Assessment of vaccination policies from a health economic perspective: opportunities and emerging foci

The Dutch National Immunization Program holds a pivotal role in public health, significantly influencing the mitigation of infectious diseases. While it encompasses a wide range of vaccines, not all EMA-approved vaccines are incorporated. Based on the Dutch Health Council's recommendations, the Ministry of Health decides on the inclusion of vaccinations as part of the National immunization Program (NIP). Here, health economic analyses play an important role. However, challenges arise when these analyses are unavailable, incomplete, or outdated, resulting in missed opportunities.Florian's thesis underscores the importance of early Health Technology Assessment (HTA) and periodic to optimize the NIP in the Netherlands. The thesis explores health economic analyses of vaccines through three approaches. The first segment focuses on underutilized vaccines for infants in the Dutch context. The subsequent part delves into the economic aspects of vaccinating older adults, incorporating early HTA and model enhancements to aid decision-making, potentially enhancing the protection against infections in this vulnerable demographic. The final part explores the scope of healthcare policy for optimizing vaccination strategies from a health economic perspective.From a public health perspective, vaccination is vital to protect the population against infectious diseases and so warrants more attention. To minimize the health burden and costs associated with infectious diseases, a proactive, ongoing, and expeditious approach is essential. Additionally, a broader perspective is necessary, considering the full spectrum of benefits vaccines offer. Instead of perceiving costs of vaccines solely as expenses, these should be viewed as investment in long-term health and well-being of the population

Local Satisfaction Explained Away

The paper makes the proposal to replace local satisfaction as a source of presupposition blocking by causal and identity inferences that indirectly ---through Trapping--- lead to the same effect

Rotavirus Vaccination of Infants Delayed and Limited within the National Immunization Programme in the Netherlands:An Opportunity Lost

In this study, we estimated the benefits of rotavirus vaccination for infants had the rotavirus vaccine been introduced in the Netherlands as of its market authorization in 2006. An age-structured, deterministic cohort model was developed to simulate different birth cohorts over a period of 15 years from 2006 until 2021, comparing both universal and targeted high-risk group vaccination to no vaccination. Different scenarios for the duration of protection (5 or 7 years) and herd immunity (only for universal vaccination) were analyzed. All birth cohorts together included 2.6 million infants, of which 7.9% were high-risk individuals, and an additional 13.2 million children between 1-15 years born prior to the first cohort in 2006. The costs and health outcomes associated with rotavirus vaccination were calculated per model scenario and discounted at 4% and 1.5%, respectively. Our analysis reveals that, had rotavirus vaccination been implemented in 2006, it would have prevented 356,800 (51% decrease) and 32,200 (5% decrease) cases of rotavirus gastroenteritis after universal and targeted vaccination, respectively. Over the last 15 years, this would have led to significant avoided costs and quality-adjusted life year losses for either vaccination strategy with the most favorable outcomes for universal vaccination. Clearly, an opportunity has been lost

Exploratory Analysis of the Economically Justifiable Price of a Hypothetical RSV Vaccine for Older Adults in the Netherlands and the United Kingdom

BACKGROUND: In older adults, the burden of respiratory syncytial virus (RSV) resembles that of influenza and may even be considered worse due to the lack of preventive interventions. This study was performed to identify the available literature on RSV infection in older adults, and to provide updated exploratory results of the cost-effectiveness of a hypothetical RSV vaccine in the Netherlands and the United Kingdom. METHODS: A literature search was performed in Medline and EMBASE on 11 November 2019, which served as input for a static decision-tree model that was used to estimate the EJP, for an RSV vaccine applying different willingness-to-pay (WTP) thresholds. WTP thresholds applied were €20 000 and €50 000 per quality-adjusted life-year for the Netherlands, and £20 000 and £30 000 per quality-adjusted life-year for the United Kingdom. Analyses were—in line with country-specific guidelines—conducted from a societal perspective for the Netherlands and a third-party payer perspective for the United Kingdom. The robustness of the cost-effectiveness results was tested in sensitivity analysis. RESULTS: After screening the literature, 3 studies for the Netherlands and 6 for the United Kingdom remained to populate the country-specific models. In the base case analysis for the Netherlands (mean RSV incidence, 3.32%), justifiable vaccine prices of €16.38 and €50.03 were found, based on applying the lower and higher WTP thresholds, respectively. Similarly, for the United Kingdom (mean incidence, 7.13%), vaccine prices of £72.29 and £109.74 were found, respectively. CONCLUSION: RSV vaccination may well be cost-effective in both the Netherlands and the United Kingdom, depending on the exact RSV incidence, vaccine effectiveness and price. However, sensitivity analysis showed that the results were robust based on varying the different parameter estimates and assumptions. With RSV vaccines reaching the final stages of development, a strong need exists for cost-effectiveness studies to understand economically justifiable pricing of the vaccine

Presupposition projection as proof construction

Even though Van der Sandt's presuppositions as anaphora approach is empirically successful, it fails to give a formal account of the interaction between world-knowledge and presuppositions. In this paper, an algorithm is sketched which is based on the idea of presuppositions as anaphora. It improves on this approach by employing a deductive system, Constructive Type Theory (CTT), to get a formal handle on the way world-knowledge influences presupposition projection. In CTT, proofs for expressions are explicitly represented as objects. These objects can be seen as a generalization of DRT's discourse markers. They are useful in dealing with presuppositional phenomena which require world-knowledge, such as Clark's bridging examples and Beaver's conditional presuppositions

Resolving Underspecification using Discourse Information

Schlangen D, Lascarides A, Copestake A. Resolving Underspecification using Discourse Information. In: Kühnlein P, Rieser H, Zeevat H, eds. Proceedings of the 5th International Workshop on Formal Semantics and Pragmatics of Dialogue (BI-DIALOG 2001). Bielefeld; 2001: 79-93