title: Systematic review of economic evaluation analyses of available vaccines in Spain from 1990 to 2012.
abstract: OBJECTIVE
  The objective of this survey was to describe the evolution of economic evaluation studies on vaccines available in Spain.
  
  
  METHODS
  We conducted a systematic review of the economic evaluations published by Spanish researchers in major bibliographic databases available online from 1990 to 2012. For all references identified, we limited them to full economic evaluation carried out in Spanish vaccine programs. The following variables were analyzed: type of study, year of publication, vaccine evaluated, the herd immunity and the main methodological aspects proposed by international guidelines. The type of vaccines studied were Hepatitis A and B, Rotavirus, Influenza, Varicella, Tetanus, Measles, Human papillomavirus, Streptococcus pneumoniae infection and Neisseria meningitides serogroup C infection.
  
  
  RESULTS
  A total of 34 references was included in the study. The number of economic evaluations has been increasing over the years by 86%. For many of the vaccines there were no economic evaluations, while others such as the vaccine against S. pneumoniae infection took up most of the studies. The non-vaccinated comparison was the most used strategy. The cost-effectiveness model was selected in 60% of cases. The most common health outcome was "cost per case prevented" and in 82% of the studies did not consider herd immunity. The results showed a cost-effectiveness ratio which was below breakeven.
  
  
  CONCLUSIONS
  It is clear that the existence of a huge gap in this kind of work compared to other countries. Although the quality of the work discussed here was significant, we found many areas which could be improved. The reviewed literature exposed the great benefit of vaccination for society by analysing the health outcomes achieved for decades since its implementation. However, the evidence on the efficiency and effectiveness vaccination is not very high, and there are few studies about economic evaluation.
authors.affiliation: Instituto Max Weber, Majadahonda, Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Cortés
authors.forename: Santiago
authors.initials: S
authors.lastname: Pérez-Camarero
authors.forename: Juan
authors.initials: J
authors.lastname: Del Llano
authors.forename: Luz María
authors.initials: LM
authors.lastname: Peña
authors.forename: Alvaro
authors.initials: A
authors.lastname: Hidalgo-Vega
mesh_terms: D001428:Bacterial Vaccines / Q000191:economics / Q000276:immunology / Q000627:therapeutic use; D003140:Communicable Disease Control / Q000191:economics*; D003141:Communicable Diseases / Q000191:economics* / Q000276:immunology; D003362:Cost-Benefit Analysis; D006801:Humans; D032521:Immunity, Herd; D032541:Mass Vaccination / Q000191:economics; D013030:Spain; D014611:Vaccination / Q000191:economics*; D014765:Viral Vaccines / Q000191:economics / Q000276:immunology / Q000627:therapeutic use
chemical_list: D001428:Bacterial Vaccines; D014765:Viral Vaccines
keywords: Economic analysis; Economic evaluation; Inmunopreventable diseases; Review; Spain; Vaccines