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Mohy A, Lagoubi Y, Gomez JA, Amadou B, Bouskraoui M. Health economic evaluation of 2-dose and 3-dose rotavirus vaccines in children below 5 years of age in Morocco. Hum Vaccin Immunother 2024; 20:2353480. [PMID: 38757507 PMCID: PMC11110695 DOI: 10.1080/21645515.2024.2353480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/07/2024] [Indexed: 05/18/2024] Open
Abstract
Following the introduction of rotavirus vaccination into the Moroccan National Immunization Program, the prevalence of the disease has decreased by nearly 50%. However, evidence on the economic value of rotavirus vaccinations in Morocco is limited. This health economic analysis evaluated, from both country payer and societal perspectives, the costs and the cost-effectiveness of three rotavirus vaccines using a static, deterministic, population model in children aged < 5 years in Morocco. Included vaccines were HRV (2-dose schedule), HBRV (3-dose schedule) and BRV-PV 1-dose vial (3-dose schedule). One-way and probabilistic sensitivity analyses were conducted to assess the impact of uncertainty in model inputs. The model predicted that vaccination with HRV was estimated to result in fewer rotavirus gastroenteritis events (-194 homecare events, -57 medical visits, -8 hospitalizations) versus the 3-dose vaccines, translating into 7 discounted quality-adjusted life years gained over the model time horizon. HRV was associated with lower costs versus HBRV from both the country payer (-$1.8 M) and societal (-$4.1 M) perspectives, and versus BRV-PV 1-dose vial from the societal perspective (-$187,000), dominating those options in the cost-effectiveness analysis. However, costs of BRV-PV 1-dose vial were lower than HRV from the payer perspective, resulting in an ICER of approximately $328,376 per QALY, above the assumed cost effectiveness threshold of $3,500. Vaccination with a 2-dose schedule of HRV may be a cost-saving option and could lead to better health outcomes for children in Morocco versus 3-dose schedule rotavirus vaccines.
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Affiliation(s)
- Ahmed Mohy
- Value Evidence & Outcomes Emerging Markets, GSK, Wavre, Belgium
| | | | - Jorge A. Gomez
- Vaccines, Emerging Markets, GSK, Buenos Aires, Argentina
| | - Barry Amadou
- Vaccines Emerging Markets, GSK, Casablanca, Morocco
| | - Mohammed Bouskraoui
- Faculté de Médecine et de Pharmacie, Cadi Ayyad University, Marrakech, Morocco
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2
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Standaert B, Ethgen O. Discounting health gain: a different view. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2023; 11:2275350. [PMID: 37937314 PMCID: PMC10627044 DOI: 10.1080/20016689.2023.2275350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/22/2023] [Indexed: 11/09/2023]
Abstract
At least since the Age of Enlightenment, good health has been a tenet for society. Healthy societies could learn better, work harder, improve their wealth, and live longer. Today societies focus on life expectancy, as we value long and healthy lives. As illustrated by the provision of COVID-19 vaccines first for the elderly, societies value life-saving actions. Paradoxically, health economic assessments conventionally devalue long-lasting health through the practice of discounting health benefits along with costs. However, health, with its intrinsic and instrumental characteristics, is not synonymous with money cash, a tradeable asset that devalues with time. If improving healthy life expectancy is a societal ambition, it seems counter-intuitive to value future health less as a result of an artificial mathematical construct when evaluating economically new medical interventions. In this paper, we investigate the application of discounting health in healthcare and consider paradoxical findings, especially in relation to disease prevention with vaccination. We argue that there is no economically sustainable argument to discount health gains, except for the benefit of the payer with a goal of spending less on life-saving products. If that is the objective for discounting health, there are other means to achieve the same goal in a more transparent and simpler way. From the long-term perspective of healthcare development, not discounting health gains would encourage research that values long-term effects. This in turn has the potential to benefit the investor, the payer, and the patient/consumer, improving the situation from multiple perspectives.
