Actualización del coste de vacunar a lo largo de toda la vida en España para el año 2023 / Updated cost of vaccinating throughout life in Spain in 2023

Fundamentos: en el calendario de vacunación a lo largo de toda la vida del consejo interterritorial del sistema nacional de Salud (cisns) se introdujeron cuatro modificaciones importantes en 2023. El objetivo de este estudio fue estimar el coste de la vacuNación a lo largo de toda la vida a una persona sana y a ciertos grupos de riesgo tomando como referencia el calendario de 2023 yCompararlo con una estimación previa de 2019. Métodos: se realizo un estudio descriptivo del coste de administrar las vacunas incluidas en el calendario de vacunación a lo Largo de toda la vida para el año 2023 y en el calendario para grupos de riesgo.Resultados: el coste estimado de vacunar a una persona sana a lo largo de toda la vida en 2023 es de 1.541,56 euros en mujeres Y 1.498,18 euros en hombres, lo que supondría un incremento del 125% con respecto al coste en 2019. Las condiciones de riesgo con El coste más alto son asplenia además de déficit del complemento e inmunodeficiencias primarias, suponiendo 3.159.82 euros y 2.566Euros, respectivamente, de media. Vacunar a toda la población sana en españa en un año costaría unos 565 millones de euros y Vacunar a la cohorte de recién nacidos de 2023 a lo largo de toda la vida unos 500 millones de euros.Conclusiones: a pesar del incremento en el coste en 2023, considerando el impacto económico de las enfermedades prevenibles por vacunación en la sociedad, la vacunación sigue siendo una intervención barata que aporta múltiples beneficios.(AU)

Background: four modifications were introduced in the lifetime vaccination schedule of the interterritorial council of the National health system (cisns) in 2023. the aim of this study was to estimate the cost of vaccinating a healthy person and people with Certain risk conditions throughout life in spain and to compare with a previous estimation from 2019.Methods: a descriptive study of the cost of administering the vaccines included in the lifetime vaccination schedule for the year 2023 and in the schedule for risk groups was carried out. Results: the estimated cost to immunize a healthy person throughout life in 2023 is 1,541.56€ for a woman and 1,498.18€ for a Men, which corresponds to an increase of 125% compared to the cost in 2019. The risk conditions with the highest cost are asplenia And complement deficiency and primary immunodeficiencies, with a cost of 3,159.82 euros and 2,566 euros respectively on average. The cost of vaccinating the whole healthy population in spain in a year is around 565m€. Moreover, the cost of vaccinating the New-borns cohort of 2023 was estimated at 500m€. Conclusions: despite the cost increase in 2023, immunization is still a very cheap intervention, considering the economic Impact of immunopreventable diseases in the society. The relative low cost of immunization throughout life makes this health inter-vention useful and worthwhile.(AU)

The Value(s) of Vaccination: Building the Scientific Evidence According to a Value-Based Healthcare Approach.

Objectives: To provide a new value-based immunization approach collating the available scientific evidence on the topic. Methods: Four value pillars (personal, allocative, technical, and societal) applied to vaccination field were investigated. A systematic literature review was performed querying three database from December 24th, 2010 to May 27th, 2020. It included studies on vaccine-preventable diseases (VPDs) that mentioned the term value in any part and which were conducted in advanced economies. An in-depth analysis was performed on studies addressing value as key element. Results: Overall, 107 studies were considered. Approximately half of the studies addressed value as a key element but in most of cases (83.3%) only a single pillar was assessed. Furthermore, the majority of papers addressed the technical value by looking only at classical methods for economic assessment of vaccinations whereas very few dealt with societal and allocative pillars. Conclusions: Estimating the vaccinations value is very complex, even though their usefulness is certain. The assessment of the whole value of vaccines and vaccinations is still limited to some domains and should encompass the wider impact on economic growth and societies.

