Incorporation of health economic evaluation into immunization policy-making in Canada: Barriers and facilitators |
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| Affiliation: | 1. ICES, Laboratory Medicine and Pathobiology and the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada;2. Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands;3. Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada;1. Ministry of Health, BP188 Cotonou, Benin;2. Agence de Médecine Préventive, Regional Office for Africa, 08BP660, Abidjan, Cote d’Ivoire;3. Agence de Médecine Préventive, Burkina Faso Country Office, 10 BP638 Ouagadougou, Burkina Faso;4. Laboratoire d’Anthroplogie Médicale Appliquée (LAMA), University of Abomey-Calavi, Cotonou, Benin;5. Independant Consultant, Geneva, Switzerland;6. World Health Organization, Inter Country Supportive Team, Ouagadougou, Burkina Faso;1. PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA;2. PATH, Rue de Varembé 7, 1202 Geneva, Switzerland;3. International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA;4. Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi;5. Afghanistan National Immunization Technical Advisory Group, District 10, Kabul, Afghanistan;6. School of Public Health, University of Ghana, Legon, Ghana;7. London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom;1. Network for Education and Support in Immunisation (NESI). Department Epidemiology and Social Medicine. University of Antwerp. Universiteitsplein 1. 2610 Antwerp, Belgium;2. Ministry of Health, Oman;3. Global Health Development/Eastern Mediterranean Public Health Network (GHD/EMPHNET), Jordan;4. World Health Organization/Regional Office for the Eastern Mediterranean (WHO/EMRO), Egypt;5. University Cadi Ayyad & Société Marocaine d’Infectiologie Pédiatrique et de Vaccinologie (SOMIPEV), Morocco;1. Department of Pediatrics, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8, Canada;2. Canadian Center for Vaccinology, Dalhousie University, 5850/5980 University Ave, IWK Health Centre, Nova Scotia Health Authority, Halifax, NS, Canada;3. World Health Organization, Avenue Appia 20, Geneva, Switzerland;1. US Centers for Disease Control and Prevention, Atlanta, GA, USA;2. Department of Pediatrics, University of Jordan, Jordan;3. Dirección de Control de Enfermedades Inmunoprevenibles, Ministerio de Salud de la Nación, Argentina;4. Sociedad Argentina de Infectología, Buenos Aires, Argentina;5. Jordan University of Science and Technology, Jordan;6. Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa |
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| Abstract: | IntroductionDespite 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.MethodsThis 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).ResultsOf 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. |
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| Keywords: | Immunization programs Vaccines Health care economics and organizations Economics Public policy |
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