title: Stakeholders' perception on including broader economic impact of vaccines in economic evaluations in low and middle income countries: a mixed methods study.
abstract: BACKGROUND
  Current health economic evaluation guidelines mainly concentrate on immediate health gains and cost savings for the individual involved in the intervention. However, it has been argued that these guidelines are too narrow to capture the full impact of vaccination in low and middle income countries. The inclusion of broader economic impact of vaccines (BEIV) has therefore been proposed. Some examples of these are productivity-related gains, macro-economic impact, and different externalities. Despite their potency, the extent to which such benefits can and should be incorporated into economic evaluations of vaccination is still unclear. This mixed methods study aims to assess the relevance of BEIV to different stakeholders involved in the vaccine introduction decision making process.
  
  
  METHODS
  In this mixed method study an internet based survey was sent to attendees of the New and Underutilized Vaccines Initiative meeting in Montreux, Switzerland in 2011. Additionally, semi-structured interviews of 15 minutes each were conducted during the meeting. Study participants included decision makers, experts and funders of vaccines and immunization programs in low and middle income countries. Descriptive analysis of the survey, along with identification of common themes and factors extracted from the interviews and open survey questions was undertaken.
  
  
  RESULTS
  Evidence on macro-economic impact, burden of disease and ecological effects were perceived as being most valuable towards aiding decision making for vaccine introduction by the 26 survey respondents. The 14 interviewees highlighted the importance of burden of disease and different types of indirect effects. Furthermore, some new interpretations of BEIVs were discussed, such as the potential negative impact of wastage during immunization programs and the idea of using vaccines as a platform for delivering other types of health interventions. Interviewees also highlighted the importance of using a broader perspective in connection to measuring economic impacts, particularly when attempting to derive the value of newer, more expensive vaccines.
  
  
  CONCLUSIONS
  According to participants, BEIVs were seen as being equally important as traditional outcome measures used in cost-effectiveness analyses. Such insight can be used to shape research agendas within this field and to eventually create broader, more inclusive practical guidelines for economic evaluations of vaccines.
authors.affiliation: CAPHRI, School of Public Health and Primary Care, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands. i.vanderputten@maastrichtuniversity.nl.|Initiative for Vaccine Research, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Geneva, Switzerland. i.vanderputten@maastrichtuniversity.nl.
authors.forename: Ingeborg M
authors.initials: IM
authors.lastname: van der Putten
authors.affiliation: CAPHRI, School of Public Health and Primary Care, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands. s.evers@maastrichtuniversity.nl.
authors.forename: Silvia M A A
authors.initials: SM
authors.lastname: Evers
authors.affiliation: Health Economics Unit, University of Birmingham, Birmingham, UK. rohand@healthcarenexus.net.
authors.forename: Rohan
authors.initials: R
authors.lastname: Deogaonkar
authors.affiliation: Health Economics Unit, University of Birmingham, Birmingham, UK. mark.jit@lshtm.ac.uk.|Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK. mark.jit@lshtm.ac.uk.
authors.forename: Mark
authors.initials: M
authors.lastname: Jit
authors.affiliation: Initiative for Vaccine Research, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Geneva, Switzerland. hutubessyr@who.int.
authors.forename: Raymond C W
authors.initials: RC
authors.lastname: Hutubessy
mesh_terms: D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003657:Decision Making; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D010465:Perception; D014611:Vaccination / Q000191:economics*; D014612:Vaccines / Q000191:economics*
chemical_list: D014612:Vaccines