ECONOMIC EVALUATIONS AND VALUE CONSIDERATIONS IN ACIP ROUTINE VACCINE RECOMMENDATIONS: A COMPREHENSIVE REVIEW
Author(s)
Tyler D. Wagner, PharmD, PhD1, Peter Neumann, ScD2, Jon D. Campbell, PhD3, David Strutton, MPH, PhD4;
1National Pharmaceutical Council, Director of Research, Richmond, VA, USA, 2Tufts Medical Center, Boston, MA, USA, 3National Pharmaceutical Council, Washington, DC, USA, 4Independent Consultant, Wyndmoor, PA, USA
1National Pharmaceutical Council, Director of Research, Richmond, VA, USA, 2Tufts Medical Center, Boston, MA, USA, 3National Pharmaceutical Council, Washington, DC, USA, 4Independent Consultant, Wyndmoor, PA, USA
OBJECTIVES: To assess economic evaluations and value considerations in Advisory Committee on Immunization Practices (ACIP) recommendations for routine vaccines on the U.S. immunization schedule, specifically examining types of economic outcomes reported, gaps in value element inclusion, and variation in cost-effectiveness across vaccine recommendations.
METHODS: We identified all ACIP recommendations for routine vaccines as of January 1, 2025, excluding travel vaccines and non-routine population recommendations. Of 16 routine vaccines on the CDC schedule, 3 lacked cost-effectiveness analysis (CEA) data in their MMWR publications since 2006. The remaining 13 vaccines with CEA data comprised 17 ACIP recommendations with available economic evaluations, reflecting multiple recommendations per vaccine for different subpopulations and immunization scenarios. Using Claude 4.5 Sonnet (Anthropic), we extracted economic data from MMWR publications and cited CEAs through a Claude Project environment and standardized extraction criteria. We extracted cost-effectiveness ratios (cost per QALY, cost per life-year), incremental costs, health outcomes (infections/hospitalizations/deaths averted, QALYs/life-years gained), and productivity costs. Validation employed stratified random sampling for independent human verification, as well as using ChatGPT-5.2 (OpenAI) extraction for comparison with inter-rater reliability (IRR) assessed using Cohen's kappa and intraclass correlation coefficients.
RESULTS: Among 17 ACIP recommendations, economic evaluations reported cost per QALY in 100%, cost per life-year in 29%, and incremental costs in 100%. Infections averted were reported in 100%, hospitalizations averted in 82%, and deaths averted in 71%. QALYs gained were quantified in 88% and life-years gained in 24%. Productivity costs were explicitly quantified in 82% of evaluations. 53%, 59%, and 65% of recommendations were less than $100K, $150K, and $200K/QALY, respectively. IRR demonstrated substantial agreement (κ=0.94, 95% CI: 0.89-0.99).
CONCLUSIONS: This comprehensive review reveals substantial variation in completeness of economic evaluations across ACIP routine vaccine recommendations, with notable gaps in life-year metrics and intermediate health outcomes. These findings highlight opportunities to standardize economic reporting in vaccine policy recommendations.
METHODS: We identified all ACIP recommendations for routine vaccines as of January 1, 2025, excluding travel vaccines and non-routine population recommendations. Of 16 routine vaccines on the CDC schedule, 3 lacked cost-effectiveness analysis (CEA) data in their MMWR publications since 2006. The remaining 13 vaccines with CEA data comprised 17 ACIP recommendations with available economic evaluations, reflecting multiple recommendations per vaccine for different subpopulations and immunization scenarios. Using Claude 4.5 Sonnet (Anthropic), we extracted economic data from MMWR publications and cited CEAs through a Claude Project environment and standardized extraction criteria. We extracted cost-effectiveness ratios (cost per QALY, cost per life-year), incremental costs, health outcomes (infections/hospitalizations/deaths averted, QALYs/life-years gained), and productivity costs. Validation employed stratified random sampling for independent human verification, as well as using ChatGPT-5.2 (OpenAI) extraction for comparison with inter-rater reliability (IRR) assessed using Cohen's kappa and intraclass correlation coefficients.
RESULTS: Among 17 ACIP recommendations, economic evaluations reported cost per QALY in 100%, cost per life-year in 29%, and incremental costs in 100%. Infections averted were reported in 100%, hospitalizations averted in 82%, and deaths averted in 71%. QALYs gained were quantified in 88% and life-years gained in 24%. Productivity costs were explicitly quantified in 82% of evaluations. 53%, 59%, and 65% of recommendations were less than $100K, $150K, and $200K/QALY, respectively. IRR demonstrated substantial agreement (κ=0.94, 95% CI: 0.89-0.99).
CONCLUSIONS: This comprehensive review reveals substantial variation in completeness of economic evaluations across ACIP routine vaccine recommendations, with notable gaps in life-year metrics and intermediate health outcomes. These findings highlight opportunities to standardize economic reporting in vaccine policy recommendations.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
P16
Topic
Economic Evaluation
Topic Subcategory
Novel & Social Elements of Value
Disease
STA: Vaccines