscal modeling, the aims of fiscal model, the analytical outputs, and discuss the relevance of this framework for evaluating the economics of vaccines.

A Predictive Model for Assessing the Impact of the COVID-19 Pandemic on the Economies of Some Eastern European Countries

The paper seeks to develop a predictive model for assessing the impact of the (COVID-19) pandemic on the economies of Eastern Europe, taking into account quarantine measures. Functions of the dependence on the number of the infected populations in Eastern Europe on pandemic duration were calculated based on trend analysis. Factors affecting the intensity of disease and the number of infected persons have been determined. Integral model of their influence has been built using regression analysis. Based on the values of the factors, the number of infected people and the rate of infection were predicted for each of the Eastern European countries. The prognostic duration of the stage of exponential disease growth and the total duration of quarantine (epidemiological saturation point) are substantiated. The predicted decline in Eastern European GDP due to COVID-19 has been estimated based on the construction of a prognostic regression model. The results obtained can be used by state authorities and economic agents as a tool for active and preventive response. They can also serve as an example of the urgent need to develop, especially in non-standard situations, mechanisms and products of open innovation.

Fifteen years of experience with the oral live-attenuated human rotavirus vaccine: reflections on lessons learned

INTRODUCTION

Rotavirus (RV) disease remains a prominent cause of disease burden in children <5 years of age worldwide. However, implementation of RV vaccination has led to significant reductions in RV mortality, compared to the pre-vaccination era. This review presents 15 years of real-world experience with the oral live-attenuated human RV vaccine (HRV; Rotarix). HRV is currently introduced in ≥80 national immunization programs (NIPs), as 2 doses starting from 6 weeks of age.

AREAS COVERED

The clinical development of HRV and post-marketing experience indicating the impact of HRV vaccination on RV disease was reviewed.

EXPERT OPINION

In clinical trials, HRV displayed an acceptable safety profile and efficacy against RV-gastroenteritis, providing broad protection against heterotypic RV strains by reducing the consequences of severe RV disease in infants. Real-world evidence shows substantial, rapid reduction in the number of RV infections and associated hospitalizations following introduction of HRV in NIPs, regardless of economic setting. Indirect effects against RV disease are also observed, such as herd protection, decrease in nosocomial infections incidence, and a reduction of disease-related societal/healthcare costs. However, not all countries have implemented RV vaccination. Coverage remains suboptimal and should be improved to maximize the benefits of RV vaccination.

How to assess for the full economic value of vaccines? From past to present, drawing lessons for the future

Background:Cost-effectiveness analysis (CEA) is the economic analysis method most commonly applied today in the context of replacing one treatment with a new one in a developed healthcare system to improve efficiency. CEA is often requested by local healthcare decision-makers to grant reimbursement. New preventative interventions, such as new vaccines, may however have much wider benefits inside and outside healthcare, when compared with treatment. These additional benefits include externalities on indirect clinical impact, reallocation of specific healthcare resources, improved quality of care, better productivity, better disease control, better fiscal revenues, and others. But these effects are sometimes difficult to integrate into a meaningful CEA result. They may appear as specific benefits for specific stakeholders, other than the stakeholders in healthcare. Objective: Based on a historical view about the application of economic assessments for vaccines our objective has been to make the inventory of who was/is interested in knowing the economic value of vaccines, in what those different stakeholders are likely to see the benefit from their perspective and how  were/are we able to measure those benefits and to report them well. Results: The historical view disclosed a limited interest in the economic assessment of vaccines at start, more than 50 years ago, that was comparable to the assessment of looking for more efficiency in new industries through optimization exercises. Today, we are exposed to a very rich panoply of different stakeholders (n= 16). They have their specific interest in many different facets of the vaccine benefit of which some are well known in the conventional economic analysis (n=9), but most outcomes are hidden and not enough evaluated and reported (n=26). Meanwhile we discovered that many different methods of evaluation have been explored to facilitate the measurement and reporting of the benefits (n=18). Conclusion: Our recommendation for future economic evaluations of new vaccines is therefore to find the right combination among the three entities of stakeholder type selection, outcome measure of interest for each stakeholder, and the right method to apply. We present at the end examples that illustrate how successful this approach can be.