Funding processes for new vaccines: the need for greater understanding of the economic issues

Aim  Given the changing landscape for the economics of vaccines, this article discusses the nature of economic assessments, the criteria being applied by decision-makers, the available evidence on the cost-effectiveness of the newer vaccines and the methodological and policy issues involved. Subjects and methods  We examine the nature of economic assessments, recent evidence on the cost-effectiveness of vaccines as well as the methodological and political issues arising as a consequence of evaluating vaccination programmes from an economic point of view. Results  Economic evaluations of vaccination look at (1) different schedules and implementation of a vaccine in national programmes; (2) benefits for high-risk individuals as versus entire populations; (3) healthcare system costs and societal costs incurred as a result of vaccination programmes versus treating disease; (4) life years gained and quality-adjusted life years. Cost-effectiveness studies of vaccination range considerably in the ratios produced owing to the wide variation of vaccination programmes and differing target populations. Nevertheless, vaccination programmes with newer or less widely used vaccines such as as pneumococcal, meningococcal, hepatitis A and influenza vaccines have consistently demonstrated their cost-effectiveness. In practice, however, implementation of vaccination programmes generally precedes the demonstration of their cost-effectiveness Conclusion  In the face of growing pressure on health-care resources, vaccines–as other health interventions and products–will have increasingly to demonstrate their cost-effectiveness. This poses particular challenges given the specificity of vaccination both as an individual and collective health intervention.