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Affiliation(s)
- Baudouin Standaert
- Faculty of Medicine & Life sciences, University of Hasselt, Diepenbeek, Belgium
| | - Olivier Ethgen
- Department of Public Health, Epidemiology & Health Economics, University of Liège, Liège, Belgium
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3
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Di Fusco M, Mendes D, Steuten L, Bloom DE, Drummond M, Hauck K, Pearson-Stuttard J, Power R, Salisbury D, Towse A, Roiz J, Szabo G, Yang J, Marczell K. The Societal Value of Vaccines: Expert-Based Conceptual Framework and Methods Using COVID-19 Vaccines as a Case Study. Vaccines (Basel) 2023; 11:234. [PMID: 36851112 PMCID: PMC9961127 DOI: 10.3390/vaccines11020234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/13/2023] [Accepted: 01/15/2023] [Indexed: 01/22/2023] Open
Abstract
Health technology assessments (HTAs) of vaccines typically focus on the direct health benefits to individuals and healthcare systems. COVID-19 highlighted the widespread societal impact of infectious diseases and the value of vaccines in averting adverse clinical consequences and in maintaining or resuming social and economic activities. Using COVID-19 as a case study, this research work aimed to set forth a conceptual framework capturing the broader value elements of vaccines and to identify appropriate methods to quantify value elements not routinely considered in HTAs. A two-step approach was adopted, combining a targeted literature review and three rounds of expert elicitation based on a modified Delphi method, leading to a conceptual framework of 30 value elements related to broader health effects, societal and economic impact, public finances, and uncertainty value. When applying the framework to COVID-19 vaccines in post-pandemic settings, 13 value elements were consensually rated highly important by the experts for consideration in HTAs. The experts reviewed over 10 methods that could be leveraged to quantify broader value elements and provided technical forward-looking recommendations. Limitations of the framework and the identified methods were discussed. This study supplements ongoing efforts aimed towards a broader recognition of the full societal value of vaccines.
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Affiliation(s)
- Manuela Di Fusco
- Health Economics and Outcomes Research, Pfizer Inc., New York, NY 10017, USA
| | - Diana Mendes
- Health & Value, Pfizer Co., Ltd., Tadworth KT20 7NS, UK
| | | | - David E Bloom
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Michael Drummond
- Centre for Health Economics, Alcuin A Block, University of York, Heslington, York YO10 5DD, UK
| | - Katharina Hauck
- Department of Infectious Disease Epidemiology, Faculty of Medicine, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Jonathan Pearson-Stuttard
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK
- Health Analytics, Lane Clark & Peacock, London W1U 1DQ, UK
| | - Rachel Power
- The Patients Association, PO Box 935, Harrow HA1 3YJ, UK
| | - David Salisbury
- Programme for Global Health, Royal Institute of International Affairs, Chatham House, London SW1Y 4LE, UK
| | | | - Julie Roiz
- Evidence, Value and Access by PPD, Evidera, London W6 8BJ, UK
| | - Gabor Szabo
- Evidence, Value and Access by PPD, Evidera, H-1113 Budapest, Hungary
| | - Jingyan Yang
- Health Economics and Outcomes Research, Pfizer Inc., New York, NY 10017, USA
- Institute for Social and Economic Research and Policy, Graduate School of Arts and Science, Columbia University, New York, NY 10027, USA
| | - Kinga Marczell
- Evidence, Value and Access by PPD, Evidera, H-1113 Budapest, Hungary
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CALABRÒ GIOVANNAELISA, ICARDI GIANCARLO, BONANNI PAOLO, GABUTTI GIOVANNI, VITALE FRANCESCO, RIZZO CATERINA, CICCHETTI AMERICO, STAIANO ANNAMARIA, ANSALDI FILIPPO, ORSI ANDREA, DE WAURE CHIARA, PANATTO DONATELLA, AMICIZIA DANIELA, BERT FABRIZIO, VILLANI ALBERTO, IERACI ROBERTO, CONVERSANO MICHELE, RUSSO CARMELA, RUMI FILIPPO, SCOTTI SILVESTRO, MAIO TOMMASA, RUSSO ROCCO, VACCARO CONCETTAMARIA, SILIQUINI ROBERTA, RICCIARDI WALTER. [Flu vaccination and value-based health care: operational solutions to safeguard public health]. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E1-E85. [PMID: 36310765 PMCID: PMC9586154 DOI: 10.15167/2421-4248/jpmh2022.63.2s2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- GIOVANNA ELISA CALABRÒ
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma
- VIHTALI - Value In Health Technology and Academy for Leadership & Innovation, Spin-Off dell'Università Cattolica del Sacro Cuore, Roma
- Autore corrispondente: Giovanna Elisa Calabrò, Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia - E-mail:
