Vaccine development and introduction is a long and complex process. Understanding potential demand to help inform supply from manufacturers or budget implications for choosing one intervention over another or no intervention at all are a few key ways in which health economics can support vaccine development and country introduction efforts.
Experts in health economics and outcomes research
Health economic analyses provide needed data to support investment decisions in vaccine development as well as inform country adoption decisions. PATH’s Center for Vaccine Innovation and Access (CVIA) has a team of health economists conducting rigorous economic research to inform global and country decision-making to inform prioritization, planning, implementation, and financing decisions about myriad vaccines.
“We support decision-makers to determine the best use of limited resources and guide the global health community on which vaccines will have the greatest impact”, says Frédéric Debellut, Senior Health Economist, CVIA. Depending on the policy question at hand, estimates of forecasted demand, impact and cost-effectiveness, economic burden of disease, immunization cost of delivery, and budget impact analyses can really assist with making informed decisions.
“We support decision-makers to determine the best use of limited resources and guide the global health community on which vaccines will have the greatest impact.”— Frédéric Debellut, Senior Health Economist, CVIA
Data to inform vaccine introduction and switch decisions
As one of PATH’s health economists, Frédéric collaborates closely with country decision-makers to understand the economic impact of vaccine introduction decisions. “One of the common questions we hear from country decision-makers is about cost. Is the vaccine cost-effective? What will it cost us?”, says Frédéric.
Countries are often being asked to prioritize multiple antigens—typhoid conjugate vaccine (TCV), malaria vaccine, human papillomavirus vaccines (HPV), and others—with limited resources. To answer these questions, Frédéric uses a variety of tools:
- Cost of delivery analyses
- Cost of illness analyses
- Impact and cost-effectiveness analyses
In his work on the Typhoid Vaccine Acceleration Consortium (TyVAC) project, which aims to accelerate the introduction of TCVs in typhoid-endemic, Gavi, the Vaccine Alliance-eligible countries, Frédéric has led research to understand the cost of typhoid illness for families and the health system, and the cost of typhoid vaccine delivery.
“When we started this project 7 years ago, we didn’t have a lot of costing information. We conducted a cost of illness study in Malawi and found that families often bear catastrophic costs for treatment of a case. The health system also bears a large cost. This information has demonstrated the high economic burden of typhoid for countries considering TCV introduction”, explains Frédéric. Further, Frédéric and colleagues have examined the potential health impact and cost-effectiveness of TCV vaccination for multiple countries, contributing to decisions to introduce the vaccine.
Frédéric’s work isn’t only relevant to new vaccine introductions, but also potential vaccine switches. For some diseases, multiple vaccine products are available. It can be difficult to discern which product is the best choice for a given country from a cost perspective, and to determine whether switching products could be cost-effective. PATH’s approach is to make all existing information available for decision-making without promoting or prioritizing one product or manufacturer over another.
“We try to develop easy-to-use tools that can be used by people without a health economics background,” notes Frédéric. “For example, PATH’s Vaccine Cost Calculators only require a very limited set of inputs from users to generate comparative analyses of the cost of certain vaccination programs with the different vaccine products available in the global market. We recently released new calculators specifically for use by middle-income countries for rotavirus and pneumococcal vaccines. We also have calculators for Gavi-eligible countries for rotavirus, pneumococcal, and HPV vaccines.”
Decision-makers in Gavi-eligible and middle-income countries can use PATH's Vaccine Cost Calculators to compare the vaccination program costs and cold chain volumes associated with different product options. Photo: PATH
When Ghana made a rotavirus vaccine product switch, PATH’s health economics team helped provide economic analyses to evaluate the financial aspects of that decision, confirming its cost-effectiveness for decision-makers. “Filling the evidence gap is one aspect that I enjoy most about my work,” Frédéric says. “Economic evaluation is a great tool to generate data that help leaders make informed decisions.”
Additional resources for country decision-makers
The PATH team develops and uses a number of tools and economic models. For example, they have a track record of supporting country led cost-effectiveness analysis using the UNIVAC decision support model developed at the London School of Hygiene and Tropical Medicine, as well as other tools like the Vaccine Cost Calculators.
These join the increasing number of resources available to decision-makers when it comes to the economic evaluation of vaccines, including training programs for policymakers in low- and middle-income countries, and repositories of resources.
“Our ultimate goal in this work is to provide high-quality economic analyses to support evidence-based vaccine introduction decisions,” notes Frédéric. From cost-effectiveness analyses to budget impact modeling and demand forecasting, PATH’s health economics and outcomes research team is doing just that.
