title: Economic evaluations of implemented vaccination programmes: key methodological challenges in retrospective analyses.
abstract: Post-implementation evaluation should play an important role in assessing the success of public health programmes; however, the value for money achieved by vaccine programmes after introduction has received relatively little attention to date. In this article we explore the methodological challenges in these analyses and offer direction for future evaluations in the area. We identify alternative approaches to addressing these challenges, which include the estimation of disease changes attributable to vaccination efforts, the hypothetical no vaccination comparator scenario and the full benefit achieved by implemented vaccination programmes. We also outline other important considerations such as the evolution of prices over time. Further work needs to be done to explore these issues and to determine how the application of different approaches may impact on the results of evaluations in various circumstances. As retrospective analyses are likely to become more frequent and influential, it is important that both the benefits and the limitations of post-implementation evaluations are recognised and understood. We argue that it would be useful to establish a methodological framework to provide standards and guidance on how to undertake such analyses in the future.
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia. Electronic address: a.newall@unsw.edu.au.
authors.forename: A T
authors.initials: AT
authors.lastname: Newall
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: J F
authors.initials: JF
authors.lastname: Reyes
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: J G
authors.initials: JG
authors.lastname: Wood
authors.affiliation: National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), University of Sydney, Westmead, NSW, Australia.
authors.forename: P
authors.initials: P
authors.lastname: McIntyre
authors.affiliation: National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), University of Sydney, Westmead, NSW, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Menzies
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia; Centre for Health Economics Research and Modelling Infectious Diseases (CHERM ID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Beutels
mesh_terms: D003362:Cost-Benefit Analysis; D005069:Evaluation Studies as Topic; D005544:Forecasting; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D012107:Research Design; D012189:Retrospective Studies
keywords: Cost-effectiveness; Economic evaluation; Post-implementation; Programme evaluation; Retrospective; Vaccination