Cost-effectiveness Analysis and Vaccine Policy

1. Cost-effectiveness Analysis and Vaccine Policy Lisa A. Prosser, Ph.D. University of Michigan May 2, 2011

2. Overview • Role of cost-effectiveness evidence in current Advisory Committee on Immunization Practices (ACIP) process • Limitations in current health valuation approaches • Lessons from newborn screening • Future directions & global implications

3. Evidence Reviewed by ACIP Source: Smith, 2010

4. Cost-effectiveness in practice • Inadequacy of the cost-effectiveness framework to capture important values • Identifying a threshold for determining cost-effectiveness • Challenge of communicating results to decision makers

5. Valuation of health benefits • Limitations of QALYs, DALYs, other established measures • Risk profile • Priorities by age • Conjoint analysis and other approaches provide complementary information

6. QALY Losses Source: Lavelle et al., 2010

7. Time trade-off amounts by patient age Source: Prosser et al., 2010

8. Thresholds • Implied threshold from ACIP recommendations • WTP per QALY – no “one size fits all” • A QALY is a QALY is a QALY (or is it?) • Prevention vs. treatment • Characteristics of the condition, patient population • WHO thresholds

9. Lessons from newborn screening • Advisory Committee for Heritable Disorders in Newborns and Children (ACHDNC) • Evidence Evaluation Methods Working Group • Decision modeling to project outcomes • Short and long-term health outcomes • …but not QALYs • “false positives” vs. identified cases

10. Newborn Screening – Projected Outcomes Source: Prosser et al., Pediatrics, 2010

11. Newborn Screening – Projected Outcomes QALYs gained via screening 46.95 QALYs lost from FPs -0.01 QALYs lost from treatment -10.52 Total QALYs 36.42 Source: Prosser et al., Pediatrics, 2010

12. Conjoint Analysis • Conjoint analysis, originally developed for marketing and transportation analysis, allows for: • Estimation of the relative importance of different aspects of a health service • Trade-offs between these aspects • Total satisfaction or utility respondents derive from health services • Relatively new in health applications

13. Conjoint Analysis - Applications • Preferences for health services and barriers to utilization of health care in sub-Saharan Africa • Measuring WTP per QALY • Population-based • Condition-specific • Valuation of QALYs • Scoring algorithm for EQ-5D • Time trade-off amounts

14. Marginal WTP *P-value <0.001 Source: Gidengil et al., forthcoming.

15. Implications for Global Vaccine Policy • Increased need to understand public values for health and health care beyond QALYs, DALYs, or other summary measures • Research on measuring preferences in resource-limited settings • Can inform valuation of health benefits and prioritization more broadly

16. Summary • Future research directions in cost-effectiveness research need to include new approaches for valuing health benefits • How preferences vary by condition, potential harms, patient population, etc. • How best to evaluate? Incorporated into or considered separately from the cost-effectiveness ratio?

17. Thank You