Estimating total spending by source of funding on routine and supplementary immunisation activities in low-income and middle-income countries, 2000-17: a financial modelling study.

BACKGROUND: Childhood immunisation is one of the most cost-effective health interventions. However, despite its known value, global access to vaccines remains far from complete. Although supply-side constraints lead to inadequate vaccine coverage in many health systems, there is no comprehensive analysis of the funding for immunisation. We aimed to fill this gap by generating estimates of funding for immunisation disaggregated by the source of funding and the type of activities in order to highlight the funding landscape for immunisation and inform policy making. METHODS: For this financial modelling study, we estimated annual spending on immunisations for 135 low-income and middle-income countries (as determined by the World Bank) from 2000 to 2017, with a focus on government, donor, and out-of-pocket spending, and disaggregated spending for vaccines and delivery costs, and routine schedules and supplementary campaigns. To generate these estimates, we extracted data from National Health Accounts, the WHO-UNICEF Joint Reporting Forms, comprehensive multi-year plans, databases from Gavi, the Vaccine Alliance, and the Institute for Health Metrics and Evaluation's 2019 development assistance for health database. We estimated total spending on immunisation by aggregating the government, donor, prepaid private, and household spending estimates. FINDINGS: Between 2000 and 2017, funding for immunisation totalled US$112·4 billion (95% uncertainty interval 108·5-118·5). Aggregated across all low-income and middle-income countries, government spending consistently remained the largest source of funding, providing between 60·0% (57·7-61·9) and 79·3% (73·8-81·4) of total immunisation spending each year (corresponding to between $2·5 billion [2·3-2·8] and $6·4 billion [6·0-7·0] each year). Across income groups, immunisation spending per surviving infant was similar in low-income and lower-middle-income countries and territories, with average spending of $40 (38-42) in low-income countries and $42 (39-46) in lower-middle-income countries, in 2017. In low-income countries and territories, development assistance made up the largest share of total immunisation spending (69·4% [64·6-72·0]; $630·2 million) in 2017. Across the 135 countries, we observed higher vaccine coverage and increased government spending on immunisation over time, although in some countries, predominantly in Latin America and the Caribbean and in sub-Saharan Africa, vaccine coverage decreased over time, while spending increased. INTERPRETATION: These estimates highlight the progress over the past two decades in increasing spending on immunisation. However, many challenges still remain and will require dedication and commitment to ensure that the progress made in the previous decade is sustained and advanced in the next decade for the Immunization Agenda 2030. FUNDING: Bill & Melinda Gates Foundation.

The CAPACITI Decision-Support Tool for National Immunization Programs.

OBJECTIVES: Immunization programs in low-income and middle-income countries (LMICs) are faced with an ever-growing number of vaccines of public health importance recommended by the World Health Organization, while also financing a greater proportion of the program through domestic resources. More than ever, national immunization programs must be equipped to contextualize global guidance and make choices that are best suited to their setting. The CAPACITI decision-support tool has been developed in collaboration with national immunization program decision makers in LMICs to structure and document an evidence-based, context-specific process for prioritizing or selecting among multiple vaccination products, services, or strategies. METHODS: The CAPACITI decision-support tool is based on multi-criteria decision analysis, as a structured way to incorporate multiple sources of evidence and stakeholder perspectives. The tool has been developed iteratively in consultation with 12 countries across Africa, Asia, and the Americas. RESULTS: The tool is flexible to existing country processes and can follow any type of multi-criteria decision analysis or a hybrid approach. It is structured into 5 sections: decision question, criteria for decision making, evidence assessment, appraisal, and recommendation. The Excel-based tool guides the user through the steps and document discussions in a transparent manner, with an emphasis on stakeholder engagement and country ownership. CONCLUSIONS: Pilot countries valued the CAPACITI decision-support tool as a means to consider multiple criteria and stakeholder perspectives and to evaluate trade-offs and the impact of data quality. With use, it is expected that LMICs will tailor steps to their context and streamline the tool for decision making.

