Centre for Evaluation of Vaccination (CEV)
Although economic evaluations of viral hepatitis vaccination have had shortcomings, the availability of these analyses have allowed conclusions to be drawn for HBV vaccination, and to a lesser extent for targeted HAV vaccination. In all areas where the overall HBV chronic infection rate exceeds 0.5% and the prevalence of all markers is higher than 5%, universal vaccination of either neonates, infants, or adolescents is desirable on the basis of economic and epidemiological arguments (although in high-endemicity areas other competing interventions may be equally or more attractive). In very low-endemicity areas (where these percentages are lower), there is insufficient evidence to show a preference for universal over selective HBV vaccination.(13)To date, there have been too few analyses of universal childhood HAV vaccination strategies to make general statements about the relative efficiency of such programmes. In order to facilitate such analyses in the future, the greatest need appears to be for reliable acute disease surveillance. The economic and epidemiological impact of HAV vaccination of adult at-risk groups in low endemicity areas (on which almost all evaluations have been focused) was usually found to be relatively unattractive compared with other health care interventions.
Future analyses of vaccination programmes should benefit from addressing the potential shortcomings we have discussed in this article.(12) Namely, better overall transparency
and validation, more careful choice of models (tailored to the infection and the target groups) and time spans, and more extensive sensitivity analyses seem most pressingly relevant to improve the quality of and comparability between such analyses. Furthermore, it is in the general interest that any economic evaluation (also nonvaccine-related) adheres more closely to the overall general guidelines. This needs to be monitored by peer reviewers, who might have to referee lengthy papers when the subject is a model-based economic evaluation. Indeed, a well-balanced analysis demands transparent and clear descriptions of all relevant epidemiological, disease model and cost-related aspects. Therefore editors should be prepared to accept that such a paper could be relatively long, particularly when the modelling and epidemiological aspects are complex, as for many vaccination programmes.
Finally, to improve the credibility of economic evaluation it seems desirable that general guidelines become less ambiguous about potentially important elements (in the case
of the vaccination, discounting of health gains and future unrelated costs). Nonetheless, economic evaluation should be only one of the many considerations that come into play. Moreover, in order to be a useful tool in decision making, it should not only be used at convenience to introduce new interventions, but also to cancel existing practices that are both inefficient and inequitable.
Beutels P, Edmunds WJ, Antoñanzas F, De Wit GA, Evans D, Feilden R et al. Economic evaluation of vaccination programmes. Pharmacoeconomics 2002; 20:1-7. Prepared from material presented at a VHPB meeting held October 12-13, 2002, in Istanbul, Turkey.
Beutels P. Economic evaluations of hepatitis B immunisation: a global review of recent studies (1994-2000). Health Econ 2001; 10:751-774.