New Vaccine Development Establishing Priorities: Volume II, Diseases of Importance in Developing Countries (1986) / Chapter Skim
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7. Calculation and Comparison of the Health Benefits and Differential Costs Associated with Candidate Vaccines
7. Calculation and Comparison of the Health Benefits and Differential Costs Associated with Candidate Vaccines
Pages 82-105
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From page 82... ...
2. Estimate the proportion of the total disease burden that is vaccine preventable.
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From page 83... ...
fox each vaccine. These figures represent vaccine preventable illness values ad justed for the predicted efficacy of the vaccine.
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diseases in which vaccine efficacy is expected to be the same for all conditions, calculation of PROM simply entails multiplying the vaccine preventable illness values (one for each IME perspective) by the efficacy.
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Target Population Target populations for the vaccines are described in the relevant appendixes and briefly outlined in Table 7.1. The number of new potential vaccine recipients entering the target population each year must be determined to calculate the vaccine costs for each immunization program.
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From page 86... ...
Because of the trend in most developing countries toward greater relative numbers of individuals in the younger age groups, the major effect of adopting these assumptions would be to somewhat underestimate the benefits of vaccines reducing disease in these age groups, assuming incidence rates remain constant. Adverse Reactions Because no vaccine in this analysis is predicted to have serious side effects, the current calculations omit adverse reactions.
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The present values of health benefits and expected reduction in morbidity costs are calculated on the assumption that the benefits and reduced costs occur at the time of steady-state yield of vaccine benefits. Equations for deriving present values are given in Chapter 3.*
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Because of these judgments, the cost comparisons in this analysis are somewhat simplified, including only those expenditures on the candidate vaccines necessary to achieve the potential health benefits. Table 7.3 shows these expenditures: vaccine development costs and vaccine costs for the immunization programs.
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~ Vaccine preventable illness values represent the burden of illness that could be averted by delivering a hypothetical vaccine that is 100
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Vaccine Use Dengue virus Attenuated live vector virus 0.75 25,000,000 12 (Infants and children in containing gene for broadly endemic areas; travelers cross-reacting protective to endemic areas) antigen Escherichia cold A combination of purified 0.50 25,000,000 12 (enterotoxigenic)
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From page 97... ...
97 Expected Annual Annualized Present Value Annualized Present Value Annual Number of Cost of Vaccination of Vaccination Program of Total Expenditures to New Potential Doses/ Cost/Dose Cost/Course Programs Costs Achieve Health Benefits Vaccinees Course (dollars) (dollars)
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From page 98... ...
virus containing gene for protective glycoprotein antigen Respiratory syncytial virus Polypeptides produced by 0.80 25,000,000 7 (Infants) recombinant DNA technology Attenuated live virus 0.80 25, 000, 000 7 Rotavirus Attenuated high passage 0.90 10,000,000 4 (Infants, O to 6 months)
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From page 99... ...
99 Expected Annual Annualized Present Value Annualized Present Value Annual Number of Cost of Vaccination of Vaccination Program of Total Expenditures to New Potential Doses/ Cost/Dose Cos~c/Course Programs Costs Achieve Health Benefits Vaccinees Course (dollars) (dollars)
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From page 100... ...
, , (~1 befits at risk, s~tbetic or recontact militate personnel, sporozoite antigen treeless) preparation lt~alent syntbet~ 0.50 14 2,111,795 or recomb Want sporozoite antigen preparation (P.- falcipa~, P
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From page 101... ...
101 Proportion of Predicted Possible Reduction Annualized Present Disease that is Vaccine Preventable Vaccine in Morbidity and Value of Health Vaccine Preventable Illness Value Efficacy Mortality Benefits 1.00 34,365 0.85 29.210 9,558 0.65 635.861 0.75 476, 896 126, 454 0.50 489,124 0.80 391,299 145,260 0.90 424,202 0.90 381,782 210,943 1.00 30,229 0.90 27,206 15,112 1.00 30,229 0.90 27,206 14,392 0.50 1, 197, 128 0.90 1, 077, 415 213, 192 1.00 18, 075 0.
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From page 102... ...
in mammalian cells (Birth cohort in areas of Attenuated live vector 0~50 22 67~821 high rink) virus containing gene for protective glycoprotein ant igen Respiratory syncytial virus Polypeptides produced by 0~80 8 183~326 (Infants)
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From page 103... ...
103 Proportion of Predicted Possible Reduction Annualized Present Disease that is Vaccine Preventable Vaccine in Morbidity and Value of Health Vaccine Preventable Illness Value Efficacy Mortality Benefits 1;00 67,821 0.99 67.143 41,910 1.00 67,821 0.95 64,430 37,983 0.75 50,866 0.95 48,322 8,260 0.66 120.995 0.80 96,796 52,412 0.75 137.495 0.80 109.996 59.559 1.00 925.042 0.80 740.034 521.852 1.00 925,042 0.90 832,538 450,795 1.00 925,042 0-.90 832,538 450,795 1.00 1,308.121 0.80 1.046.497 431.471 1.00 1,308, 121 0.85 1,111.903 194,745 0.85 703, 858 0.85 598, 279 222, 096 0.90 730.329 0.80 584,263 180,513 0.50 3,306,131 0.80 2,644.904 1,363,943 1.00 229,217 0.90 206.295 94,986 1.00 229,217 0.65 148,991 65,548 1.00 32,887 0.90 29,598 11,127
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; i.e., total time to steady state of vaccine benefits, 13 years FIGURE 7.3 The sequence of calculations for comparing the potential health benefits of two vaccine candidates. percent effective to the entire target population, at the time envisaged for immunization.
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From page 105... ...
. These cost calculations can be used to compare vaccine candidates from various viewpoints, as discussed in Chapter 9.
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