A systematic review of economic evaluations of vaccines in Middle East and North Africa countries: is existing evidence good enough to support policy decision-making?

INTRODUCTION: A vaccine introduction process should be systematic and transparent and take into account many factors, including cost-effectiveness evidence. This study aimed to assess quantity, characteristic, and quality of economic evaluation (EE) studies on vaccines performed in Middle East and North Africa (MENA) countries. AREAS COVERED: PubMed and Scopus electronic databases were searched since inception to December 2019 to identify published EE studies of vaccines, which were conducted in the 26 MENA countries. Methodological quality of the included studies was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. EXPERT OPINION: Of the 616 studies identified, 46 were included in the review. Most studies (65%) were conducted in Iran, Israel, and Turkey. The most commonly evaluated vaccines were rotavirus vaccine (n = 15; 33%), human Papillomavirus vaccine (n = 8; 17%), and pneumococcal vaccine (n = 7; 15%). We classified 5 (11%), 27 (59%), 12 (26%), and 2 (4%) studies as excellent, good, moderate, and poor quality, respectively. There were limited cost-effectiveness evidences in the region. It is imperative to have local guidelines on good practice and reporting, availability of local data, and funding sources to improve quantity and quality of EE studies of vaccines in the region, thereby, facilitating transparent and consistent decision-making processes.

A review of prospective pathways and impacts of COVID-19 on the accessibility, safety, quality, and affordability of essential medicines and vaccines for universal health coverage in Africa.

BACKGROUND: The ongoing pandemic of coronavirus disease 2019 (COVID-19) has the potential to reverse progress towards global targets. This study examines the risks that the COVID-19 pandemic poses to equitable access to essential medicines and vaccines (EMV) for universal health coverage in Africa. METHODS: We searched medical databases and grey literature up to 2 October 2020 for studies reporting data on prospective pathways and innovative strategies relevant for the assessment and management of the emerging risks in accessibility, safety, quality, and affordability of EMV in the context of the COVID-19 pandemic. We used the resulting pool of evidence to support our analysis and to draw policy recommendations to mitigate the emerging risks and improve preparedness for future crises. RESULTS: Of the 310 records screened, 134 were included in the analysis. We found that the disruption of the international system affects more immediately the capability of low- and middle-income countries to acquire the basket of EMV. The COVID-19 pandemic may facilitate dishonesty and fraud, increasing the propensity of patients to take substandard and falsified drugs. Strategic regional cooperation in the form of joint tenders and contract awarding, joint price negotiation and supplier selection, as well as joint market research, monitoring, and evaluation could improve the supply, affordability, quality, and safety of EMV. Sustainable health financing along with international technology transfer and substantial investment in research and development are needed to minimize the vulnerability of African countries arising from their dependence on imported EMV. To ensure equitable access, community-based strategies such as mobile clinics as well as fees exemptions for vulnerable and under-served segments of society might need to be considered. Strategies such as task delegation and telephone triage could help reduce physician workload. This coupled with payments of risk allowance to frontline healthcare workers and health-literate healthcare organization might improve the appropriate use of EMV. CONCLUSIONS: Innovative and sustainable strategies informed by comparative risk assessment are increasingly needed to ensure that local economic, social, demographic, and epidemiological risks and potentials are accounted for in the national COVID-19 responses.

A visual approach to the economic evaluation of vaccines: opening the health economic black box.

