New Vaccine Development Establishing Priorities: Volume II, Diseases of Importance in Developing Countries (1986) / Chapter Skim
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3. Overview of the Analytic Approach
3. Overview of the Analytic Approach
Pages 30-43
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From page 30... ...
The preliminary selection of candidates for new or improved vaccine development (described in Appendix A) was based on expert views of the current state of knowledge about each disease pathogen and the corresponding host response.
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From page 31... ...
Once the ranking of vaccine candidates has been completed, decision makers at the National Institute of Allergy and Infectious Diseases (NIAID) can determine the most effective distribution of the Institute's funds among those candidates selected for accelerated development, in the light of their knowledge of other efforts within and outside the United States.
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From page 32... ...
For the reasons discussed in Chapter 4, it was judged impractical to attempt to estimate global averages for treatment costs for the conditions resulting from the target diseases. The tertiary impacts, which are also not considered in this analysis, involve changes in the costs of care for other diseases that the patient may get because the vaccine has prevented death due to the target disease.
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From page 33... ...
Calculation Procedures A comprehensive approach to comparing costs associated with achieving the health benefits from a vaccine would entail calculating the present value of the annualized equivalent of the net expected health system costs. This would include the cost of development, the cost of the vaccination program, and the cost of adverse side effects, less the cost of medical treatment averted.
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From page 34... ...
of the vaccine ~ for the program and the cost of its administration program, Cp) , TUse = time until steady-state vaccine use, that is, the time to licensure plus the time to adoption at the predicted use rate; r = annual cost of medical treatment averted; TLag = lag between administration of vaccine and realization of health benefits, that is, the delay of vaccination benefits; and annual medical costs from side effects.
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From page 35... ...
The scheme integrates the components of benefit and cost separately, adjusts each for the probability that it will occur and for the expected delay until realization, and presents the conclusions of a central analysis. ITERATION OF INSULTS The interpretation of results from implementation of the comprehensive approach to the analysis (Figure 3.1 -- which develops annualized net expected costs and annualized expected health benefits for each candidate vaccine -- is discussed in the committee's first report (Chapter 3, Institute of Medicine, 1985~.
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From page 38... ...
After all assumptions and estimates have been made and all calculations performed, the analysis yields the annualized potential health benefits of and the annualized potential expenditures on vaccines for each candidate. These could be arrayed in a table like that shown in Table 3.1.
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From page 39... ...
The spacing of the numerical values may permit grouping of vaccines into clear categories. Depending on the degree of confidence decision makers have in estimates incorporated into the calculations for vaccine candidates that achieve nearly equivalent health benefit values, it may be necessary to resort to other criteria, for example, affordability or availability of other control measures to inform choices.
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From page 40... ...
The first step in this procedure is to rank vaccine candidates on the basis of health benefit {greater is preferable) and on expenditure (lower is preferable)
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From page 41... ...
ratio can be used to differentiate between contenders. This process requires value judgments about society's willingness to forgo resource savings or to incur costs in TABLE 3.3 Vaccine Dominance A B C D E F G H I J Total A -- O B X -- 1 C X X -- 2 D X X X -- 3 E X X X -- 3 F X X X X X -- 5 G X X X X -- 4 H X X X X X -- 5 I X X X X -- 4 J X X X X X X X X X -- 9 Total 9 8 7 2 5 1 2 1 1 0 NOTE: Column dominates row; see text for explanation.
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From page 42... ...
SUMMARY The approach described in this report is recommended by the committee for the selection of priorities for accelerated development of vaccines against diseases prevalent in developing countries because it separately identifies each logical component of potential benefits and potential expenditures associated with individual vaccine contenders. The analysis distinguishes quantifiable consequences from the probability they will occur and also incorporates information on when the consequences are likely to occur.
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From page 43... ...
1985. New Vaccine Development: Establishing Priorities, Volume I
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