Family Spillover Effects in Vaccine Cost-Effectiveness Analysis

Speaker(s)

Qian Y1, Phillips M1, Eiden A2, Bencina G3, Carias C4, Lavelle T1
1Tufts University School of Medicine and Tufts Medical Center, Boston, MA, USA, 2Merck & Co., Inc., Philadelphia, PA, USA, 3MSD, Value & Implementation Outcomes Research, Madrid, Spain, 4Merck & Co., Inc., Rahway, NJ, USA

Presentation Documents

OBJECTIVES: This study evaluated the inclusion of family spillover effects, referring to the burden on family caregivers when caring for patients, in cost-effectiveness analyses (CEAs) of vaccines.

METHODS: This systematic review used the Tufts CEA Registry from January 2018 to December 2022. We selected CEAs conducted from the societal perspective for the four vaccines most evaluated within our search, excluding non-English articles. We examined the frequency studies considered family spillover, defined as costs or health effects on the family members caring for patients.

RESULTS: We identified 153 studies, with 69 eligible CEAs, including human papillomavirus (n=8), influenza (n=31), pneumococcal (n=22), and rotavirus (n=9).[1] Of these, 32 (46.4%) considered family spillover effects, predominately adding caregiver productivity loss (n=31, 96.9%) or out-of-pocket costs (e.g., transportation) (n=12, 37.5%) to patient costs. One study (3.1%) included caregiver health utility values to account for spillover health effects. In a subset of 235 pairs of incremental cost-effectiveness ratios (ICERs) from 15 studies that allowed for a comparison between ICERs with and without family spillover, including family spillover resulted in vaccination going from having a positive ICER to becoming cost-saving in 37 cases (15.7%), with 13 cases (5.5%) maintaining their cost-saving status. For ICERs that stayed positive with and without spillover (n=185; 78.7%), the addition of family spillover reduced the ICERs in 182 pairs (98.4%) by a mean of 16.5%, with 3 pairs (1.6%) increased by a mean of 19.0%.

CONCLUSIONS: Around half of vaccine CEAs conducted from a societal perspective neglected family spillover effects. Among studies that considered spillover effects, they typically consisted of spillover costs but rarely caregiver health effects. Incorporating family spillover generally resulted in more favorable CEA results.

[1] The sum of CEAs per vaccine type do not add up to the total sample size because some CEAs evaluated more than one vaccine type.

Code

EE11

Topic

Economic Evaluation, Study Approaches

Topic Subcategory

Literature Review & Synthesis, Novel & Social Elements of Value, Work & Home Productivity - Indirect Costs

Disease

No Additional Disease & Conditions/Specialized Treatment Areas, Vaccines