Challenges and Opportunities of Health Technology Assessment in Older Adult Immunization

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