ABSTRACT
Objectives: Vaccination is paramount to reduce the health and economic impact of vaccine preventable diseases (VPDs), but are mainly focused on the immunization of children where COVID-19 demonstrated the importance of considering other age groups too. Providing healthcare decision makers with evidence-based assessments and recommendations is crucial but health technology assessments (HTAs) of older adult vaccination might be challenging. Method(s): Drawing upon the review of relevant literature and recent study cases, an expert panel elaborated on a list of HTA challenges and recommendations for older adult vaccination that could be instrumental to foster implementation of lifelong immunization. Result(s): Five challenges were identified for older adult vaccination: i) population characteristics, including immunosenescence, waning rates, comorbidities, changing functional status, and frailty;ii) limited surveillance data, causing a knowledge gap between population characteristics and vaccine effectiveness;iii) uncertainty in health economic value assessments - as a spill-over of the first two challenges;iv) prioritization of sub-groups might not align with health equity principles;and v) vaccination acceptance/hesitancy could prevent attaining optimal vaccination coverage and population benefits. Five concrete recommendations were issued in response to abovementioned challenges: i) introduce specific adult working groups within NITAGs as in the UK and US;ii) develop standardized/transferrable assessment methods adapted for older adults vaccination;iii) filling evidence gaps by the design of inclusive surveillance systems;iv) strengthen transparency of assessments to improve trust within healthcare and the society;and v) establish dedicated budget plans for prevention so that policy decisions - supported by adequate HTAs - can be implemented, inclusive older adults vaccination. Conclusion(s): Global interest in strengthening evidence-based policymaking for vaccination is increasing. It is therefore the right time to rethink how HTA could serve in fostering older adults' vaccination and to convey the message that implementing preventive measures and promoting lifelong immunization programs are instrumental to secure healthcare systems' sustainability. Copyright © 2022
ABSTRACT
Objectives: National strategies for preparedness on future outbreaks of COVID-19 often include the timely preparedness with available vaccines. Fiscal health modelling (FHM) has recently been brought forward as an additional analysis by defining the fiscal impact of a health condition from a governmental perspective. As governments are the main decision-makers on preparedness, this study assesses a FHM framework for a communicable disease. Method(s): Using data of the Dutch COVID-19 pandemic, two approaches for identifying the fiscal impact of COVID-19 were assessed: 1. modelling of future fiscal impact based on publicly available population counts;and 2. assessment of the extrapolated tax and benefit income and gross domestic product (GDP) in a particular time period with the respective realized values. The appropriateness of different modelling approaches was in line with the ISPOR FHM guidelines and extensively validated in an expert meeting. Result(s): Dutch publicly available data was the basis for the analysis performed, showing total counts of 2.36 million infections, 52,678 hospitalisations, 9,805 ICU admissions and 9,493 deaths in a period of 24 months following the start of COVID-19 in 2020. Consequences which can be causally linked to these counts influencing income tax collected and social benefits paid (approach 1) amounted to a fiscal loss of 158 million over 2 years. The total losses in terms of the fiscal income and GDP (approach 2), were estimated at respectively 13,582 million and 96.3 billion over 24 months. Conclusion(s): This study is a full integrated fiscal macro-economic orientation to analyse different aspects of an infectious disease outbreak and its influence on government public accounts. The suitability of the two presented approaches depends on the perspective of the analysis, time horizon of the analysis and availability of data. The consequence-linking approach is more suited to a prospective estimation and the extrapolating approach more to a retrospective one. Copyright © 2022
ABSTRACT
Objectives: The current COVID-19 pandemic caused ∼20,000 deaths and ∼50,000 hospital admissions in the Netherlands. Efforts to manage this communicable disease and its impact on the health-care system without prior development of specific vaccines have put a strain on the fiscal budget. This study aims to indicatively quantify the impact of COVID-19 on the Dutch government’s fiscal position, simultaneously indicating the value of preventive vaccines from a payer perspective. Methods: Dutch COVID-19 specific population data on laboratory-confirmed infections, hospital admissions and mortality, was collected from the domestic start of the COVID-19 pandemic on 27 February 2020 until the first administered vaccine on 6 January 2021. A fiscal health modelling approach was used to estimate the loss in tax revenues. Occurred productivity losses were added as an indicator for the future burden on the social security system. Tax revenue losses were caused by premature mortality, whereas the productivity losses occurred through mortality as well as morbidity. Outcomes were expressed in total monetary impact (€, 2020). Results: The impact of the pandemic in the analysed time-period was estimated to amount to a total of €920.7 million. Tax loss due to premature mortality amounted to €58.8 million with 50% attributed to patients >60 years. Productivity loss due to morbidity summed up to €862 million with 46% due to patients 40-59 years. Conclusions: The fiscal impact of the current pandemic highlights the importance of a broader approach to health-economic analysis. A fiscal health framework, optimally linked to a disease simulation model, is a better instrument to inform decision-making in the context of communicable diseases. The reported fiscal estimates also highlight the benefit of investments in communicable disease prevention such as anticipative development of vaccines. In the decision-making process around pandemic preparedness measures, investment funding and real-options can consequently be informed by a fiscal health framework.
ABSTRACT
Objectives: Older adults are often evaluated as one homogeneous group. As currently illustrated with the COVID-19 pandemic, older adults are however heterogeneous in risk factors for infection and disease, including, for example, frailty, immunity, and clustering. This research aims to assess the use and the importance of including such heterogeneity in older adults in health economic evaluations of preventive interventions, such as vaccinations. Methods: Multiple scoping reviews were conducted to identify the internal (e.g. immunosenescence, comorbidity, and lifestyle) and external (e.g. social interaction, and location such as nursing homes) risk factors in older adults for acquiring infectious diseases and their related consequences. Both, inclusion and presence of risk factors were assessed, derived from economic evaluations and observational studies. We determined which older adults are more vulnerable to respiratory infections (and related disease), such as influenza, pneumococcal and respiratory syncytial virus (RSV) infections. We evaluated the critical heterogenic characteristics that should be considered in the assessment. Results: Scientific literature typically underreports the broad ranges of heterogeneity in older adults that impact on the risk of acquiring infectious diseases and related disease in the economic assessments of preventative strategies. Only a few publications are available that incorporate crucial internal and/or external factors, such as frailty and location. The impacts of the heterogeneity in these risk factors are not precisely measured beyond age. Yet, immunosenescence, levels of frailty, and comorbidities, such as diabetes and obesity are considered crucial internal heterogeneity factors. The interplay between location/clustering and exact timing (seasonality in epidemics) should be considered core external triggers in heterogeneity, potentially impacting the cost-effectiveness. Conclusions: Risk factors involving heterogeneity in older adults are only sparsely incorporated in health economic evaluations of preventative interventions. Economic evaluations would benefit greatly from the inclusion of these risk factors;this would provide more precise, realistic, and robust analyses.