| | - GIANCARLO ICARDI
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
- U.O. Igiene, IRCCS Ospedale Policlinico San Martino, Genova
| | - PAOLO BONANNI
- Dipartimento di Scienze della Salute (DSS), Università di Firenze
| | - GIOVANNI GABUTTI
- Coordinatore Nazionale GdL Vaccini e Politiche Vaccinali della SItI
| | - FRANCESCO VITALE
- Dipartimento Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, Università degli Studi di Palermo
| | - CATERINA RIZZO
- Dipartimento di ricerca traslazionale e nuove tecnologie in medicina e chirurgia, Università degli Studi di Pisa
| | - AMERICO CICCHETTI
- Alta Scuola di Economia e Management dei Sistemi Sanitari (ALTEMS), Università Cattolica del Sacro Cuore, Roma
| | - ANNAMARIA STAIANO
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi “Federico II”, Napoli
- Presidente Società Italiana di Pediatria (SIP)
| | - FILIPPO ANSALDI
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
- A.Li.Sa. Azienda Ligure Sanitaria Regione Liguria
| | - ANDREA ORSI
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
- U.O. Igiene, IRCCS Ospedale Policlinico San Martino, Genova
| | - CHIARA DE WAURE
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia
| | - DONATELLA PANATTO
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - DANIELA AMICIZIA
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
- A.Li.Sa. Azienda Ligure Sanitaria Regione Liguria
| | - FABRIZIO BERT
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università degli Studi di Torino
- SSDU Igiene Ospedaliera e Governo delle Infezioni Correlate all’Assistenza, ASL TO3
| | - ALBERTO VILLANI
- Dipartimento Emergenza Accettazione Ospedale Pediatrico Bambino Gesù, IRCCS, Roma
- Dipartimento di Medicina dei Sistemi, Università di Roma Tor Vergata
| | - ROBERTO IERACI
- Strategie vaccinali, Regione Lazio
- Ricercatore associato CID Ethics-CNR
| | | | - CARMELA RUSSO
- U.O.S.V.D. Epidemiologia - Comunicazione e Formazione Coordinamento delle Attività di Promozione della Salute e di Educazione Sanitaria, ASL Taranto
| | - FILIPPO RUMI
- Alta Scuola di Economia e Management dei Sistemi Sanitari (ALTEMS), Università Cattolica del Sacro Cuore, Roma
| | | | - TOMMASA MAIO
- Federazione Italiana Medici di Medicina Generale (FIMMG)
| | - ROCCO RUSSO
- Coordinatore tavolo tecnico vaccinazioni, Società Italiana di Pediatria (SIP)
| | | | - ROBERTA SILIQUINI
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università degli Studi di Torino
- AOU Città della Salute e della Scienza di Torino
| | - WALTER RICCIARDI
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma
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Acceptance and application of a broad population health perspective when evaluating vaccine. Vaccine 2022; 40:3395-3401. [PMID: 35525728 PMCID: PMC9068250 DOI: 10.1016/j.vaccine.2022.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 12/04/2022]
Abstract
The traditional health economic analysis is limited to estimating the impact on the treated patient. As vaccines are usually aimed at preventing infectious diseases, they may be associated with additional values for the non-treated wider population. Although there are valid reasons for treating vaccines differently, and a wide support for a broader perspective in the literature (i.e., beyond the net costs and health gain related to the outcome for the vaccinated individual), it remains unclear to what extent the Health Technology Assessment (HTA) agencies accept and apply a broader perspective. The purpose of this study is to examine and discuss what type of consequences are relevant for a health economic analysis of vaccines and which consequences are considered by HTA agencies. The study includes a strategic review of literature and HTA decisions in Sweden and other countries, online round-table discussions with stakeholders in Sweden, and a basic estimation of the value of a COVID-19 vaccination in Sweden. The study shows that, other than herd effect, broader economic consequences for the population are generally not included in the economic evaluation of vaccines. Also, all economic consequences for the treated patient (production loss) and caregiver (health loss) are not always considered. The perspective chosen can have a major impact on the outcome of the analysis. A vaccine for COVID-19 is estimated to provide a value of €744–€956 per dose when using a societal perspective including broader consequences for the population. Providing a complete and appropriate picture of the value of vaccination is of importance to allocate resources efficiently, to provide incentives for vaccine development, and to show the cost of delaying decisions to implement a new vaccine.
