Exploring new ways of measuring the economic value of vaccination with an application to the prevention of rotaviral disease

Health economic (HE) evaluation of new vaccines has been based on a technique called incremental cost-effectiveness analysis (CEA). In the thesis of Bo Standaert he exposes the shortcomings of this approach. Vaccine prevention should be evaluated at the level of a population and not the individual. CEA is also not a good method to value vaccination in low-income countries where infectious diseases are most prevalent. Therefore alternatives should be initiated. The thesis starts with the CEA of rotavirus vaccination in a developed country. Standaert first evaluated the disease cost burden, then the benefit-loss in function of disease severity and age, to finally calculate the CE of the new vaccine. A more simplified version, back of the envelop model, is proposed for those countries that have no access to elaborate datasets. The modelling was evaluated against vaccine impact studies to demonstrate that the predictions were conservative. New interesting features were discovered. One is about the herd protection in the age-group too young to be vaccinated. Another is that another source of infection in the child population is present that appears as soon as the child only infection is under control. Two other features were identified. One is about the improvement in quality of care because the vaccine introduction allows for better patient influx in hospital care during winter periods when many other infectious diseases occur within the same age-group normally causing recurrent chaotic conditions in health care delivery every year. The second was that Standaert was able to evaluate with real life data the reduction in absenteeism on the work floor among working mothers after the introduction of the rotavirus vaccine. For developing countries some other explorations were done. One was identifying when optimal benefit may occur when using a 2 dose vaccination scheme instead of a 3 dose under a fixed vaccination budget when varying the price per dose, the overall vaccine efficacy, and the coverage rate of the rotavirus vaccine. Another project was to identify who else in society could be interested in having vaccination programs implemented, and what type of benefit we are looking for. Extra tax payment was discovered being the added new benefit from the perspective of a government by reducing specific child mortality after rotavirus vaccination that will join later the workforce in a country. This evaluation technique has been applied for Egypt but other emerging economies were investigated as well.

PhD defence: