Documenting the Full Value of Vaccination: A Systematic Review of Value Frameworks

OBJECTIVES: Economic evaluations of vaccination rarely account for broader value elements (i.e., non-health patient impacts and those to families, communities, and society), which may influence how decision-makers design, fund, and implement immunization programs. Omission of broader value elements may reflect a lack of established methodology for measurement, disagreement on which value elements to include in economic evaluations, and a lack of consensus on whether value elements should vary by intervention or condition. We conducted a systematic review of value frameworks to identify broader value elements for the evaluation of vaccination and catalogue associated measurement guidance.

METHODS: We searched Ovid Medline, PubMed, Embase, and grey literature for vaccination-specific and healthcare-related value frameworks. Two reviewers screened search results for framework inclusion and extracted information about framework development, which value elements were included, and whether measurement guidance was specified.

RESULTS: Our search identified 61 value frameworks across therapeutic areas, eight of which were specifically developed for vaccination. Across all frameworks, the most frequently captured broader value elements included unmet need (43%), equity (34%), implementation feasibility (31%), and caregiver impact (23%). Descriptive analyses revealed that a higher proportion of vaccination (vs. non-vaccination) frameworks included equity (63% vs. 30%), reduction in uncertainty (38% vs. 11%), and economic activity (38% vs. 0%). Several value elements specifically pertinent to vaccination (e.g., research and development costs, dosing and administration complexity, affordability) were not documented in the vaccination frameworks. Guidance for measuring vaccination-specific value elements is lacking (e.g., no framework specified how to measure antimicrobial resistance, only one framework provided guidance on fear of contagion measurement).

CONCLUSIONS: Value frameworks differ substantially in detailing which broader value elements should be considered for vaccination, and measurement guidance is lacking. Future research should address methods to measure broader value elements so that economic evaluations account for the full value of vaccination.