OBJECTIVES: The Covid-19 pandemic highlighted that the application of preventive measures could have a significant impact on governments’ fiscal transfers and taxation. Anticipating these changes could provide powerful indicators regarding resource allocation decisions and public finances. This can be achieved through the use of Fiscal Health Models (FHM), which allow to account for transfer payments and tax revenue, complementing the information provided by cost-effectiveness analyses (CEA).

METHODS: Targeted literature reviews and hand searches were conducted on the application of FHMs in the last 10 years, from an international standpoint. Grey literature produced by French Institutions was also investigated to determine prevention financing.

RESULTS: This review allowed to identify six relevant articles on the use of FHMs: four models in several contexts (AIDS, Covid-19, vaccination), one article providing guidelines and one literature review on economic evaluation of vaccination programs. In each case, FHMs were used to inform fiscal consequences of prevention strategies and macroeconomic impact of infectious diseases. By translating health, morbidity and mortality data into fiscal outcomes, FHMs measure broader economic changes than CEAs and could be a useful tool to encourage prevention financing. However, these outcomes are not used in French submissions yet. The dossiers submitted to the HAS focus only on the impact of a strategy on the expenditure of the healthcare system.

CONCLUSIONS: FHMs are a precious tool to estimate the changes in tax transfer and revenues, especially when diseases have a strong impact on GDP and societies, or when international stakeholders participate in financing. Yet, they are not conducted in France, due to their complexity, and as the institutions involved in prevention financing are distinct from the HAS.