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Health Economics of Vaccines Boersma, Cornelis; Postma, Maarten J University of Groningen Health Economics of Vaccines Boersma, Cornelis; Postma, Maarten J. Published in: Value in Health DOI: 10.1016/j.jval.2020.11.006 IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below. Document Version Publisher's PDF, also known as Version of record Publication date: 2021 Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Boersma, C., & Postma, M. J. (2021). Health Economics of Vaccines: From Current Practice to Future Perspectives. Value in Health, 24(1), 1-2. https://doi.org/10.1016/j.jval.2020.11.006 Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons). Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Download date: 25-09-2021 - Contents lists available at sciencedirect.com Journal homepage: www.elsevier.com/locate/jval VALUE HEALTH. 2021; 24(1):1-2 Editorial Health Economics of Vaccines: From Current Practice to Future Perspectives Cornelis Boersma, PhD, Maarten J. Postma, PhD This special themed section of Value in Health with a focus on as currently analyzed in the EU project, Vaccine and Infectious the health economics of vaccines seems timely with potentially Diseases in the Aging Population (VITAL; EU project #806776). various coronavirus disease 2019 (COVID-19) vaccines being close Additionally, new vaccination strategies are continuously to market access. Although COVID-19 vaccines will likely not considered. Typically, chickenpox reflects an area where many immediately be subject to health economics scrutiny, in the post– countries are still reluctant to implement protective infant vacci- COVID-19 peak era there will soon be more emphasis on health nation strategies, largely informed by worries on decremental economics when broader high-risk groups will be targeted and long-term effects on herpes zoster caused by the same virus.9 boosters and revaccinations are to be decided on.1 Considerations Also, it has often been argued that infant varicella vaccination is now eminent in controlling COVID-19 (eg, economic impacts, not cost-effective, except when a broader societal (instead of a specific cost-effectiveness methodologies, basic reproduction rate narrower healthcare perspective) is applied.10 However, Luyten estimates, real-world data calibrations, discounting of long-term et al argue that favorable cost-effectiveness can already be ach- effects, transmission modeling) have been present for other ieved within the healthcare perspective if alternative social/public potentially vaccine-preventable infections for decades. The arti- preferences for quality-adjusted life-years (QALYs) gained for cles in this themed section address all those issues, with illus- children versus those for older adults and for side effects are trations for meningococcal, varicella, human papilloma, and used.11 Additionally, Rafferty et al analyzed infant varicella vacci- influenza vaccines. Finally, it is argued that a broader scope (as nation using an innovative approach with an agent-based model well as an adapted view) is needed that justifies the specifics that and alternative vaccination schedules being investigated and vaccines pose. This is in line with a recent statement of the World show potential favorable cost-effectiveness already from the Health Organization.2 healthcare perspective in Canada, notably one of the few countries Since the start of the COVID-19 pandemic, similarities with that often even apply the societal perspective.12 the influenza virus—both seasonal and potential pandemic na- Whereas articles in this themed section mostly address the ture—have been sketched. This theme includes 4 papers on European situation or Canada, 4 other articles explicitly take a influenza vaccination cost-effectiveness directed toward global view. Specifically, new analyses with the PRIME model improving protection of older adults against the complications of (Papillomavirus Rapid Interface for Modeling and Economics13) influenza infections.3-6 In particular, for influenza vaccines, such explicitly relate the implementation of human papilloma virus improvements target better-adjuvated, cell-based (rather than (HPV) vaccination programs in 179 countries to its cost- egg-based), higher-dosed, and quadrivalent vaccines.7 Zeevat effectiveness and country-specific gross domestic product per et al performed a cost-effectiveness analysis of the quadrivalent capita.14 Obviously, costs of immunization services reflect a core versus trivalent influenza vaccine for older adults and medical piece of real-world data to populate health economic models. In a risk groups.3 Three further articles analyze the potential of pe- targeted literature review, it is found that such data are still diatric influenza vaccination for further indirect protection of lacking for most low- and middle-income countries—specifically, older adults and medical risk groups, presenting detailed data if additionally considering the need to understand costing effects analysis in one article4 and cost-effectiveness analyses in the of scaling-up vaccine coverages in such settings.15 The authors next.5,6 Currently, the United Kingdom is one of few European express a call for intensified research into these costs. Responding countries that implemented pediatric influenza vaccination to this call to the global health community, Sim et al estimate the based on favorable cost-effectiveness outcomes,8 and such in- costs/investment required for keeping up adequate immunization formation for other countries as presented here is urgently services in 94 countries for 10 vaccines, including rotavirus, HPV, needed. With current health economic influenza vaccination and pneumococcal vaccines.16 In their next article,17 those in- programs being investigated in isolation, this collection of arti- vestments are confronted with the potential benefits to be ach- cles also expresses the need to develop integrated health eco- ieved on the costs of the corresponding 10 pathogens, including a nomic models for multiple infections. After all, control strategies value-of-a-statistical-life approach. for one (eg, COVID-19) influence the others (influenza, respira- Mauskopf et al argue that conventional cost-effectiveness may tory syncytial virus, pneumococcal infections), and infections not incorporate all values of vaccination, for example the capa- augment or mitigate each other in seriousness of manifestations, bility of vaccines to reduce risks for catastrophic outcomes to 1098-3015/$36.00 - see front matter Copyright ª 2020, ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. 2 VALUE IN HEALTH JANUARY 2021 justify taking the value of a statistical life into the analysis.18 An REFERENCES illustration further broader impacts—possible not fully covered in the QALY—is presented by Beck et al for meningococcal disease, 1. Health Technology Assessment international. HTA’s critical role in the (early) considered a disease of relatively high severity.19 As in some other assessment of (potential) vaccines to prevent the spread of COVID-19 glob- 20 ally. https://htai.org/hta-support-for-covid-19/position-statements-and-hta- disease areas (such as rare diseases ), it is consistently argued reads. Accessed November 27, 2020. that relevant value drivers for vaccines are not in the cost- 2. Ultsch B, Damm O, Beutels P, et al. Methods for health economic evaluation of vaccines and immunization decision frameworks: a consensus framework effectiveness per QALY, and, therefore, a broader perspective Phamaceconomics 21 from a European vaccine economics community. than conventionally taken is required. For example, in this 2016;34(3):227–244. respect health and productivity effects for caregivers, effects on 3. Zeevat F, Crépey P, Dolk CF, Postma AJ, Breeveld-Dwarkasing VNA, Postma MJ. antimicrobial resistance, and distributive effects have been spe- Cost-effectiveness of quadrivalent versus trivalent influenza vaccination in fl Value Health fi 22-24 fi the Dutch National In uenza Prevention Program. ci cally mentioned. These speci c issues are addressed in the 2021;24(1):3–10. 25 final article. This article by Annemans et al is a timely and 4. Dolk FCK, de Boer PT, Nagy L, et al. Consultations for influenza-like illness in illustrative example of what societies are currently facing with primary care in The Netherlands: a regression approach. Value Health. 2021;24(1):11–18. COVID-19, namely its immense macroeconomic impact and 5. de Boer PT, Nagy L, Dolk FCK, Wilschut JC, Pitman R, Postma MJ. Cost- enormous drive to implement effective and safe vaccination effectiveness of pediatric influenza vaccination in The Netherlands. Value strategies. In this respect, potential enormous impacts of infec- Health. 2021;24(1):19–31. tious diseases, heterogeneity of populations with corresponding 6. Scholz SM, Weidemann F, Damm O, Ultsch B, Greiner W, Wichmann O. Cost- effectiveness
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