Economic Evaluation of Vaccination Programs: A Guide for Selecting Modeling Approaches.

Objectives: Illustrate 3 economic evaluation methods whose value measures may be useful to decision makers considering vaccination programs.

Methods: Keyword searches identified example publications of cost-effectiveness analysis (CEA), fiscal health modeling (FHM), and constrained optimization (CO) for economic evaluation of a vaccination program in countries where at least 2 of the methods had been used. We examined the extent to which different value measures may be useful for decision makers considering adoption of a new vaccination program. With these findings, we created a guide for selecting modeling approaches illustrating the decision-maker contexts and policy objectives for which each method may be useful.

Results: We identified 8 countries with published evaluations for vaccination programs using >1 method for 4 infections: influenza, human papilloma virus, rotavirus, and malaria. CEA studies targeted health system decision makers using a threshold to determine the efficiency of a new vaccination program. FHM studies targeted public sector spending decision makers estimating lifetime changes in government tax revenue net of transfer payments. CO studies targeted decision makers selecting from a mix of options for preventing an infectious disease within budget and feasibility constraints. Cost and utility inputs, epidemiologic models, comparators, and constraints varied by modeling method.

Conclusions: Although CEAs measures of incremental cost-effectiveness ratios are critical for understanding vaccination program efficiency for all decision makers determining access and reimbursement, FHMs provide measures of the program's impact on public spending for government officials, and COs provide measures of the optimal mix of all prevention interventions for public health officials.