Economic evaluation of vaccination programmes in humans: A methodological exploration with applications to hepatitis B, varicella-zoster, measles, pertussis, hepatitis A and pneumococcal vaccination.

摘要

This dissertation intends to provide a thorough discussion of the economic evaluation of vaccination programmes in theory as well as in practice. It is intended for health care professionals, economists and mathematical modellers with overlapping interests in this field. Peculiar aspects such as herd immunity and general but influential aspects such as discounting are thoroughly discussed. Though not the centre of our attention, other important aspects of the economics of vaccination, such as equity concerns and private versus public demand are not ignored.; In the first part of this dissertation we discuss the general methodology of economic evaluation in health care and relate it to the analysis of vaccination programmes. In chapter I a general introduction is given to health economics and vaccination, and to the economics of the vaccine market. Chapter II presents the general concepts of economic evaluation for health care interventions. Chapter III focuses on the categorisation and estimation of costs, whereas the various methods to measure health outcomes are discussed in chapter IV, all in relation to vaccination and infectious diseases. In chapter V we review in detail the rationale for discounting costs and health effects, and its relevance for vaccination programmes. In chapter VI, formal definitions for relevant epidemiological aspects are introduced, as well as the various types of models that can be developed to estimate the impact of vaccination programmes. In chapter VII, we focus our attention on how uncertainty can be dealt with, and how economic evaluation can be used in the decision making process. The final chapter of the first part, chapter VIII, draws from all previous chapters to discuss what makes (the economic evaluation of) vaccination programmes different from other health care interventions and introduces economic aspects of eradication. Furthermore, in collaboration with internationally renowned experts, some recommendations for future economic evaluations in this field were formulated to complement general guidelines.; In the second part of the dissertation applied analyses and reviews of applied analyses are presented, most of which have been published in full in peer reviewed journals. The applications differ in target group, modelling technique, vaccine type, vaccination strategy (with or without prior screening), etc.; By presenting both a detailed account of the methodology, and eleven applied papers on six different infectious diseases in various target groups and populations, it is hoped that the reader will find this dissertation helpful in understanding the strengths and practical limitations of a not entirely flawless theoretical framework.