Economic evaluation of vaccines:Considerations on evidence, discounting, models and futures challenges

OBJECTIVES: During the last decade, with the arrival of new innovative vaccines, there was a huge increase in the number of papers on economic evaluation of vaccination programmes. Our study had a 3-fold objective: 1) Appraise available methodological papers dealing with specificities of vaccines in term of health economics; 2) Illustrate the impact of each issue in term of decision-making process with concrete examples; and 3) Identify futures challenges. METHODS: A comprehensive literature search was conducted to identify methodological papers dealing with specificities of economic evaluations of vaccines. Each issue was illustrated with concrete examples of cost-effectiveness analyses recently performed for HPV vaccines, or pneumococcal diseases. RESULTS: Except guidelines issued in 2008 by the WHO and a few general papers, most of methodological papers focused on modelling techniques and showed a trend in using more and more sophisticated methods (e.g. calibration). Several papers highlighted the need for having strong dynamic transmission models of infectious diseases to evaluate appropriately the cost-effectiveness of vaccination programmes. Other papers focused on the issue of discounting, and showed the extreme impact of discounting for some vaccines given this long-term assessment, possibly warranting an alternative method of discounting for vaccines. Fewer papers highlighted the different type of clinical evidence compared with curative pharmaceutical drugs, in particular the need to model immunological responses into clinical endpoints of disease and short-term efficacy into long-term effectiveness. Although there is an increasing level of expertise in the field, other important issues such as the choice of realistic assumptions (coverage rates or vaccine prices) and the inclusion of externalities (i.e. changes in the epidemiology of the infection) are not well analysed. CONCLUSIONS: It is important for decision makers to keep in mind the above vaccine specificities when they assess the cost-effectiveness of new vaccination programmes in order to provide relevant conclusions

A general theory of intertemporal decision-making and the perception of time

Animals and humans make decisions based on their expected outcomes. Since relevant outcomes are often delayed, perceiving delays and choosing between earlier versus later rewards (intertemporal decision-making) is an essential component of animal behavior. The myriad observations made in experiments studying intertemporal decision-making and time perception have not yet been rationalized within a single theory. Here we present a theory-Training--Integrated Maximized Estimation of Reinforcement Rate (TIMERR)--that explains a wide variety of behavioral observations made in intertemporal decision-making and the perception of time. Our theory postulates that animals make intertemporal choices to optimize expected reward rates over a limited temporal window; this window includes a past integration interval (over which experienced reward rate is estimated) and the expected delay to future reward. Using this theory, we derive a mathematical expression for the subjective representation of time. A unique contribution of our work is in finding that the past integration interval directly determines the steepness of temporal discounting and the nonlinearity of time perception. In so doing, our theory provides a single framework to understand both intertemporal decision-making and time perception.Comment: 37 pages, 4 main figures, 3 supplementary figure

From Discounting to Incorporating Decisions\u27 Long-Term Impacts

Ms. Atherton urges a different approach to valuing the impact of present day decisions on future generations

Technology assessment between risk, uncertainty and ignorance

The use of most if not all technologies is accompanied by negative side effects, While we may profit from today’s technologies, it is most often future generations who bear most risks. Risk analysis therefore becomes a delicate issue, because future risks often cannot be assigned a meaningful occurance probability. This paper argues that technology assessement most often deal with uncertainty and ignorance rather than risk when we include future generations into our ethical, political or juridal thinking. This has serious implications as probabilistic decision approaches are not applicable anymore. I contend that a virtue ethical approach in which dianoetic virtues play a central role may supplement a welfare based ethics in order to overcome the difficulties in dealing with uncertainty and ignorance in technology assessement

Decision by sampling

We present a theory of decision by sampling (DbS) in which, in contrast with traditional models, there are no underlying psychoeconomic scales. Instead, we assume that an attribute’s subjective value is constructed from a series of binary, ordinal comparisons to a sample of attribute values drawn from memory and is its rank within the sample. We assume that the sample reflects both the immediate distribution of attribute values from the current decision’s context and also the background, real-world distribution of attribute values. DbS accounts for concave utility functions; losses looming larger than gains; hyperbolic temporal discounting; and the overestimation of small probabilities and the underestimation of large probabilities

Decision by sampling

We present a theory of decision by sampling (DbS) in which, in contrast with traditional models, there are no underlying psychoeconomic scales. Instead, we assume that an attribute's subjective value is constructed from a series of binary, ordinal comparisons to a sample of attribute values drawn from memory and is its rank within the sample. We assume that the sample reflects both the immediate distribution of attribute values from the current decision's context and also the background, real-world distribution of attribute values. DbS accounts for concave utility functions; losses looming larger than gains; hyperbolic temporal discounting; and the overestimation of small probabilities and the underestimation of large probabilities

Cognitive barriers during monitoring-based commissioning of buildings

Monitoring-based commissioning (MBCx) is a continuous building energy management process used to optimize energy performance in buildings. Although monitoring-based commissioning (MBCx) can reduce energy waste by up to 20%, many buildings still underperform due to issues such as unnoticed system faults and inefficient operational procedures. While there are technical barriers that impede the MBCx process, such as data quality, the focuses of this paper are the non-technical, behavioral and organizational, barriers that contribute to issues initiating and implementing MBCx. In particular, this paper discusses cognitive biases, which can lead to suboptimal outcomes in energy efficiency decisions, resulting in missed opportunities for energy savings. This paper provides evidence of cognitive biases in decisions during the MBCx process using qualitative data from over 40 public and private sector organizations. The results describe barriers resulting from cognitive biases, listed in descending order of occurrence, including: risk aversion, social norms, choice overload, status quo bias, information overload, professional bias, and temporal discounting. Building practitioners can use these results to better understand potential cognitive biases, in turn allowing them to establish best practices and make more informed decisions. Researchers can use these results to empirically test specific decision interventions and facilitate more energy efficient decisions