OBJECTIVES

Invasive meningococcal group B disease (“MenB”) is a rare but severe disease, imposing catastrophic health and economic burdens on patients and households. Traditional vaccine evaluation uses Cost-Utility Analysis (CUA), whose simplifying assumption of separability in lifetime health and economic variables makes it struggle with the above characteristics. We retrospectively estimate private and social willingness-to-pay (WTP) for infant MenB vaccination in the UK prior to introduction in 2015 using Cost-Benefit Analysis (CBA).

METHODS

In a more flexible and comprehensive utility-theoretic way than CUA or traditional CBA can, our innovative CBA uses a health-augmented lifecycle model (HALM) that captures the life course interactions of mortality and morbidity risk, productivity and labor, consumption, leisure, and financial risk protection. We allow long-term sequelae to reduce patient- and parental lifetime productivity and create catastrophic financial risks when lacking disability insurance. Private WTP--the core monetary welfare measure for CBA-based policy evaluation--equals the compensating variation of vaccination-induced lifetime utility gain.

RESULTS

Using average MenB incidence from 2000-2014, private WTP for a 2+1 vaccination schedule is £403, comprising £120 of (disability) insurance value, £138 of positive parental spillover value, and £145 for the intrinsic and residual instrumental value of the vaccinated person’s improved health. The private rate of return (RoR) is 58%. If social severity preferences serve to scale benefits to the vaccinated person (i.e. excluding spillovers) by 3 as suggested by the literature, the severity-weighted social WTP and RoR rise to £933 and 266%. Using 2014 incidence rates, a Value of Statistical Life of £2.31M and lower vaccine effectiveness result in private WTP (RoR) of £162 (-37%), £316 (+24%) and £258 (+1%) respectively.

CONCLUSIONS

HALM-based CBA provides an empirically richer, more utility-theoretically-grounded approach to vaccine evaluation than CUA. Our baseline and severity-weighted specifications show a positive RoR to infant MenB vaccination in the UK.