title: Systematic review of economic evaluations of vaccination programs in mainland China: Are they sufficient to inform decision making?
abstract: The purpose of the study was to systematically review economic evaluations of vaccine programs conducted in mainland China. We searched for economic evaluations of vaccination in China published prior to August 3, 2015 in eight English-language and three Chinese-language databases. Each article was appraised against the 19-item Consensus on Health Economic Criteria list (CHEC-list). We found 23 papers evaluating vaccines against hepatitis B (8 articles), Streptococcus pneumoniae (5 articles), human papillomavirus (3 articles), Japanese encephalitis (2 articles), rotavirus (2 articles), hepatitis A (1 article), Enterovirus 71 (1 article) and influenza (1 article). Studies conformed to a mean of 12 (range: 6-18) items in the CHEC-list criteria. Five of six Chinese-language articles conformed to fewer than half of the 19 criteria items. The main criteria that studies failed to conform to included: inappropriate measurement (20 articles) and valuation (18 articles) of treatment and/or vaccination costs, no discussion about distributional implications (18 articles), missing major health outcomes (14 articles), no discussion about generalizability to other contexts (14 articles), and inadequate sensitivity analysis (13 articles). In addition, ten studies did not include major cost components of vaccination programs, and nine did not report outcomes in terms of life years even in cases where QALYs or DALYs were calculated. Only 13 studies adopted a societal perspective for analysis. All studies concluded that the appraised vaccination programs were cost-effective except for one evaluation of universal 7-valent pneumococcal conjugate vaccine (PCV-7) in children. However, three of the five studies on PCV-7 showed poor overall quality, and the number of studies on vaccines other than hepatitis B vaccine and PCV-7 was limited. In conclusion, major methodological flaws and reporting problems exist in current economic evaluations of vaccination programs in China. Local guidelines for good practice and reporting, institutional mechanisms and education may help to improve the overall quality of these evaluations.
authors.affiliation: Center for Clinical Epidemiology and Evidence-Based Medicine, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Renmin Nanlu 3-17, Chengdu 610041, China.
authors.forename: Xiong-Fei
authors.initials: XF
authors.lastname: Pan
authors.affiliation: Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
authors.forename: Ulla K
authors.initials: UK
authors.lastname: Griffiths
authors.affiliation: Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Pennington
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing 102206, China.
authors.forename: Hongjie
authors.initials: H
authors.lastname: Yu
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. Electronic address: mark.jit@lshtm.ac.uk.
authors.forename: Mark
authors.initials: M
authors.lastname: Jit
mesh_terms: D002681:China / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003657:Decision Making; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D011008:Pneumococcal Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D014612:Vaccines / Q000191:economics* / Q000276:immunology*; D014777:Virus Diseases / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D014612:Vaccines
keywords: China; Economic evaluation; Vaccines