Presentation (CTI)

OBJECTIVES: Preventive interventions e.g. vaccines not only reduce health and cost burden to potentially infected individuals but also create positive externalities e.g. through the reduction of fear of contagion (FOC) in wider society. Despite the inclusion of FOC in the ISPOR value flower (2018), vaccination economic evaluations have largely relied on direct costs and quality-adjusted life years for infected individuals, or productivity impacts for a societal perspective. This may not fully capture the economic value of FOC-associated psychological effects, thus underestimating societal value. We aimed to identify published valuations of FOC to understand the potential for inclusion in economic evaluation.
METHODS: A targeted literature review was conducted on PubMed from inception to 7th January 2026. Studies that quantitatively assessed the impact of vaccination on FOC were included.
RESULTS: We identified 1260 unique studies. Two met inclusion criteria; both focused on COVID-19. The first employed a discrete choice experiment to estimate willingness to pay (WTP) for a COVID-19 vaccine. Attributes included chance of future exposure and out-of-pocket costs, controlling for chance of infection and severity of symptoms. Estimated WTP to eliminate FOC during COVID-19 pandemic was $13,046, exceeding the WTP and net benefit of vaccination itself, reported in previous studies. The second surveyed the public to test whether negative emotional reactions mediate the relationship between perceived threat, coping behavior and support for economic sacrifice. Anxiety partially mediated the link between perceived threat to self/society and acceptance of economic sacrifice; thus, fear-related responses had measurable economic value.
CONCLUSIONS: A small literature exists suggesting FOC is a quantifiable value domain. In future, it may be possible to incorporate FOC into vaccine economic evaluation, allowing more comprehensive value assessment. However, valuing FOC remains methodologically complex, uncertain, and COVID-19-specific. Further research is needed to estimate values in other diseases and assess impact within economic evaluation.