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Mauskopf J, Blake L, Eiden A, Roberts C, Hu T, Nyaku M. Economic Evaluation of Vaccination Programs: A Guide for Selecting Modeling Approaches. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:810-823. [PMID: 35221205 DOI: 10.1016/j.jval.2021.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/08/2021] [Accepted: 10/20/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Illustrate 3 economic evaluation methods whose value measures may be useful to decision makers considering vaccination programs. METHODS Keyword searches identified example publications of cost-effectiveness analysis (CEA), fiscal health modeling (FHM), and constrained optimization (CO) for economic evaluation of a vaccination program in countries where at least 2 of the methods had been used. We examined the extent to which different value measures may be useful for decision makers considering adoption of a new vaccination program. With these findings, we created a guide for selecting modeling approaches illustrating the decision-maker contexts and policy objectives for which each method may be useful. RESULTS We identified 8 countries with published evaluations for vaccination programs using >1 method for 4 infections: influenza, human papilloma virus, rotavirus, and malaria. CEA studies targeted health system decision makers using a threshold to determine the efficiency of a new vaccination program. FHM studies targeted public sector spending decision makers estimating lifetime changes in government tax revenue net of transfer payments. CO studies targeted decision makers selecting from a mix of options for preventing an infectious disease within budget and feasibility constraints. Cost and utility inputs, epidemiologic models, comparators, and constraints varied by modeling method. CONCLUSIONS Although CEAs measures of incremental cost-effectiveness ratios are critical for understanding vaccination program efficiency for all decision makers determining access and reimbursement, FHMs provide measures of the program's impact on public spending for government officials, and COs provide measures of the optimal mix of all prevention interventions for public health officials.
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Affiliation(s)
- Josephine Mauskopf
- Department of Health Economics, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Leslie Blake
- Department of Health Economics, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Amanda Eiden
- Center for Observation and Real-World Evidence, Merck & Co, Inc, Kenilworth, NJ, USA
| | - Craig Roberts
- Center for Observation and Real-World Evidence, Merck & Co, Inc, Kenilworth, NJ, USA
| | - Tianyan Hu
- Center for Observation and Real-World Evidence, Merck & Co, Inc, Kenilworth, NJ, USA
| | - Mawuli Nyaku
- Center for Observation and Real-World Evidence, Merck & Co, Inc, Kenilworth, NJ, USA.
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7
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Janssen RS, Bruxvoort K, Jacobsen SJ, Slezak J, David C, Hyer R, Poland GA. Considerations for estimating real-world outcomes and value in vaccination: A case study with adult hepatitis B virus vaccination. Vaccine 2021; 39:5666-5672. [PMID: 34404556 DOI: 10.1016/j.vaccine.2021.07.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND In the absence of field efficacy studies, estimating the real-world effectiveness of vaccines may consider immunogenicity from randomized controlled clinical trials and real-world adherence. Combining seroprotection rates (SPRs) with regimen completion rates gives an estimate of an effective vaccine protection rate (eVPR), which can be leveraged to evaluate real-world cost-effectiveness by linking it with vaccine costs to estimate the cost-per-protected patient (CPP). METHODS This study evaluated eVPR and CPP as estimates of vaccine clinical- and cost-effectiveness of two-dose (HepB-CpG) and three-dose (HepB-Alum) hepatitis B virus (HBV) vaccines in the general adult population and a subpopulation with diabetes mellitus. eVPR was calculated from head-to-head SPR data from phase 3 clinical trials directly comparing HepB-CpG and HepB-Alum vaccine regimens and real-world head-to-head adherence data. CPP was calculated as the average cost of each regimen divided by eVPR. RESULTS Higher eVPR in the adult population was achieved with HepB-CpG (68.0%) versus HepB-Alum (41.6%), reflecting the combination of higher SPR and vaccine regimen completion. The CPP for HepB-CpG ($331.31) was $45.67 (95% CI: $36.66, $55.19) less than HepB-Alum ($377.09). Greater savings were observed among persons with diabetes, with CPP $149.60 (95% CI: $80.29, $195.63) lower with HepB-CpG ($367.57) than HepB-Alum ($517.37). CONCLUSIONS Metrics estimating vaccine real-world effectiveness and value may guide informed decisions in vaccine selection. For example, using eVPR and CPP, HepB-CpG represents a more effective, value-advantaged approach than HepB-Alum toward reducing HBV infection.
