Are economic evaluations of vaccines useful to decision-makers? Case study of Haemophilus influenzae type b vaccines.
BACKGROUND
In concert with efforts to increase global provision, economic evaluations of newer and relatively costly vaccines have proliferated in the medical literature. The extent to which existing vaccine evaluations are useful to decision makers is not clear. We conducted a systematic review of published economic evaluations of conjugate Haemophilus influenzae type b (Hib) vaccine, anticipating that their usefulness to past and present decision makers would be limited by the quality of the analyses and by the extent to which the results were transferable to other settings.


METHODS
We systematically identified economic evaluations of conjugate Hib vaccine. We appraised their quality according to a customized checklist and assessed the extent of and reasons for variability of the results.


RESULTS
Quality assessment of the available economic evaluations disclosed a number of shortcomings, including the failure across all models to derive systematic estimates of vaccine efficacy as well as a lack of transparency in the costing of Hib disease treatment. Wide variations in results appeared to be caused primarily by epidemiologic and health system differences between settings and secondarily to methodologic differences between models. The generalizability of model results appeared low.


CONCLUSIONS
There is scope for improving the overall quality of economic evaluations of Hib vaccination. Relevance to decision makers may also be increased by addressing local budget constraints and vaccine price. There is a need to better understand the decision process, particularly at the national level, to ensure the role of future economic evaluations as important decision tools in the implementation of new vaccines.
Brinsmead
Regina
R
Clinical Pharmacology, School of Medical Practice and Population Health, Faculty of Health, University of Newcastle, Newcastle, Australia. ginab@smartchat.net.au
Hill
Suzanne
S
Walker
Damian
D
D001315:Australia; D016667:Bacterial Capsules; D015331:Cohort Studies; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003657:Decision Making; D005260:Female; D006192:Haemophilus Infections / Q000517:prevention & control*; D018073:Haemophilus Vaccines / Q000008:administration & dosage* / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D008297:Male; D011135:Polysaccharides, Bacterial / Q000008:administration & dosage* / Q000191:economics*; D012042:Registries; D006113:United Kingdom; D014611:Vaccination / Q000191:economics
D018073:Haemophilus Vaccines; C044237:Haemophilus influenzae type b polysaccharide vaccine; D011135:Polysaccharides, Bacterial