Capturing the value of vaccination within health technology assessment and health economics:Country analysis and priority value concepts

Background: A value of vaccination framework for economic evaluation (EE) identified unique value concepts for the broad benefits vaccination provides to individuals, society, healthcare systems and national economies. The objectives of this paper were to work with experts in developed countries to objectively identify three priority concepts to extend current EE. Methods: The previously developed classification of value concepts in vaccination distinguished 18 concepts, categorised as conventional payer and societal perspective concepts and novel broader societal concepts. Their inclusion in current EE guidelines was assessed. Experts identified eight criteria relevant to decision-making and measurement feasibility, which were weighted and used to score each concept. The relative ranking of concepts by importance and the gaps in guidelines were used to identify three priority concepts on which to focus immediate efforts to extend EE. Results: The EE guidelines review highlighted differences across countries and between guidelines and practice. Conventional payer perspective concepts (e.g., individual and societal health gains and medical costs) were generally included, while gaps were evident for conventional societal perspective concepts (e.g., family/caregiver health and economic gains). Few novel broader societal benefits were considered, and only in ad hoc cases. The top-three concepts for near-term consideration: macroeconomic gains (e.g., benefiting the economy, tourism), social equity and ethics (e.g., equal distribution of health outcomes, reduced health/financial equity gaps) and health systems strengthening, resilience and security (e.g., efficiency gains, reduced disruption, increased capacity). Conclusions: Gaps, inconsistencies and limited assessment of vaccination value in EE can lead to differences in policy and vaccination access. The three priority concepts identified provide a feasible approach for capturing VoV more broadly in the near-term. Robust methods for measuring and valuing these concepts in future assessments will help strengthen the evidence used to inform decisions, improving access to vaccines that are demonstrably good value for money from society's point of view. (C) 2022 GlaxoSmithKline Biologicals S.A. Published by Elsevier Ltd

eStroke: How to Align Stakeholders and Reach Sustainability

There is a massive need for stroke treatment and rehabilitation in China. In 2018, Neusoft Medical cooperated with the State Engineering Laboratory of Internet Medical Diagnosis and Treatment Technology headed by Xuanwu Hospital to create the eStroke National Thrombolysis and Thrombectomy Image Platform (eStroke, in short). The primary objective of eStroke is to shorten the time of diagnosis for proper treatment in order to improve patient survival and reduce sequelae when the patient survives. After three years, the project is well underway but needs to scale up, as only 83 hospitals have joined, and only 13,000 patients have been served. No partner is satisfied. The project was set up as a public welfare project with an agreement not to charge users. Neusoft had hoped that eStroke's user base would grow and indirectly drive equipment sales such as CT and MRI machines. However, since eStroke does not directly generate profits, sales staff had no incentive to promote eStroke. Dr. Huang Feng, who is in charge of the eStroke project at Neusoft, plans to apply for a special marketing budget from Neusoft Medical in the annual budget review meeting to expand the scale of eStroke users rapidly. Still, the concerns and demands of various stakeholders of the eStroke platform are far more complicated than simply calling for investing more capital and increasing the workforce. How should Dr. Huang consider the claims of all stakeholders? How can he persuade the company to invest more? Will the new budget alone help eStroke expand quickly

Cost-Effectiveness of Treatments for Relapsing Remitting Multiple Sclerosis: A French Societal Perspective.

The paper aimed to estimate the incremental cost-effectiveness ratio (ICER) at the public published price for delayed-release dimethyl fumarate versus relevant Multiple Sclerosis disease-modifying therapies available in France in June 2015.The economic model was adapted to the French setting in accordance with the Haute Autorité de Santé guidelines using a model previously developed for NICE. A cohort of Relapsing Remitting Multiple Sclerosis patients was simulated over a 30-year time horizon. Twenty one health states were taken into account: Kurtzke Expanded Disability Status Scale (EDSS) 0-9 for Relapsing Remitting Multiple Sclerosis patients, EDSS 0-9 for Secondary Progressive Multiple Sclerosis patients, and death. Estimates of relative treatment efficacy were determined using a mixed-treatment comparison. Probabilities of events were derived from the dimethyl fumarate pivotal clinical trials and the London Ontario Dataset. Costs and utilities were extracted from the published literature from both the payer and societal perspectives. Univariate and probabilistic sensitivity analyses were performed to assess the robustness of the model results.From both perspectives, dimethyl fumarate and interferon beta-1a (IFN beta-1a) 44 mcg were the two optimal treatments, as the other treatments (IFN beta-1a 30 mcg, IFN beta-1b 250 mcg, teriflunomide, glatiramer acetate, fingolimod) were dominated on the efficiency frontier. From the societal perspective, dimethyl fumarate versus IFN beta-1a 44 mcg incurred an incremental cost of €3,684 and an incremental quality-adjusted life year (QALY) of 0.281, corresponding to an ICER of €13,110/QALY.Despite no reference threshold for France, dimethyl fumarate can be considered as a cost-effective option as it is on the efficiency frontier

Cost-effectiveness acceptability curve of DMF versus IFN beta-1a 44mcg (non-dominated strategy).

<p>Cost-effectiveness acceptability curve of DMF versus IFN beta-1a 44mcg (non-dominated strategy).</p

Base case results (costs, in € per patient; QALYs): societal perspective.

<p>Base case results (costs, in € per patient; QALYs): societal perspective.</p

Model schematic.

<p>Model schematic.</p

Results of the univariate sensitivity analysis.

<p>(a) percentage of scenarios in which each treatment was efficient, extendedly dominated or strictly dominated. (b) Tornado diagram DMF vs. IFN beta-1a 44mcg</p

Costs (direct and indirect) associated with the treatment of MS (costs presented here are the same in both the payer’s and the societal perspectives).

<p>Costs (direct and indirect) associated with the treatment of MS (costs presented here are the same in both the payer’s and the societal perspectives).</p

Summary plot of the rate ratio and 95% CIs for MTC of ARR for DMF versus comparators [15].

<p>Summary plot of the rate ratio and 95% CIs for MTC of ARR for DMF versus comparators [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0150703#pone.0150703.ref015" target="_blank">15</a>].</p

Efficiency frontier comparing treatments.

<p>Efficiency frontier comparing treatments.</p