OBJECTIVES: The economic evaluation of vaccines has attracted a great deal of controversy. In the academic literature, several vaccination advocates argue that the evaluation frame for vaccines should be expanded to give a more complete picture of their benefits. We seek to contribute to the debate and facilitate informed dialogue about vaccine assessment using visualization, as able to support both deliberation by technical committees about the substance of evaluation and communication of the underlying rationale to non-experts. METHODS: We present two visualizations, an Individual Risk Plot (IRP), and a Population Impact Plot (PIP), both showing the beneficiary population on one axis and the degree of individual benefit and cost of an individual dose on the second axis. We sketch out such graphs for 10 vaccines belonging to the UK routine childhood immunization schedule and present our own analysis for the rotavirus and meningitis B vaccines. RESULTS: While the IRPs help classify diseases by morbidity and mortality, the PIPs display the health and economic loss averted after introducing a vaccine, allowing further comparisons. CONCLUSION: The visualizations presented, albeit open to provide an increasingly complete accounting of the value of vaccination, ensure consistency of approach where comparative judgments are most needed.

Immunization funding across 28 European countries.

INTRODUCTION: Disease prevention and improving vaccination coverage in Europe are key elements contributing to resilient health systems and ensuring better health outcomes for all. The aim of this study was to describe the immunization funding landscape across all European Union 28 countries (EU28). AREAS COVERED: Data collected in a targeted literature review supported descriptive analysis on the different indicators that were looked at: vaccines included in the EU28 national immunization programs (NIP), national immunization funding, immunization funding per capita (2015-2019) and percentage of health-care budget allocated to immunization. EXPERT OPINION: Immunization funding represents a small proportion of total healthcare spend in Europe (median 0.3%). In the context of the current COVID-19 pandemic, demographic changes, and the potential introduction of new vaccines; the need for adequate financing of immunization programs will be important, to establish resilient immunization systems and provide sustainable protection of the population against vaccine-preventable diseases.

PLAIN LANGUAGE SUMMARYWhat is the context?Herpes zoster, or shingles, is a viral disease characterized by a painful, localized skin rash. It affects approximately 32% of US citizens at least once in their lifetime.The risk of contracting shingles increases with age.Most American adults over 50 years have not received the shingles vaccine, and vaccination rates are especially low for African-Americans.What is new?This is the first study to evaluate what drives shingles vaccination decisions among US adults ≥ 50 years of age. We also assessed the differences between African-American and non-African-American adults, and inside the African-American group.In this choice experiment, 1,454 people ≥ 50 years completed a survey of 8 choice questions, as well as questions on their previous experiences with vaccines, socioeconomic, and demographic characteristics. Seven factors were evaluated.We found that American adults preferred to get vaccinated, and the most influential factors were costs and vaccine effectiveness while location of vaccination was the least important. There were differences in preferences between African-American and non-African-American adults, mainly driven by costs and vaccine effectiveness. 3 different groups of African-American adults with systematically different preferences could be identified; two were likely to vaccinate, with one being more cost sensitive at lower price thresholds, and the third was unlikely to vaccinate.What is the impact?Decisions on shingles vaccination appear to be mostly driven by costs, which could be a barrier to those who do not have appropriate insurance, especially among some African-Americans.However, healthcare professionals should continue to educate patients on other vaccine characteristics, as they also influence vaccination decisions.

Prioritizing investments in rapid response vaccine technologies for emerging infections: A portfolio decision analysis.

This study reports on the application of a Portfolio Decision Analysis (PDA) to support investment decisions of a non-profit funder of vaccine technology platform development for rapid response to emerging infections. A value framework was constructed via document reviews and stakeholder consultations. Probability of Success (PoS) data was obtained for 16 platform projects through expert assessments and stakeholder portfolio preferences via a Discrete Choice Experiment (DCE). The structure of preferences and the uncertainties in project PoS suggested a non-linear, stochastic value maximization problem. A simulation-optimization algorithm was employed, identifying optimal portfolios under different budget constraints. Stochastic dominance of the optimization solution was tested via mean-variance and mean-Gini statistics, and its robustness via rank probability analysis in a Monte Carlo simulation. Project PoS estimates were low and substantially overlapping. The DCE identified decreasing rates of return to investing in single platform types. Optimal portfolio solutions reflected this non-linearity of platform preferences along an efficiency frontier and diverged from a model simply ranking projects by PoS-to-Cost, despite significant revisions to project PoS estimates during the review process in relation to the conduct of the DCE. Large confidence intervals associated with optimization solutions suggested significant uncertainty in portfolio valuations. Mean-variance and Mean-Gini tests suggested optimal portfolios with higher expected values were also accompanied by higher risks of not achieving those values despite stochastic dominance of the optimal portfolio solution under the decision maker's budget constraint. This portfolio was also the highest ranked portfolio in the simulation; though having only a 54% probability of being preferred to the second-ranked portfolio. The analysis illustrates how optimization modelling can help health R&D decision makers identify optimal portfolios in the face of significant decision uncertainty involving portfolio trade-offs. However, in light of such extreme uncertainty, further due diligence and ongoing updating of performance is needed on highly risky projects as well as data on decision makers' portfolio risk attitude before PDA can conclude about optimal and robust solutions.

