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Pediatric Vaccines and Cost-Effectiveness Thresholds: How Much is Too Much to Pay for Prevention?

Jordan Amdahl1, Derek Weycker2, Ray Farkouh3

  • 1Policy Analysis Inc., Chestnut Hill, MA, USA.

Infectious Diseases and Therapy
|November 10, 2020
PubMed

Insights

Cost-effectiveness evaluations for pediatric vaccines lack clear thresholds, potentially overlooking societal values like risk aversion. This impacts public health policy and healthcare budgets.

Area of Science:

  • Health economics
  • Public health policy
  • Vaccine decision-making

Background:

  • Cost-effectiveness evaluations are crucial for the US Advisory Committee on Immunization Practices (ACIP) pediatric vaccine recommendations.
  • Existing evaluations for pediatric vaccines show highly variable incremental cost-effectiveness ratios (ICERs).
  • There is no explicit ACIP threshold for determining acceptable costs for preventing childhood communicable diseases.

Purpose of the Study:

  • To review and discuss the limitations of conventional cost-effectiveness thresholds, specifically the quality-adjusted life-year (QALY) metric.
  • To highlight the inadequacy of QALYs in capturing societal preferences regarding risk and health benefit distribution.
  • To question the applicability of a uniform 'yardstick' for valuing disease prevention in children versus older adults.

Main Methods:

  • Literature review and critical discussion of existing cost-effectiveness methodologies.
  • Analysis of the implications of current metrics on public health policy.
  • Examination of the theoretical and practical considerations in valuing health outcomes.

Main Results:

  • Conventional ICER thresholds based on QALYs may not adequately reflect societal values, such as risk aversion.
  • QALY models do not account for the distribution of health benefits across different population segments.
  • The assumption that 'a QALY is a QALY' may be inappropriate when considering diverse age groups and societal preferences.

Conclusions:

  • Current cost-effectiveness evaluation methods for pediatric vaccines may be insufficient.
  • Revisiting these methods is essential for equitable and effective public health policy.
  • The findings have significant implications for healthcare budgeting and population well-being.

Keywords:
ChildCost-benefit analysisImmunizationInfant

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