Brassel Simon, Neri Margherita, O'Neill Phill, Steuten Lotte
Office of Health Economics, London, United Kingdom.
Vaccine X. 2021 Apr 6;8:100096. doi: 10.1016/j.jvacx.2021.100096. eCollection 2021 Aug.
Many health technology assessment (HTA) agencies limit their assessments of vaccines to the health benefits for the vaccinated individual, the costs associated with vaccine administration and the disease avoided. However, because the value of vaccines tends to accrue to a large extent beyond the vaccinated individual, they are systematically undervalued in many current HTA processes. This is also the case in the UK, where the Joint Committee on Vaccination and Immunisation (JCVI) is in charge of assessing preventative vaccines, while therapeutic vaccines fall in the realm of the National Institute for Clinical Excellence (NICE). To contribute to a forward-looking perspective, we designed a framework to capture the broader value of vaccination. We reviewed the current state of the global vaccines pipeline and selected seven preventative and three therapeutic vaccines that are likely to enter the UK market within five years. We assessed on which value elements the selected vaccines would potentially generate value, and compared those against the novel broader value framework. A review of the current value elements considered by the JCVI and NICE allowed identifying the critical gaps between potential value generation and value recognition. To our knowledge, this is the first time that the broader value of vaccination has been pro-actively assessed for pipeline vaccinations. Our findings show that the existing narrow evaluation frameworks are likely to systematically undervalue the value of potential future vaccines coming to the UK market. This is particularly relevant, where their impact on AMR and other health interventions, and on the productivity of the workforce is of concern. Recommendations to overcome this include an explicit and more consistent inclusion of, and data collection on, the impact of vaccines on AMR and other health interventions by JCVI and NICE; the consideration of a societal perspective and the fiscal impact of vaccines to societies.
许多卫生技术评估（HTA）机构将其对疫苗的评估局限于接种疫苗个体的健康益处、疫苗接种相关成本以及避免的疾病。然而，由于疫苗的价值在很大程度上会惠及接种者之外的人群，在当前许多卫生技术评估过程中，它们被系统性地低估了。英国的情况也是如此，疫苗接种与免疫联合委员会（JCVI）负责评估预防性疫苗，而治疗性疫苗则由国家卫生与临床优化研究所（NICE）负责评估。为了提供前瞻性视角，我们设计了一个框架来衡量疫苗更广泛的价值。我们审视了全球疫苗研发的现状，挑选了七种可能在五年内进入英国市场的预防性疫苗和三种治疗性疫苗。我们评估了所选疫苗可能在哪些价值要素上产生价值，并将其与全新的更广泛价值框架进行比较。对JCVI和NICE目前所考虑的价值要素进行审查，有助于找出潜在价值创造与价值认知之间的关键差距。据我们所知，这是首次对处于研发阶段的疫苗主动评估其更广泛的价值。我们的研究结果表明，现有的狭义评估框架可能会系统性地低估未来可能进入英国市场的疫苗的价值。在关注疫苗对抗菌药物耐药性（AMR）和其他卫生干预措施以及劳动力生产力的影响时，这一点尤为重要。克服这一问题的建议包括，JCVI和NICE明确且更一致地纳入疫苗对AMR和其他卫生干预措施的影响并进行数据收集；考虑社会视角以及疫苗对社会的财政影响。