Productivity loss/gain in cost-effectiveness analyses for vaccines: a systematic review.

Introduction: The kinds of costs included in cost-effectiveness analyses (CEAs) for vaccines, such as direct medical costs and indirect costs, may affect their outcomes. While some guidelines recommend inclusion of costs associated with productivity losses/gains, very little guidance is provided about the productivity elements to include and their calculation approach.Areas covered: We conducted a systematic review of CEAs for vaccines and vaccine programs published between 1 January 2010 and 19 November 2019 that included productivity costs using Medline, Embase, and the Cochrane Library. The kind of productivity elements included their calculation approach, and the impact of their inclusion on cost-effectiveness are summarized. Among 88 studies identified, productivity elements included were reported for 71 studies (81%) with absenteeism being the most commonly included element. Only 24 studies (27%) reported the approach used to calculate productivity costs (human capital vs. friction approach). Most studies (81%) reported a more favorable cost-effectiveness with the inclusion of productivity losses/gains.Expert opinion: Inclusion of productivity losses/gains for CEAs for vaccines has resulted in more favorable cost-effectiveness based on the studies reviewed. However, clearer guidance on the productivity elements to include by disease area and more transparency on the calculation method used may be needed.

Multi-criteria decision analysis to prioritize the introduction of new vaccines in Indonesia by using the framework of the strategic multi-attribute ranking tool for vaccines (SMART vaccines).

Background: Decision-making processes regarding new vaccine prioritizations are complex. The objective of this study was to prioritize the introduction of new vaccines in Indonesia.Methods: A multi-criteria decision analysis (MCDA) was applied in this study. A preliminary data collection form was developed to collect country-specific data in relation to 30 pre-defined attributes. In particular, an open-ended questionnaire was conducted among targeted respondents from global level, national level and vaccine manufacturers, which were involved in the financial flows of new vaccine procurement in Indonesia. For setting new vaccines priorities, targeted respondents were asked to assign weight on 10 selected criteria.Results: Top 3 attributes with the highest weight from respondents were premature deaths averted per year, incident cases prevented per year, and cost-effectiveness. Applying criteria scores and weight assessment, the result showed that PCV, rotavirus, HPV, and JE would be on the 1st, 2nd, 3rd, and 4th rank for setting new vaccine priority in Indonesia. There was a significant difference score (p value <0.05) between all these vaccines.Conclusions: PCV, rotavirus and HPV vaccines should be more prioritized than JE vaccine. This ranking is in line with the WHO's priority list, which potentially illustrates the validity and usefulness of our MCDA-approach.

Economic Evaluation of Vaccines: Belgian Reflections on the Need for a Broader Perspective.

