title: Economic evaluation of vaccines in Canada: A systematic review.
abstract: Economic evaluations should form part of the basis for public health decision making on new vaccine programs. While Canada's national immunization advisory committee does not systematically include economic evaluations in immunization decision making, there is increasing interest in adopting them. We therefore sought to examine the extent and quality of economic evaluations of vaccines in Canada.
  
  
  
  We conducted a systematic review of economic evaluations of vaccines in Canada to determine and summarize: comprehensiveness across jurisdictions, studied vaccines, funding sources, study designs, research quality, and changes over time.
  
  
  
  Searches in multiple databases were conducted using the terms "vaccine," "economics" and "Canada." Descriptive data from eligible manuscripts was abstracted and three authors independently evaluated manuscript quality using a 7-point Likert-type scale scoring tool based on criteria from the International Society for Pharmacoeconomics and Outcomes Research (ISPOR).
  
  
  
  42/175 articles met the search criteria. Of these, Canada-wide studies were most common (25/42), while provincial studies largely focused on the three populous provinces of Ontario, Quebec and British Columbia. The most common funding source was industry (17/42), followed by government (7/42). 38 studies used mathematical models estimating expected economic benefit while 4 studies examined post-hoc data on established programs. Studies covered 10 diseases, with 28/42 addressing pediatric vaccines. Many studies considered cost-utility (22/42) and the majority of these studies reported favorable economic results (16/22). The mean quality score was 5.9/7 and was consistent over publication date, funding sources, and disease areas.
  
  
  
  We observed diverse approaches to evaluate vaccine economics in Canada. Given the increased complexity of economic studies evaluating vaccines and the impact of results on public health practice, Canada needs improved, transparent and consistent processes to review and assess the findings of the economic evaluations of vaccines.
authors.affiliation: a Sanofi Pasteur , Toronto , Ontario , Canada.|b Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto , Ontario , Canada.
authors.forename: Ayman
authors.initials: A
authors.lastname: Chit
authors.affiliation: a Sanofi Pasteur , Toronto , Ontario , Canada.|b Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto , Ontario , Canada.
authors.forename: Jason K H
authors.initials: JK
authors.lastname: Lee
authors.affiliation: b Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto , Ontario , Canada.
authors.forename: Minsup
authors.initials: M
authors.lastname: Shim
authors.affiliation: c Health Services and Systems Research Program, Duke-NUS Graduate Medical School Singapore , Singapore.
authors.forename: Van Hai
authors.initials: VH
authors.lastname: Nguyen
authors.affiliation: b Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto , Ontario , Canada.|d Department of Economics , McMaster University , Hamilton , Ontario , Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Grootendorst
authors.affiliation: e Center for Disease Modeling, York Institute for Health Research, York University , Toronto , Ontario , Canada.
authors.forename: Jianhong
authors.initials: J
authors.lastname: Wu
authors.affiliation: a Sanofi Pasteur , Toronto , Ontario , Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Van Exan
authors.affiliation: f Canadian Center for Vaccinology and the Departments of Pediatrics and Community Health and Epidemiology, Dalhousie University , Halifax , Nova Scotia , Canada.
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Langley
mesh_terms: D001955:British Columbia; D002170:Canada; D003362:Cost-Benefit Analysis; D003657:Decision Making; D006801:Humans; D017589:Immunization Programs / Q000191:economics; D009864:Ontario; D017063:Outcome Assessment, Health Care; D011792:Quebec; D014611:Vaccination / Q000191:economics*; D014612:Vaccines / Q000191:economics*
chemical_list: D014612:Vaccines
keywords: Canada; cost-effectiveness; economics; review; vaccine