title: Valuing vaccines using value of statistical life measures.
abstract: Vaccines are effective tools to improve human health, but resources to pursue all vaccine-related investments are lacking. Benefit-cost and cost-effectiveness analysis are the two major methodological approaches used to assess the impact, efficiency, and distributional consequences of disease interventions, including those related to vaccinations. Childhood vaccinations can have important non-health consequences for productivity and economic well-being through multiple channels, including school attendance, physical growth, and cognitive ability. Benefit-cost analysis would capture such non-health benefits; cost-effectiveness analysis does not. Standard cost-effectiveness analysis may grossly underestimate the benefits of vaccines. A specific willingness-to-pay measure is based on the notion of the value of a statistical life (VSL), derived from trade-offs people are willing to make between fatality risk and wealth. Such methods have been used widely in the environmental and health literature to capture the broader economic benefits of improving health, but reservations remain about their acceptability. These reservations remain mainly because the methods may reflect ability to pay, and hence be discriminatory against the poor. However, willingness-to-pay methods can be made sensitive to income distribution by using appropriate income-sensitive distributional weights. Here, we describe the pros and cons of these methods and how they compare against standard cost-effectiveness analysis using pure health metrics, such as quality-adjusted life years (QALYs) and disability-adjusted life years (DALYs), in the context of vaccine priorities. We conclude that if appropriately used, willingness-to-pay methods will not discriminate against the poor, and they can capture important non-health benefits such as financial risk protection, productivity gains, and economic wellbeing.
authors.affiliation: Center for Disease Dynamics, Economics & Policy, 1616 P Street NW, Suite 430, Washington, DC 20036, USA; Princeton University, M43 Guyot Hall, Room 132, Princeton, NJ 08544, USA. Electronic address: Ramanan@cddep.org.
authors.forename: Ramanan
authors.initials: R
authors.lastname: Laxminarayan
authors.affiliation: University of Washington, Department of Global Health, Ninth and Jefferson Building, 13th Floor, 908 Jefferson Street, Box 359931, Seattle, WA 98104, USA. Electronic address: djamison@uw.edu.
authors.forename: Dean T
authors.initials: DT
authors.lastname: Jamison
authors.affiliation: Resources for the Future, 1616 P Street NW, Suite 600, Washington, DC 20036, USA. Electronic address: krupnick@rff.org.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Krupnick
authors.affiliation: University of Bergen, Department of Medical Ethics, Department of Global Public Health and Primary Care, Kalfarveien 31, 5018 Bergen, Norway. Electronic address: Ole.Norheim@igs.uib.no.
authors.forename: Ole F
authors.initials: OF
authors.lastname: Norheim
mesh_terms: D003362:Cost-Benefit Analysis; D006801:Humans; D019057:Quality-Adjusted Life Years; D013223:Statistics as Topic; D014611:Vaccination / Q000191:economics; D014612:Vaccines / Q000191:economics*
chemical_list: D014612:Vaccines
keywords: Vaccine policy; Vaccine priorities; Value of statistical life; Willingness-to-pay measures