Health economics research
Decision-making tools and guidance
Guidance on cost-effectiveness
The need to improve the transparency, completeness and comparability of data led IVR to develop clear, practical and high-quality guidance (see attached document on standardization on the next page) for those who carry out economic evaluations of vaccination programmes. Adherence to high-quality, standardized guidelines will increase the quality, interpretability and transferability of future analyses. The guidelines also address more specific issues related to the economics of vaccination programmes, such as methods to estimate future benefits and the much-debated inclusion of indirect costs and discounting of future health outcomes.
Broader economic impact of vaccines and immunization programmes
IVR convened a group of experts in Toronto, Canada in July 2011 to discuss broader approaches to evaluate the economic impact of vaccination, and to facilitate the collection of local evidence. Vaccinations can affect economic activity both at the individual and population level. They result in lifetime productivity gains by preventing diseases that cause cognitive impairment, physical handicap, or reduced schooling. In addition, fewer child deaths will lead to lower fertility rates over time. This, in turn, will decrease the ratio of economically dependent people in society, which will strengthen the labour force and the economy. Most economic evaluations of vaccinations do not consider other added value of vaccination in the wider community, e.g. herd immunity.
Traditional cost-effectiveness analyses present outcomes in terms of cost savings per disability-adjusted life years (DALYs) averted. These are often difficult to interpret in developing countries, either because they lack cost-effectiveness thresholds or base-line comparisons; or because vaccine financing decisions are made by actors outside the Ministry of Health.
The Ministry of Finance, for example, may be more interested in a Return on Investment or Budget Impact Analysis to show the value of investment in vaccines and immunization programmes. IVR has therefore developed alternative methods to measure the broader economic impact of vaccination to convince decision-makers outside the health sector.
Cost-effectiveness tools for lower- and middle-income countries
Low- and middle-income countries are not always able to use their own locally relevant data in model-based economic appraisals of a vaccine, and accurately interpret the results. IVR therefore embarked on a series of consultations to assess economic analytical tools to support vaccine introduction decisions for pneumococcal, rotavirus and human papillomavirus vaccines. The objective of these assessments is to provide a menu of existing cost-effectiveness tools for vaccines and their characteristics, rather than to endorse a single tool. The outcome will allow policy-makers in developing countries to assess and apply the most appropriate model to inform their own decision-making.
Access to evidence-based tools
To disseminate cost-effectiveness tools, IVR is facilitating the international roll-out of the ProVac Initiative (see link below) established at the Pan American Health Organization. The objective of this initiative is to strengthen national capacity to make evidence-based decisions for new vaccine introduction in low- and middle-income countries through improved resource prioritization, to achieve the greatest and sustainable impact of vaccines.
Cervical Cancer Prevention and Control Costing Tool (C4P)
WHO has developed a generic costing and planning tool for cervical cancer prevention and control.
The tool helps programme planners and managers to generate annual cost projections over a five-year period to scale up activities within the health system. It allows sub-national segmentation, extensive modification of inputs, a strategic approach, resource allocation, and recognition of prevailing prices and other key variables.
It also provides access to transparent underlying calculations and assumptions. The tool is pre-populated with the required data and linked to data sources.
The tool was successfully field tested in the United Republic of Tanzania and Rwanda. A multidisciplinary team from the Government of Tanzania and nongovernmental organizations found the tool user-friendly and practical. It has also been independently validated by a team of international reviewers.
A generic version of the tool has also been developed which can be used in different country settings. The immunization module is available on request by e-mail:vaccineresearch@who.int