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WHO Guide for Standardization of Economic Evaluations of Immunization Programmes

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WHO Guide for Standardization of Economic Evaluations of Immunization Programmes WHO/IVB/08.14 ORIGINAL: ENGLISH WHO guide for standardization of economic evaluations of immunization programmes Immunization, Vaccines and Biologicals WHO/IVB/08.14 ORIGINAL: ENGLISH WHO guide for standardization of economic evaluations of immunization programmes Immunization, Vaccines and Biologicals The Department of Immunization, Vaccines and Biologicals thanks the donors whose unspecifi ed fi nancial support has made the production of this document possible. This document was produced by the Initiative for Vaccine Research (IVR) of the Department of Immunization, Vaccines and Biologicals Ordering code: WHO/IVB/08.14 Printed: December 2008 This publication is available on the Internet at: www.who.int/vaccines-documents/ Copies of this document as well additional materials on immunization, vaccines and biologicals may be requested from: World Health Organization Department of Immunization, Vaccines and Biologicals CH-1211 Geneva 27, Switzerland • Fax: + 41 22 791 4227 • Email: [email protected] • © World Health Organization 2008 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 3264; fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; email: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specifi c companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The named authors alone are responsible for the views expressed in this publication. Printed by the WHO Document Production Services, Geneva, Switzerland ii Contents Preface ................................................................................................................................vi Abbreviations and Acronyms ........................................................................................ viii Acknowledgements .............................................................................................................x Executive Summary .........................................................................................................xii Chapter 1: Introduction ..................................................................................................1 1.1 Evidence-based decision-making ..............................................................................1 1.2 Existing guidance on economic evaluation ..............................................................3 1.3 What is different about this guide? ............................................................................3 1.4 Aim and target audience of this guide ......................................................................3 1.5 Structure of the Guide ................................................................................................4 Chapter 2: Economic Evaluation of Health Care .......................................................5 2.1 Different types of economic evaluation ....................................................................5 2.2 The role of economic evaluation ...............................................................................6 2.3 Budget impact analysis/fi nancing of programme implementation .........................7 Chapter 3: Framing the Analysis ...................................................................................9 3.1 Target audience ............................................................................................................9 3.2 Study question .............................................................................................................9 3.3 Type of evaluation ....................................................................................................10 3.4 Target population ......................................................................................................10 3.5 Comparator ...............................................................................................................11 3.6 Perspective .................................................................................................................12 3.7 Time frame and analytic horizon .............................................................................13 3.8 Recommendations .....................................................................................................14 Chapter 4: Assessing the Cost of a Vaccination Programme ..................................15 4.1 Approaches to costing ..............................................................................................15 4.2 Identifi cation: which costs to include?....................................................................18 4.3 How to measure resource use? ................................................................................21 4.4 Valuing resources ......................................................................................................23 4.5 Valuing productivity losses/gains ............................................................................25 4.6 Vaccination-specifi c costing issues .........................................................................26 4.7 Recommendations .....................................................................................................28 iii Chapter 5: Assessing the Effects of the Vaccination Programme ...........................29 5.1 Vaccine effi cacy .........................................................................................................29 5.2 Vaccine effectiveness .................................................................................................32 5.3 Choosing and valuing outcomes..............................................................................34 5.4 Recommendations .....................................................................................................36 Chapter 6: Modelling ......................................................................................................37 6.1 Specifi c parameters for infectious disease epidemiology .......................................37 6.2 Impact of vaccination ...............................................................................................40 6.3 Modelling infectious diseases ...................................................................................44 6.4 Model validation .......................................................................................................53 6.5 Recommendations .....................................................................................................55 Chapter 7: Discounting .................................................................................................56 7.1 Using constant discount rates ..................................................................................56 7.2 When a non-constant discount rate should be considered....................................57 7.3 Recommendations .....................................................................................................57 Chapter 8: Estimating, Presenting and Interpreting Cost-effectiveness Data .....58 8.1 Linking costs and effects ..........................................................................................58 8.2 Sources of and methods of representing uncertainty.............................................62 8.3 Interpreting results ....................................................................................................64 8.4 Reporting uncertainty to decision-makers .............................................................66 8.5 Recommendations .....................................................................................................68 Chapter 9: Economic Evaluation and the Decision-Making Process .....................69 9.1 The use of economic evaluation in policy and practice .........................................69 9.2 Decision-making bodies ...........................................................................................71 9.3 Other criteria to consider when making decisions ................................................71 9.4 The trade-off between effi ciency and equity ..........................................................72 9.5 Including the broader benefi ts of vaccines
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