THE CHEERS CHECKLIST IN VACCINE ECONOMIC EVALUATION: A CRITICAL ANALYSIS FROM THE EPISTEMOLOGY OF COMMENSURABILITY
Author(s)
Nelson Alvis-Guzman, MPH, PhD, MD1, Nelson José Alvis Zakzuk, MSc2, Nelson Rafael Alvis Zakzuk, Jr., MBA3.
1Professor, Universidad de la Costa - ALZAK Foundation, Barranquilla, Colombia, 2University of Sao Paulo, Sao Paulo, Brazil, 3ALZAK Foundation, Cartagena, Colombia.
1Professor, Universidad de la Costa - ALZAK Foundation, Barranquilla, Colombia, 2University of Sao Paulo, Sao Paulo, Brazil, 3ALZAK Foundation, Cartagena, Colombia.
OBJECTIVES: Conduct a critical epistemological analysis of the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist and its Value of Information extension (CHEERS-VOI), applying the partial commensurability framework proposed by Lozano (2026 https://doi.org/10.26633/RPSP.2026.44). Focus specifically on vaccine economic evaluations within Expanded Immunization Programmes (EIPs) in Latin America and the Caribbean (LAC).
METHODS: A critical theoretical analytical review. The primary analytical framework was Lozano’s (2026) four conditions for indicator commensurability: ontological, semantic, methodological and pragmatic-political. These conditions were systematically applied to all 28 CHEERS 2022 items and the six additional CHEERS-VOI items. Particular attention was paid to the context of vaccine evaluation in Latin America and the Caribbean (LAC) and low and middle income countries (LMICs).
RESULTS: CHEERS has five core strengths: reporting standardization, methodological transparency, cross-applicability, uncertainty quantification and decision orientation. However, all four commensurability conditions are systematically unmet: (i) ontological: the QALY is treated as a universal equivalent, despite the lack of cultural validation of utility instruments; (ii) semantic: key terms, such as 'perspective' and 'cost-effectiveness threshold', have different institutional meanings across health systems; (iii) methodological: models assume the availability of data that LAC health information systems do not routinely produce; and (iv) pragmatic-political: Goodhart's Law applies. CHEERS compliance becomes a publication criterion, displacing genuine methodological rigour. Four dimensions of incommensurability not captured by CHEERS are identified: community trust, distributive equity, systemic implementation costs and social determinants of health. Eight targeted improvements are proposed.
CONCLUSIONS: CHEERS produces 'forced commensurability': formal comparability that conceals constitutive differences between studies and implementation contexts. The proposed improvements follow Lozano’s operational agenda, which involves declaring the ontological scope of effect indicators, mapping key terms semantically, auditing data transferability, formally recognising incommensurable dimensions and institutionalising anti-Goodhart safeguards. For vaccine economic evaluations in LAC EIPs, this agenda addresses methodological, ethical and health justice issues simultaneously
METHODS: A critical theoretical analytical review. The primary analytical framework was Lozano’s (2026) four conditions for indicator commensurability: ontological, semantic, methodological and pragmatic-political. These conditions were systematically applied to all 28 CHEERS 2022 items and the six additional CHEERS-VOI items. Particular attention was paid to the context of vaccine evaluation in Latin America and the Caribbean (LAC) and low and middle income countries (LMICs).
RESULTS: CHEERS has five core strengths: reporting standardization, methodological transparency, cross-applicability, uncertainty quantification and decision orientation. However, all four commensurability conditions are systematically unmet: (i) ontological: the QALY is treated as a universal equivalent, despite the lack of cultural validation of utility instruments; (ii) semantic: key terms, such as 'perspective' and 'cost-effectiveness threshold', have different institutional meanings across health systems; (iii) methodological: models assume the availability of data that LAC health information systems do not routinely produce; and (iv) pragmatic-political: Goodhart's Law applies. CHEERS compliance becomes a publication criterion, displacing genuine methodological rigour. Four dimensions of incommensurability not captured by CHEERS are identified: community trust, distributive equity, systemic implementation costs and social determinants of health. Eight targeted improvements are proposed.
CONCLUSIONS: CHEERS produces 'forced commensurability': formal comparability that conceals constitutive differences between studies and implementation contexts. The proposed improvements follow Lozano’s operational agenda, which involves declaring the ontological scope of effect indicators, mapping key terms semantically, auditing data transferability, formally recognising incommensurable dimensions and institutionalising anti-Goodhart safeguards. For vaccine economic evaluations in LAC EIPs, this agenda addresses methodological, ethical and health justice issues simultaneously
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
MSR37
Topic
Economic Evaluation, Epidemiology & Public Health, Methodological & Statistical Research
Topic Subcategory
Confounding, Selection Bias Correction, Causal Inference
Disease
Biologics & Biosimilars, Pediatrics, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory), Vaccines