Why we think that current cost effectiveness framework is unfair
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The current cost-effectiveness framework for evaluating vaccines is unfair because it disadvantages interventions for children. It heavily discounts future health gains, so the long-term benefits of childhood vaccines become negligible over time. The tool used to measure quality of life is also insensitive to losses in young children. Additionally, the framework does not account for the public's preference for prevention over cure or for interventions targeting severe illnesses over mild ones.
Why we think that current cost effectiveness framework is unfair
- 1. Why do we think that the current cost effectiveness analysis framework is unfair for evaluating vaccines that prevent rare but serious illness in children?
- 2. Interventions for children are disadvantaged because a much higher importance is placed on immediate health gains compared to those that run far into the future • Cost effectiveness models discount the costs and health benefits of vaccination by 3.5% every year • The aim of this is to place higher importance on immediate costs and health gains than those that occur in the future • The result of this is that childhood health gains which are sustained far into the future become negligible over time
- 3. Interventions for children are disadvantaged because the tool used to measure health loss is insensitive to quality of life losses in young children • The EQ-5D is the tool used to measure quality of life • It consists of 5 questions, in which the respondent rates whether the person affected has problems walking about, problems washing and dressing, problems doing their usual activities, pain or discomfort, anxiety or depression • For a child who is too young to walk about/wash and dress/ have ‘usual’ activities/display anxiety or depression, these questions are largely irrelevant
- 4. The public prefer prevention over cure but the current cost effectiveness framework does not account for this • 1 QALY has the same weighting or value regardless of its origin • QALYs gained through prevention of illness are valued the same as those gained through treatment • There is evidence that the public would rather prevent illness occurring in the first place that treat an existing problem but this is not reflected in the analysis
- 5. The public prefer interventions for severe health problems over milder ones but cost effectiveness does not account for this • 1 QALY has the same weighting regardless of its origin • The QALY loss associated with 5,400 cases of uncomplicated influenza occurring today has the same value as the QALY loss associated with the death of a 3 month old child with an average UK life expectancy (80 years) when discounting is applied