Towards a Broader Assessment of Value in Vaccines: The BRAVE Way Forward

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Abstract

Background

The COVID-19 pandemic shows that the impact of effective vaccines can extend well beyond vaccinated individuals and healthcare systems. Yet, these broader value elements are not typically considered in Health Technology Assessment (HTA) which may underestimate vaccines’ broader value.

Objectives

This study aimed to (1) describe the gap between broader value elements identified in value frameworks for vaccines and those recognised in HTA of vaccines in nine developed markets, and (2) develop expert-informed, consensus-based recommendations on how hurdles for broader value recognition could be overcome.

Methods

We used a four-step modified Delphi method consisting of literature research (phase I, pearl-growing approach using PubMed Web of Science and Google covering the years 2000–2019), two consecutive phases of expert elicitation (phase II and III, including two email surveys and one virtual round table with 10 experts from 9 countries) and synthesis of recommendations (phase IV).

Results

Results show that about half of the broader value elements relevant to vaccines are not (consistently) considered in HTA processes of multiple higher-income countries. Experts identified five priority areas for broader value recognition, including considering (1) more comprehensive cost offsets within the health care system, (2) carer quality of life, (3) transmission value, (4) prevention of antimicrobial resistance and (5) macroeconomic effects.

Conclusion

To achieve a broader recognition of the value of vaccines, a three-pronged approach was recommended, focusing on (1) Evidence: proactively steering generation of high-quality evidence to quantify the broader value of vaccines to society; (2) Ability: leveraging and further developing existing methodological and analytic expertise to appropriately recognise the broad value of vaccines within HTA processes; (3) Willingness: Stimulating stakeholder engagement to change the status quo and move towards more transparent and comprehensive value assessment processes for vaccines globally.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40258-021-00683-z.

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Most cited references 23

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Effectiveness and efficiency of search methods in systematic reviews of complex evidence: audit of primary sources.

Trisha Greenhalgh, Richard Peacock (2006)

To describe where papers come from in a systematic review of complex evidence. Method Audit of how the 495 primary sources for the review were originally identified. Only 30% of sources were obtained from the protocol defined at the outset of the study (that is, from the database and hand searches). Fifty one per cent were identified by "snowballing" (such as pursuing references of references), and 24% by personal knowledge or personal contacts. Systematic reviews of complex evidence cannot rely solely on protocol-driven search strategies.

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Valuing vaccination.

Till Bärnighausen, David Bloom, Elizabeth T Cafiero-Fonseca … (2014)

Vaccination has led to remarkable health gains over the last century. However, large coverage gaps remain, which will require significant financial resources and political will to address. In recent years, a compelling line of inquiry has established the economic benefits of health, at both the individual and aggregate levels. Most existing economic evaluations of particular health interventions fail to account for this new research, leading to potentially sizable undervaluation of those interventions. In line with this new research, we set forth a framework for conceptualizing the full benefits of vaccination, including avoided medical care costs, outcome-related productivity gains, behavior-related productivity gains, community health externalities, community economic externalities, and the value of risk reduction and pure health gains. We also review literature highlighting the magnitude of these sources of benefit for different vaccinations. Finally, we outline the steps that need to be taken to implement a broad-approach economic evaluation and discuss the implications of this work for research, policy, and resource allocation for vaccine development and delivery.

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Incorporating societal concerns for fairness in numerical valuations of health programmes.

P Ubel, P Menzel, C Nord … (1999)

The paper addresses some limitations of the QALY approach and outlines a valuation procedure that may overcome these limitations. In particular, we focus on the following issues: the distinction between assessing individual utility and assessing societal value of health care; the need to incorporate concerns for severity of illness as an independent factor in a numerical model of societal valuations of health outcomes; similarly, the need to incorporate reluctance to discriminate against patients that happen to have lesser potentials for health than others; and finally, the need to combine measurements of health-related quality of life obtained from actual patients (or former patients) with measurements of distributive preferences in the general population when estimating societal value. We show how equity weights may serve to incorporate concerns for severity and potentials for health in QALY calculations. We also suggest that for chronically ill or disabled people a life year gained should count as one and no less than one as long as the year is considered preferable to being dead by the person concerned. We call our approach 'cost-value analysis'.

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Author and article information

Contributors

Lotte Steuten:

ORCID: http://orcid.org/0000-0002-5688-236X

lsteuten@ohe.org

Journal

Journal ID (nlm-ta): Appl Health Econ Health Policy

Journal ID (iso-abbrev): Appl Health Econ Health Policy

Title: Applied Health Economics and Health Policy

Publisher: Springer International Publishing (Cham )

ISSN (Print): 1175-5652

ISSN (Electronic): 1179-1896

Publication date (Electronic): 23 September 2021

Publication date PMC-release: 23 September 2021

Pages: 1-13

Affiliations

[1 ]GRID grid.482825.1, ISNI 0000 0004 0629 613X, Office of Health Economics, ; London, UK

[2 ]GRID grid.28577.3f, ISNI 0000 0004 1936 8497, City, University of London, ; London, UK

Author information

Lotte Steuten http://orcid.org/0000-0002-5688-236X

Article

Publisher ID: 683

DOI: 10.1007/s40258-021-00683-z

PMC ID: 8458004

PubMed ID: 34553333

SO-VID: 25c0932d-b91d-42cb-80a3-7b67e849060e

License:

Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

History

Date accepted : 29 August 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100009032, Pfizer UK;

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Towards a Broader Assessment of Value in Vaccines: The BRAVE Way Forward

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Abstract

Background

Objectives

Methods

Results

Conclusion

Supplementary Information

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Novel Coronavirus Disease COVID-19

Most cited references 23

Effectiveness and efficiency of search methods in systematic reviews of complex evidence: audit of primary sources.

Valuing vaccination.

Incorporating societal concerns for fairness in numerical valuations of health programmes.

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Cited by 19

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