The Relationship Between Cost Effectiveness, National Vaccination Programs

A new thesis presented at Sahlgrenska Academy, University of Gothenburg, found that although immunizing children against chicken pox saves money, offering shingles vaccinations to all adults 65 years of age would not.

“It’s become clear that new vaccine development can be rapid. But new vaccines tend to cost more per dose than those that are already established in the market,” said Ellen Wolff, a health economist at the Public Health Agency of Sweden, in a press release.

Immunization has been a key instrument of public health policy, helping to protect individuals and their community by reducing the spread of infection; however, incorporating vaccinations into national programs requires economic prioritization. Even with the demand for health care on a limitless scale, resources in the form of labor, equipment, and funds in the care sector are limited, according to the study.

An analysis of the cost-effectiveness of vaccination programs allows researchers to compare the health effects and cost of 2 or more alternative programs versus not providing vaccinations.

The results are commonly presented in terms of cost per quality-adjusted life-year (QALY), an indicator combining effects of health-related length and quality of life. The analysis includes not only such expenses as vaccination doses, but also the cost of care.

The research from Ellen Wolff and her team influenced Sweden’s current national vaccination programs, according to the press release. These include the now sex-neutral vaccination against human papillomavirus, which has included boys and girls since the end of 2020.

Additionally, the researchers have studied the cost-effectiveness of various vaccination strategies for protecting infants from pertussis. The most cost-effective strategy proved to be immunizing babies at exactly the right time with no delay, at the ages of 3, 5, and 12 months. Alternatively, vaccinating pregnant women, or the parents or guardians of newborn babies, was less cost-effective.

Another study from Wolff’s thesis investigated the cost-effectiveness of pneumococcal vaccination for adults 65 and 75 years of age. The results indicated that giving adults 65 years of age these vaccinations is not cost-effective, whereas vaccinating adults 75 years of age may be.

Although the varicella vaccination is not yet included in Sweden’s public vaccination program for children, the thesis predicts that this measure would be cost-effective and even money-saving. On the other hand, vaccinating adults who are 65 years of age against shingles fails to attain cost-effectiveness, according to the study.

A questionnaire study in the thesis asked respondents whether they thought society should spend more resources on implementing preventive vaccination programs or treating disease once it has arisen. More than 1900 gave clear priority to prevention, based on a representative sample of Sweden’s population.

“Preventive measures like immunization may involve heavy spending in the present, while the health effects arise in the future,” Wolff said in a press release. “It may therefore be hard to get decision-makers to prioritize prevention, compared with the treatment of disease that’s already manifested.”

REFERENCE

Cost-effective or not? New research on national vaccination programs. University of Gothenburg. https://www.gu.se/en/news/cost-effective-or-not-new-research-on-national-vaccination-programs. Published December 21, 2020. Accessed January 5, 2021.