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Affiliation(s)
- Robert S Janssen
- Clinical Development, Dynavax Technologies, 2100 Powell St, Emeryville, CA 94608, USA.
| | - Katia Bruxvoort
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, USA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, USA
| | - Jeff Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, USA
| | - Coline David
- Market Access and Policy, Dynavax Technologies, 2100 Powell St, Emeryville, CA 94608, USA
| | - Randall Hyer
- Medical Affairs, Dynavax Technologies, 2100 Powell St, Emeryville, CA 94608, USA
| | - Gregory A Poland
- Mayo Vaccine Research Group, Mayo Clinic, 200 1st St, SW Rochester, MN 55905, USA
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8
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Sauboin C, Mihajlović J, Postma MJ, Geets R, Antic D, Standaert B. Informing decision makers seeking to improve vaccination programs: case-study Serbia. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2021; 9:1938894. [PMID: 34367530 PMCID: PMC8317957 DOI: 10.1080/20016689.2021.1938894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 06/13/2023]
Abstract
Background:The optimisation of vaccine policies before their implementation is beholden upon public health decision makers, seeking to maximise population health. In this case study in Serbia, the childhood vaccines under consideration included pneumococcal conjugate vaccination (PCV), rotavirus (RV) vaccination and varicella zoster virus (VZV) vaccination. Objective: The objective of this study is to define the optimal order of introduction of vaccines to minimise deaths, quality adjusted life years (QALYs) lost, or hospitalisation days, under budget and vaccine coverage constraints. Methods: A constrained optimisation model was developed including a static multi-cohort decision-tree model for the three infectious diseases. Budget and vaccine coverage were constrained, and to rank the vaccines, the optimal solution to the linear programming problem was based upon the ratio of the outcome (deaths, QALYs or hospitalisation days) per unit of budget. A probabilistic decision analysis Monte Carlo simulation technique was used to test the robustness of the rankings. Results: PCV was the vaccine ranked first to minimise deaths, VZV vaccination for QALY loss minimisation and RV vaccination for hospitalisation day reduction. Sensitivity analysis demonstrated the most robust ranking was that for PCV minimizing deaths. Conclusion: Constrained optimisation modelling, whilst considering all potential interventions currently, provided a comprehensive and rational approach to decision making.
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Affiliation(s)
- Christophe Sauboin
- Health Economics Department, GSK, Wavre, Belgium
- Department of Health Sciences, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
- Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
| | - Jovan Mihajlović
- Department of Health Sciences, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
- Mihajlović Health Analytics (Miha), Novi Sad, Serbia
| | - Maarten Jacobus Postma
- Department of Health Sciences, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
- Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
| | - Regine Geets
- Health Economics Department, GSK, Wavre, Belgium
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Buchy P, Chen J, Zhang XH, Benninghoff B, Lee C, Bibera GL. A review of rotavirus vaccine use in Asia and the Pacific regions: challenges and future prospects. Expert Rev Vaccines 2021; 20:1499-1514. [PMID: 33275065 DOI: 10.1080/14760584.2020.1853532] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Rotavirus infection causes a significant proportion of diarrhea disease burden in children <5 years of age in Asia and the Pacific regions. The World Health Organization recommends that rotavirus vaccination should be included in national immunization programs to prevent rotavirus gastroenteritis (RVGE).Areas covered: A literature review was performed to identify and summarize published evidence on RVGE epidemiology and status of rotavirus vaccine use, including the impact and cost-effectiveness of rotavirus vaccination programs in Asia and the Pacific regions (49 countries) during the period 2000-2018.Expert opinion: Rotavirus vaccination programs have successfully reduced the burden of RVGE in many countries. However, such programs still do not exist in most Asia-Pacific countries, and therefore the burden of RVGE remains high in children <5 years of age. Challenges to vaccine implementation include a lack of surveillance data; safety concerns around intussusception; a general lack of awareness about RVGE disease epidemiology and vaccines among physicians, policy-makers, and parents; insufficient cost-effectiveness analyses; and potential issues with vaccine affordability including vaccination costs and lack of political will. Recommendations to overcome these challenges include developing cost-effectiveness analyses for more diverse national and regional settings, providing non-governmental support for low-income countries, and improving advocacy efforts.Plain language summaryWhat is the context?