ICES, Laboratory Medicine and Pathobiology and the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
ICES, Laboratory Medicine and Pathobiology and the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Vaccine. 2020 Mar 4;38(11):2512-2518. doi: 10.1016/j.vaccine.2020.01.092. Epub 2020 Feb 11.
Despite the WHO recommendation that economic evidence be considered in national vaccine recommendations, this element of decision-making has been lacking or not done routinely in Canada. This study aimed to investigate barriers and facilitators to using economic evaluations in public health immunization programs decision-making across Canadian jurisdictions.
This mixed methods study consisted of a cross-sectional survey and semi-structured interviews of national, provincial and territorial public health level key informants, and of members of the national immunization research network in Canada. Barriers were categorized according to accessibility (e.g. access to human resources to conduct the evaluation) and acceptability (e.g. political resistance to using the evaluation).
Of 63 survey participants, 12 were federal, provincial or territorial key informants (response rate 12/31, 39%) and 51 were members from the research network (response rate 51/214, 24%). Eleven stakeholders gave semi-structured interviews. All respondents support increased use of economic evaluation and of it becoming a routine part of immunization policy-making. However, 70% of the survey respondents identified limited resources (human and financial) to perform economic evaluations, and 39% reported lack of expertise to interpret economic evidence. Vaccine effectiveness and the burden of disease were seen as more important than cost-effectiveness by survey respondents and interviewees. Potential facilitators were for economic evaluations to either be conducted at the national level, or through a collaboration between provinces and territories with capacity to address shared needs so that evaluations occurred in a co-ordinated but distributed way.
Barriers to incorporation of economic evaluation in immunization policy-making in Canada include lacking human and financial resources to conduct them and understanding of economic evidence. National, provincial and territorial public health actors reported that facilitators to incorporating economic evidence include developing increased capacity to conduct and use economic evaluations and establishing inter-jurisdictional systems to share the work of conducting economic evaluation and/or by national leadership.
尽管世界卫生组织（WHO）建议在国家疫苗推荐中考虑经济证据，但加拿大在决策中一直缺乏或没有常规进行这一要素。本研究旨在调查加拿大各司法管辖区在公共卫生免疫规划决策中使用经济评估的障碍和促进因素。
这项混合方法研究包括对加拿大国家、省和地区公共卫生层面的主要利益相关者，以及国家免疫研究网络成员的横断面调查和半结构化访谈。障碍根据可及性（例如，进行评估的人力资源获取）和可接受性（例如，对使用评估的政治抵制）进行分类。
在 63 名调查参与者中，有 12 名是联邦、省或地区的主要利益相关者（回应率 12/31，39%），51 名是研究网络的成员（回应率 51/214，24%）。11 名利益相关者接受了半结构化访谈。所有受访者都支持增加经济评估的使用，并使其成为免疫决策的常规部分。然而，70%的调查受访者认为进行经济评估的资源（人力和财力）有限，39%的受访者报告缺乏解释经济证据的专业知识。调查受访者和访谈者认为疫苗效力和疾病负担比成本效益更重要。潜在的促进因素包括在国家层面进行经济评估，或通过有能力解决共同需求的省份和地区之间的合作，以协调但分布式的方式进行评估。
加拿大将经济评估纳入免疫政策制定的障碍包括缺乏进行评估的人力和财力资源，以及对经济证据的理解。国家、省和地区的公共卫生行为体报告说，纳入经济证据的促进因素包括增加进行和使用经济评估的能力，以及建立跨司法管辖区的系统来分担进行经济评估的工作，或者通过国家领导。
