OBJECTIVES

Many countries with limited budget strive to develop a comprehensive vaccination program. The information for National Immunization Technical Advisory Group (NITAG) and decision-makers is often focused to a single new vaccine impacting one specific disease in a specific target group, showing cost-effective results. We developed an approach to simultaneously compare multiple paediatric vaccines which enabled their ranking according to multiple pre-defined outcomes applied to the Serbian setting.

METHODS

We developed a portfolio model for vaccination (PMV) to analyse a comprehensive paediatric immunization program and how to prioritise the vaccine selection and plan the budget over time. The PMV included all the vaccines that could be implemented in children with the evaluation of improvement of various outcome measures such as mortality reduction, Quality Adjusted Life Year-gains (QALY), cost offsets, hospitalisation and medical visits reduction. Using a constrained optimisation algorithm, the model helps defining an optimal path of vaccine introduction, budget necessity for vaccination planning over several years, cost-offsets obtained to be reallocated in the system for the selected country.

RESULTS

The model was presented to external experts including NITAG members in November 2018. Based on the 3 vaccines that were evaluated (rotavirus, varicella, pneumococcal), the PMV proposed rotavirus and varicella vaccines as the priority choices when looking for reducing hospitalizations and QALY loss, respectively. The pneumococcal vaccine was prioritized for mortality reduction. The experts felt better informed about the proposals made because of the comparison among different vaccines resulting in priority setting and a concrete budget plan. As a follow-up, they requested cost-effectiveness evaluation of those two vaccines.

CONCLUSIONS

Decision-makers need to be better informed with adequate evaluation tools covering comprehensive vaccination program expansion options to decide on new vaccine introductions. Constrained optimisation linked to budget planning in a PMV model was perceived as a helpful instrument by external experts.