• Rotavirus (RV) infection causes acute gastroenteritis (GE) in children under 5 years of age.• Rotavirus vaccination (RVV) implementation has been slow in Asia and the Pacific (AP) regions, which could be responsible for the region falling behind in their fight against RVGE.What is new?• RVV via national immunization programs (NIPs) is available in 8/49 countries and through the private market or non-governmental support in other countries. Coverage rates vary between countries, possibly driven by the mechanism through which RVV is available.• A substantial positive impact of RVV on RVGE disease burden with a very low risk of intestinal intussusception for up to 7 days after RVV has been documented in the AP regions.• Economic evaluation studies, mainly cost-effectiveness analyses, predict a significant reduction in treatment costs related to RVGE and its complications showing that RVV is good value for money.What is the impact?• The prospect of continued safe and effective use of RVV in the AP regions is promising.• Challenges to RVV implementation include establishing evidence of burden of disease, poor awareness of rotavirus vaccines, limited evidence from cost-effectiveness analyses from several countries, issues of affordability of the vaccine and a lack of political will.• Recommendations for RVV implementation into the NIPs include conducting clinical and cost-effectiveness studies in countries where these are not available, establishing reliable surveillance mechanisms, providing non-governmental support for low-income countries and improving advocacy efforts.• Maintenance of high vaccination coverage is needed in countries that have implemented national RVV programs.Graphical abstract[Formula: see text].
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Janse M, Brouwers T, Claassen E, Hermans P, van de Burgwal L. Barriers Influencing Vaccine Development Timelines, Identification, Causal Analysis, and Prioritization of Key Barriers by KOLs in General and Covid-19 Vaccine R&D. Front Public Health 2021; 9:612541. [PMID: 33959579 PMCID: PMC8096063 DOI: 10.3389/fpubh.2021.612541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
A frequently mentioned factor holding back the introduction of new vaccines on the market are their prohibitively long development timelines. These hamper their potential societal benefit and impairs the ability to quickly respond to emerging new pathogens. This is especially worrisome since new pathogens are emerging at all-time high rates of over one per year, and many age-old pathogens are still not vaccine preventable.Through interviews with 20 key-opinion-leaders (KOLs), this study identified innovation barriers that increase vaccine development timelines. These innovation barriers were visualized, and their underlying causes revealed by means of qualitative root cause analysis. Based on a survey the innovation barriers were quantitatively ranked based on their relative impact on both regular, and Covid-19 vaccine development timelines. KOLs identified 20 key innovation barriers, and mapping these barriers onto the Vaccine Innovation Cycle model revealed that all phases of vaccine development were affected. Affected by most barriers is the area between the preclinical studies and the market entry. Difficult hand-off between academia and industry, lack of funding, and lack of knowledge of pathogen targets were often mentioned as causes. Quantitative survey responses from 93 KOLs showed that general vaccine development and Covid-19 vaccine development are impacted by distinct sets of innovation barriers. For the general vaccine development three barriers were perceived of the highest impact; limited ROI for vaccines addressing disease with limited market size, limited ROI for vaccines compared to non-vaccine projects, and academia not being able to progress beyond proof of principle. Of highest impact on Covid-19 vaccine development, are lack of knowledge concerning pathogen target, high risk of upscaling unlicensed vaccines, and proof of principle not meeting late-stage requirements. In conclusion, the current study demonstrates that barriers hampering timelines in vaccine development are present across the Vaccine Innovation Cycle. Prioritizing the impact of barriers in general, and in Covid-19 vaccine development, shows clear differences that can be used to inform policies to speed up development in both war and peace time.
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Affiliation(s)
- Marga Janse
- Athena Institute, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands
| | - Thomas Brouwers
- Athena Institute, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands
| | - Eric Claassen
- Athena Institute, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands
| | - Peter Hermans
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht (UMCU), Utrecht, Netherlands
| | - Linda van de Burgwal
- Athena Institute, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands
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