Evaluating Vaccination Programs That Prevent Diseases With Potentially Catastrophic Health Outcomes: How Can We Capture the Value of Risk Reduction?

In the last 5 years, guidelines have been developed for performing cost-effectiveness analyses (CEAs) for the economic evaluation of vaccination programs against infectious diseases. However, these cost-effectiveness guidelines do not provide specific guidance for including the value of reducing the risk of rare but potentially catastrophic health outcomes, such as mortality or long-term sequelae. Alternative economic evaluation methods, including extended CEA, the impact inventory, cost-benefit analyses, willingness to pay or the value of a statistical life, to capture the value of this risk reduction could provide more complete estimates of the value of vaccination programs for diseases with potentially catastrophic health and nonhealth outcomes. In this commentary, using invasive meningococcal disease as an example, we describe these alternative approaches along with examples to illustrate how the benefits of vaccination in reducing risk of catastrophic health outcomes can be valued. These benefits are not usually captured in CEAs that only include population benefits estimated as the quality-adjusted life-years gained and reduced costs from avoided cases.
Highlights • Although current guidelines for economic evaluation of vaccination programs focus on cost-effectiveness analysis, several recent value frameworks have indicated that cost-effectiveness analysis does not account for many of the benefits attributable to prevention programs. • Vaccination for diseases such as invasive meningococcal disease may reduce the risk of mortality and serious long-term sequelae, the value of which accrues to all protected by vaccination and can be measured using estimates of the value of a statistical life. • Decisions about vaccination programs should take into account the value of all the benefits attributable to vaccination and not just those captured in cost-effectiveness analyses.