Economic evaluation of vaccines in Canada: A systematic review

An Umbrella Review of the Cost Effectiveness of Human Papillomavirus Vaccines

BACKGROUND AND OBJECTIVES

Although many systematic reviews for the human papillomavirus vaccines cost effectiveness have been published, they vary in perspectives, methods, and quality. We aimed to condense systematically such evidence to facilitate locating, processing, and learning, not only about the consensus of findings but also how models were built and their evolution over time and across settings.

METHODS

We conducted an umbrella review of cost-effectiveness studies for human papillomavirus vaccines using three databases (PubMed, Embase, and Cochrane). Based on their objectives, we classified studies into three groups (human papillomavirus vaccines cost effectiveness, model characteristics, and all-type vaccines, including human papillomavirus vaccines). We used the AMTAR2 to assess the quality of the studies. Additionally, we provided a summary of study findings, discussions, and evidence gaps in the literature.

RESULTS

Though most studies were critically low quality and had a low quality of reporting, the human papillomavirus vaccine was consistently cost effective in young girls and men who have sex with men. Stratified analyses by rated quality did not change the results. The quality assessment of the reviews did not necessarily reflect the quality assessment of underlying studies. The human papillomavirus vaccine models became more complex over time, capturing more realistic disease transmission with different human papillomavirus strains and herd immunities.

CONCLUSIONS

Additional evidence is needed for vulnerable populations (e.g., childhood cancer survivors) who are at high risk for human papillomavirus vaccine-related cancers and, therefore, may be more cost effective when receiving human papillomavirus vaccines. Quantifying human papillomavirus vaccine cost effectiveness via meta-analyses is feasible if investigators can increase the homogeneity of their populations.

A systematic review of economic evaluations of vaccines in Middle East and North Africa countries: is existing evidence good enough to support policy decision-making?

INTRODUCTION

A vaccine introduction process should be systematic and transparent and take into account many factors, including cost-effectiveness evidence. This study aimed to assess quantity, characteristic, and quality of economic evaluation (EE) studies on vaccines performed in Middle East and North Africa (MENA) countries.

AREAS COVERED

PubMed and Scopus electronic databases were searched since inception to December 2019 to identify published EE studies of vaccines, which were conducted in the 26 MENA countries. Methodological quality of the included studies was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.

EXPERT OPINION

Of the 616 studies identified, 46 were included in the review. Most studies (65%) were conducted in Iran, Israel, and Turkey. The most commonly evaluated vaccines were rotavirus vaccine (n = 15; 33%), human Papillomavirus vaccine (n = 8; 17%), and pneumococcal vaccine (n = 7; 15%). We classified 5 (11%), 27 (59%), 12 (26%), and 2 (4%) studies as excellent, good, moderate, and poor quality, respectively. There were limited cost-effectiveness evidences in the region. It is imperative to have local guidelines on good practice and reporting, availability of local data, and funding sources to improve quantity and quality of EE studies of vaccines in the region, thereby, facilitating transparent and consistent decision-making processes.

Economic evaluation of meningococcal serogroup B (MenB) vaccines: A systematic review

BACKGROUND

Meningococcal serogroup B (MenB) has emerged as the leading cause of invasive meningococcal disease (IMD) in several countries following the release of effective vaccines against serogroups A, C, W, and Y. In 2013, however, the first multicomponent MenB vaccine (Bexsero®) was licensed in Europe.

AIM

To review the evidence on the cost-effectiveness of vaccination against MenB.

METHODS

Searches were performed in MEDLINE, EMBASE, Web of Science, NHS EED, Econlit, Tufts CEA registry, and HTA. Three reviewers independently screened and selected studies. Using a narrative synthesis, studies were categorized by vaccination strategies. The quality of included studies was assessed using the Comparative Health Economics Evaluation Reporting Standards (CHEERS) checklist.

RESULTS

13 studies were included. Ten studies were conducted in the European region and three in the Americas. None of the vaccination strategies were considered cost-effective. Including herd effects improved value for money for MenB vaccines. Routine infant vaccination was the most effective short-term strategy, however, adolescent strategies offered the best value for money. Without herd immunity, routine infant vaccination had the lowest incremental cost-effectiveness ratio estimates.

CONCLUSION

Routine MenB vaccination does not offer substantial value for money, mainly due to high vaccine costs and low disease incidence.

