Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA.
Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA.
J Med Econ. 2022 Jan-Dec;25(1):894-902. doi: 10.1080/13696998.2022.2091858.
Pricing, affordability, and access are important deliberations around infectious disease interventions. Determining a fair price that not only incentivizes development but ensures value and access for patients is critical given the increasing global health crisis. Using Ebola virus disease (EVD) as an exemplar, we aim to elucidate the estimation of a jurisdiction-specific value-based price (VBP) for a vaccine package and to consider how prices compare across selected countries that have experienced EVD outbreaks.
Using a dynamic transmission model, we assessed the cost-effectiveness of a vaccine package - composed of the vaccine, storage, maintenance, and administration - for vaccination toward herd immunity in 4 countries affected with EVD (Democratic Republic of Congo, Liberia, Sierra Leone, Uganda). Based on the cost-effectiveness metrics and using willingness-to-pay thresholds equal to varying percentages of the Gross Domestic Product (GDP), we demonstrated how a VBP is calculated using a cost-effectiveness-based approach.
The VBP for the vaccine is directly proportional to effectiveness (DALYs prevented), cost-effectiveness (ICER) and GDP per capita. Higher effectiveness, greater cost-effectiveness, and higher GDP per capita resulted in higher price ceilings compared to lower cost-effectiveness and lower GDP.
Despite the concerns with the cost-effectiveness-based approach, we illustrated that it is an easily comprehensible method for determining the VBP of a vaccine using cost-effectiveness analysis. Choice of data, population characteristics, and disease dynamics are among the factors that need to be considered when comparisons are made across countries.
在传染病干预措施方面，定价、负担能力和可及性是重要的考虑因素。鉴于全球卫生危机不断加剧，确定既能激励研发又能确保患者获得价值和可及性的公平价格至关重要。我们以埃博拉病毒病（EVD）为例，旨在阐明针对特定司法管辖区的疫苗一揽子计划的基于价值的定价（VBP）的估算方法，并考虑在经历过 EVD 暴发的选定国家/地区之间的价格比较情况。
我们使用动态传播模型评估了针对埃博拉病毒病（EVD）影响的 4 个国家（刚果民主共和国、利比里亚、塞拉利昂和乌干达）的疫苗接种实现群体免疫的疫苗一揽子计划（疫苗、储存、维护和管理）的成本效益。根据成本效益指标，并使用等于国内生产总值（GDP）不同百分比的支付意愿阈值，我们展示了如何使用基于成本效益的方法来计算 VBP。
疫苗的 VBP 与有效性（预防的 DALYs）、成本效益（ICER）和人均 GDP 直接相关。更高的有效性、更高的成本效益和更高的人均 GDP 导致价格上限高于成本效益较低和 GDP 较低的情况。
尽管存在对基于成本效益的方法的担忧，但我们说明它是一种使用成本效益分析确定疫苗 VBP 的易于理解的方法。在进行国家间比较时，需要考虑数据选择、人口特征和疾病动态等因素。
