A Gathering of Research Related to Vaccine HEOR

Section Editor: George Papadopoulos, BSc(Hons), GradDipEpi, MAICD, Partner & Director, Lucid Health Consulting & School of Medicine, University of New South Wales, Sydney, New South Wales, Australia

“The impact of vaccination on the health of the world’s peoples is hard to exaggerate. With the exception of safe water, no other modality has had such a major effect on mortality reduction and population growth.” (Plotkin and Mortimer, 1988).

The articles in this month’s Research Roundup look at the topic of vaccine health economics and outcomes research (HEOR), including the challenges and opportunities presented by COVID-19, accounting for herd immunity and the value of trust in addressing vaccine hesitancy. We, as always, trust you enjoy delving into the research presented here and look forward to highlighting research in the next edition.

Health Economics and Emergence From COVID-19 Lockdown: The Great Big Marginal Analysis
Donaldson C, Mitton C. Health economics and emergence from COVID-19 lockdown: the great big marginal analysis. Health Econ Policy and Law. 2020:1-5. doi:10.1017/S1744133120000304.

Summary
Despite denials of politicians and other advisors, trade-offs have already been apparent in many policy decisions addressing the COVID-19 pandemic and its social and economic consequences. The authors illustrate why it is important, from a well-being perspective, to recognize such trade-offs and provide a framework based on the economic concept of “marginal analysis” for doing so. The framework exposes crucial questions to be addressed, such as the critical value of reducing the reproductive rate of the virus and further opening of the economy and/or background infection, above which health considerations predominate. These may vary from jurisdiction to jurisdiction and the value of lives forgone resulting from the small increases in reproductive rate of the virus and/or background infection levels that may have to be tolerated as the economy is gradually opened.

Relevance
In the view of the authors, the trade-offs referred to in the paper are inevitable and for purposes of optimizing overall human welfare, they are better recognized, analyzed, and publicly debated. 

Impact of Vaccines; Health, Economic and Social Perspectives
Rodrigues CMC, Plotkin SA. Front Microbiol. 2020;11:1526.
https://doi: 10.3389/fmicb.2020.01526

Summary
The development of safe and efficacious vaccination against diseases that cause substantial morbidity and mortality has been one of the foremost scientific advances of the 21st century. It is estimated that vaccines have prevented 6 million deaths from vaccine-preventable diseases annually. The importance of various organizations in global cooperation and participation was essential in the setting of the 2019 global pandemic of SARS-CoV-2, in light of the health and economic impact of COVID-19 on societies in high-, middle- and low-income countries. The review covers a brief history of vaccine development, the health benefits of vaccination, such as reduction in infectious diseases morbidity and mortality, the eradication of infectious diseases, herd immunity, and also the economic and social benefits such as the cost-effective preparedness for outbreaks.

Relevance
This excellent and comprehensive review highlights the benefits of vaccinations to society from the perspectives of health, economy, and social fabric which need to be considered in the overall assessment of impact to ensure that vaccines are prioritized by those making funding decisions.

Consideration of Value-Based Pricing for Treatments and Vaccines Is Important, Even in the COVID-19 Pandemic
Neumann PJ,  Cohen JT,  Kim DD,  Ollendorf DA. Health Affairs 2021;40(1):53-61. https://doi.org/10.1377/hlthaff.2020.01548

Summary
Pricing in a pandemic is complicated and fraught. The authors review alternative pricing strategies (cost-recovery models, monetary prizes, and advance market commitments) for COVID-19 drugs, vaccines, and diagnostics. The authors argue that hybrid pricing strategies are undoubtedly needed in a pandemic, but even in a public health crisis, value-based pricing is important. All pricing strategies should be informed by formal health technology assessment and cost-effectiveness analysis and ideally, analyses would be conducted from both a health system and societal perspectives. Incorporating the added value of social benefits into cost-effectiveness analyses does not mean that manufacturers should capture the entire societal benefit of a diagnostic, vaccine, or therapy. Such analyses can provide important information and help policy makers consider the full costs and benefits of products and the wide-ranging ramifications of their actions. The authors identified 23 economic evaluations of COVID-19–related interventions, including 14 cost-effectiveness analyses, 5 cost analyses, and 4 benefit-cost analyses. These analyses evaluated a range of interventions, including policy measures (social distancing or lockdown orders), treatments (dexamethasone or remdesivir), screening strategies, and hypothetical vaccines. Although estimating the full value of a drug for COVID-19 is difficult, the pandemic’s economic impact leaves little doubt that it would be substantial.

Relevance
The authors conclude that people may believe that the setting of a pandemic is not the appropriate venue for value-based pricing. However, robust and sound value assessments to inform product prices can help ensure that tests, treatments, and vaccines are available for this crisis and for crises yet to come.

Will COVID-19 Vaccines Be Cost-Effective—And Does It Matter?
Appleby J. BMJ. 2020;371:m4491.
https://www.bmj.com/content/371/bmj.m4491/rapid-responses

Summary
A feature article in which the author poses the question of whether the COVID-19 vaccines would be considered cost-effective under the National Institute for Health and Care Excellence’s (NICE) approach to measuring value and questions whether NICE’s methods are appropriate. A question and challenge that could be equally applied to other similar health technology assessment bodies around the world. Many governments, including the United Kingdom, have committed to financially support businesses and people in lockdown and many governments have already signed deals for COVID-19 vaccines in development ahead of establishing their clinical effectiveness, let alone their cost-effectiveness. NICE guidance on the approach to economic evaluation does recognize the fact that healthcare technologies might have wider benefits or costs and that these can be reported separately with prior agreement.

Relevance
COVID-19 may be unusual, but it draws attention to a debate for NICE and other similar organizations around the globe about the extent to which we want these bodies to broaden their perspective on inclusion of wider economic benefits or costs. As the author concludes, the world has painfully learned, that health (and care) and our economic lives are (and always have been) inseparable. NICE’s response to the article is worth reviewing. They accept the challenges posed by the author as they rapidly create guidelines to inform frontline COVID-19 care and assess the benefits of new technologies, including the rapid approach of COVID-19 vaccines to improve its treatment.