Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, USA.
Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, USA.
Vaccine. 2021 Nov 5;39(46):6727-6734. doi: 10.1016/j.vaccine.2021.09.070. Epub 2021 Oct 14.
The health and economic benefits of immunization may extend beyond the elements traditionally included in cost-effectiveness analyses (CEAs). This review investigated how broader impacts are considered in economic evaluations of vaccines and whether their inclusion would substantially change CEA findings.
We reviewed CEAs of vaccines associated with the largest global health burden, published from 2014 to 2019 using the Tufts CEA Registry and Tufts Global Health CEA Registry. We supplemented this with a systematic review of published and grey literature. We conducted descriptive analyses to examine the frequency of inclusion of specific social factors and study characteristics associated with their inclusion. We also conducted a case study of the human papilloma virus (HPV) vaccine to illustrate the potential change in CEA findings from selected social impacts.
We identified 475 relevant health economic assessments. Overall, 40% of studies included at least one category of social impact. The most commonly included non-healthcare cost among cost-per-QALY studies was productivity (25%), while cost-per-DALY studies reported transportation costs most frequently (24%). Few studies examined the impact of vaccination on other sectors such as education and housing (<3%). Middle-income and North American settings were positively associated with social impact inclusion, while sub-Saharan African location was negatively associated. In the HPV case study, the addition of nonhealth costs improved cost-effectiveness by up to 90% or made the vaccine cost-saving, depending on geographic setting. The cost-saving scenario saved up to $30,000 in costs per case of cervical cancer averted.
A minority of vaccine CEAs include social impacts, particularly for nonhealth sectors. The omission of these impacts may result in a systematic undervaluation of vaccines from a societal perspective. Further efforts are required to document the full benefits of vaccination for policymaker consideration.
免疫接种的健康和经济效益可能超出成本效益分析（CEA）中通常包含的要素。本研究旨在调查在疫苗的经济评估中如何考虑更广泛的影响，以及纳入这些影响是否会实质性地改变 CEA 结果。
我们使用 Tufts CEA 登记处和 Tufts 全球卫生 CEA 登记处，检索了 2014 年至 2019 年期间发表的与全球最大健康负担相关的疫苗的 CEA，并结合对已发表和灰色文献的系统评价进行了研究。我们进行了描述性分析，以检查纳入特定社会因素的频率以及与纳入相关的研究特征。我们还对人乳头瘤病毒（HPV）疫苗进行了案例研究，以说明从选定的社会影响中改变 CEA 结果的潜力。
我们确定了 475 项相关的健康经济评估。总体而言，40%的研究至少纳入了一类社会影响。在成本效益比研究中，最常纳入的非医疗保健成本是生产力（25%），而在成本效益比研究中，最常报告的是交通成本（24%）。很少有研究考察疫苗接种对教育和住房等其他部门的影响（<3%）。中低收入和北美国家的研究更倾向于纳入社会影响，而撒哈拉以南非洲国家的研究则相反。在 HPV 案例研究中，根据地理背景，非健康成本的增加使成本效益提高了 90%或使疫苗具有成本效益。成本节约方案使每例宫颈癌预防的成本节省了高达 30000 美元。
少数疫苗 CEA 纳入了社会影响，特别是针对非卫生部门的影响。从社会角度来看，这些影响的缺失可能导致疫苗被低估。需要进一步努力记录疫苗接种的全部效益，供决策者参考。