Is 'conflict of interest' a Misnomer? Managing interests in immunization research and evaluation

Potential conflicts of interest in vaccine research can lead to negative consequences that undermine public trust and thereby put communities at risk. However, collaborations that may give rise to potential conflicts between interests can also greatly facilitate appropriate, scientifically robust, and timely vaccine development, implementation, and evaluation. At present, policies regarding the management of potential conflicts between interests are not ideal. To optimally manage interests in vaccine research, we recommend acknowledging all forms of interests and treating them all as relevant, developing appropriate collaborations, referring to all “conflicts of interest” simply as “interests” or “declarations,” and promoting transparency through developing consistent reporting mechanisms.

Incorporation of health economic evaluation into immunization policy-making in Canada: Barriers and facilitators

INTRODUCTION

Despite the WHO recommendation that economic evidence be considered in national vaccine recommendations, this element of decision-making has been lacking or not done routinely in Canada. This study aimed to investigate barriers and facilitators to using economic evaluations in public health immunization programs decision-making across Canadian jurisdictions.

METHODS

This mixed methods study consisted of a cross-sectional survey and semi-structured interviews of national, provincial and territorial public health level key informants, and of members of the national immunization research network in Canada. Barriers were categorized according to accessibility (e.g. access to human resources to conduct the evaluation) and acceptability (e.g. political resistance to using the evaluation).

RESULTS

Of 63 survey participants, 12 were federal, provincial or territorial key informants (response rate 12/31, 39%) and 51 were members from the research network (response rate 51/214, 24%). Eleven stakeholders gave semi-structured interviews. All respondents support increased use of economic evaluation and of it becoming a routine part of immunization policy-making. However, 70% of the survey respondents identified limited resources (human and financial) to perform economic evaluations, and 39% reported lack of expertise to interpret economic evidence. Vaccine effectiveness and the burden of disease were seen as more important than cost-effectiveness by survey respondents and interviewees. Potential facilitators were for economic evaluations to either be conducted at the national level, or through a collaboration between provinces and territories with capacity to address shared needs so that evaluations occurred in a co-ordinated but distributed way.

RECOMMENDATIONS

Barriers to incorporation of economic evaluation in immunization policy-making in Canada include lacking human and financial resources to conduct them and understanding of economic evidence. National, provincial and territorial public health actors reported that facilitators to incorporating economic evidence include developing increased capacity to conduct and use economic evaluations and establishing inter-jurisdictional systems to share the work of conducting economic evaluation and/or by national leadership.

Review of seasonal influenza in Canada: Burden of disease and the cost-effectiveness of quadrivalent inactivated influenza vaccines

In the 2015/16 influenza season, the Canadian National Advisory Committee on Immunization (NACI) recommended vaccination with quadrivalent inactivated influenza vaccine (QIV) for infants aged 6-23 months and trivalent inactivated influenza vaccines (TIVs) or QIVs in adults. The objective of this review (GSK study identifier: HO-13-14054) is to examine the epidemiology and disease burden of influenza in Canada and the economic benefits of vaccination. To inform this review, we performed a systematic literature search of relevant Canadian literature and National surveillance data. Influenza B viruses from phylogenetically-distinct lineages (B/Yamagata and B/Victoria) co-circulate in Canada, and are an important cause of influenza complications. Modeling studies, including those postdating the search suggest that switching from TIV to QIV in Canada reduces the burden of influenza and would likely be cost-effective. However, more robust real-world outcomes data is required to inform health policy decision makers on appropriate influenza vaccination strategies for Canada.

A systematic review of health economic evaluations of vaccines in Brazil

BACKGROUND

In Brazil, since 2005, the Ministry of Health requires Health Economic Evaluation (HEE) of vaccines for introduction into the National Immunization Program.

OBJECTIVES

To describe and analyze the full HEE on vaccines conducted in Brazil from 1980 to 2013.

METHODS

Systematic review of the literature. We searched multiple databases. Two researchers independently selected the studies and extracted the data. The methodological quality of individual studies was evaluated using CHEERS items.

RESULTS

Twenty studies were reviewed. The most evaluated vaccines were pneumococcal (25%) and HPV (15%). The most used types of HEE were cost-effectiveness analysis (45%) and cost-utility analysis (20%). The research question and compared strategies were stated in all 20 studies and the target population was clear in 95%. Nevertheless, many studies did not inform the perspective of analysis or data sources.

CONCLUSIONS

HEE of vaccines in Brazil has increased since 2008. However, the studies still have methodological deficiencies.