OBJECTIVES: The standard framework of economic evaluation of health programs, which is increasingly used for policy funding decisions, is insufficiently equipped to reflect the full range of health and economic benefits conferred by vaccines and thus undervalues vaccination. METHODS: In 2019, a group of Belgian health economic and clinical experts, supported by 2 senior international vaccination experts (1 American, 1 Belgian), convened 4 roundtable meetings to highlight which particular value elements of vaccination remain neglected in economic evaluations. RESULTS: They concluded that the standard economic evaluation framework fails to reflect the full value of vaccination with respect to prevention of complications linked to some vaccine-preventable diseases, health gains for caregivers, herd effects, changes in exposure to and distribution of serotypes, the effect on antimicrobial resistance, productivity gains for caregivers and patients, and the distributive implications of vaccination programs. CONCLUSIONS: Here, suggestions are made regarding how these shortcomings can be addressed in future economic evaluations of vaccines and how a more level playing field between vaccines and other health programs can be created.

Costs of Immunization Programs for 10 Vaccines in 94 Low- and Middle-Income Countries From 2011 to 2030.

OBJECTIVES: Understanding the level of investment needed for the 2021-2030 decade is important as the global community faces the next strategic period for vaccines and immunization programs. To assist with this goal, we estimated the aggregate costs of immunization programs for ten vaccines in 94 low- and middle-income countries from 2011 to 2030. METHOD: We calculated vaccine, immunization delivery and stockpile costs for 94 low- and middle-income countries leveraging the latest available data sources. We conducted scenario analyses to vary assumptions about the relationship between delivery cost and coverage as well as vaccine prices for fully self-financing countries. RESULTS: The total aggregate cost of immunization programs in 94 countries for 10 vaccines from 2011 to 2030 is $70.8 billion (confidence interval: $56.6-$93.3) under the base case scenario and $84.1 billion ($72.8-$102.7) under an incremental delivery cost scenario, with an increasing trend over two decades. The relative proportion of vaccine and delivery costs for pneumococcal conjugate, human papillomavirus, and rotavirus vaccines increase as more countries introduce these vaccines. Nine countries in accelerated transition phase bear the highest burden of the costs in the next decade, and uncertainty with vaccine prices for the 17 fully self-financing countries could lead to total costs that are 1.3-13.1 times higher than the base case scenario. CONCLUSION: Resource mobilization efforts at the global and country levels will be needed to reach the level of investment needed for the coming decade. Global-level initiatives and targeted strategies for transitioning countries will help ensure the sustainability of immunization programs.

Economic Benefits of Immunization for 10 Pathogens in 94 Low- and Middle-Income Countries From 2011 to 2030 Using Cost-of-Illness and Value-of-Statistical-Life Approaches.

OBJECTIVES: Vaccination has prevented millions of deaths and cases of disease in low- and middle-income countries (LMICs). During the Decade of Vaccines (2011-2020), international organizations, including the World Health Organization and Gavi, the Vaccine Alliance, focused on new vaccine introduction and expanded coverage of existing vaccines. As Gavi, other organizations, and country governments look to the future, we aimed to estimate the economic benefits of immunization programs made from 2011 to 2020 and potential gains in the future decade. METHODS: We used estimates of cases and deaths averted by vaccines against 10 pathogens in 94 LMICs to estimate the economic value of immunization. We applied 3 approaches-cost of illness averted (COI), value of statistical life (VSL), and value of statistical life-year (VSLY)-to estimate observable and unobservable economic benefits between 2011 and 2030. RESULTS: From 2011 to 2030, immunization would avert $1510.4 billion ($674.3-$2643.2 billion) (2018 USD) in costs of illness in the 94 modeled countries, compared with the counterfactual of no vaccination. Using the VSL approach, immunization would generate $3436.7 billion ($1615.8-$5657.2 billion) in benefits. Applying the VSLY approach, $5662.7 billion ($2547.2-$9719.4) in benefits would be generated. CONCLUSION: Vaccination has generated significant economic benefits in LMICs in the past decade. To reach predicted levels of economic benefits, countries and international donor organizations need to meet coverage projections outlined in the Gavi Operational Forecast. Estimates generated using the COI, VSL, or VSLY approach may be strategically used by donor agencies, decision makers, and advocates to inform investment cases and advocacy campaigns.