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

Margherita Neri · Lotte Steuten

59 citations0/0 files storedApplied Health Economics and Health Policy

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Health Systems, Economic Evaluations, Quality of Life Pharmaceutical Economics and Policy Delphi Technique in Research

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.

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References

2005Effectiveness and efficiency of search methods in systematic reviews of complex evidence: audit of primary sources 1999Incorporating societal concerns for fairness in numerical valuations of health programmes 1993Economics of Health Care Financing: The Visible Hand 2014Valuing vaccination 2015The broader economic impact of vaccination: reviewing and appraising the strength of evidence 2018The broad socioeconomic benefits of vaccination 2018Economic Analysis of Vaccination Programs: An ISPOR Good Practices for Outcomes Research Task Force Report 2010Rethinking the benefits and costs of childhood vaccination: The example of the Haemophilus influenzae type b vaccine☆

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