OBJECTIVES:

Canada’s National Advisory Committee on Immunization (NACI) makes recommendations on the use of human vaccines. Traditionally, NACI reviewed vaccine characteristics and disease burden. With its expanded mandate, NACI now considers cost-effectiveness via economic evaluations; thus, warranting guidelines. Existing guidelines are either not specific to the universal healthcare context, or not specific to vaccination programs.

METHODS:

A task group was convened to develop NACI’s Guidelines for the Economic Evaluation of Vaccination Programs in Canada. The group comprised of international experts in health economics, guidelines development, childhood health and infectious diseases modelling, as well as federal/ provincial/ territorial liaisons. Recommendations were made through consensus, informed by literature reviews, consultations and review by government partners, decision-makers, academics, health technology assessment agencies, industry, patient groups, and others.

RESULTS:

The guidelines consist of 15 chapters on conducting economic evaluations (i.e., from conceptualizing the decision problem to reporting). Unlike other health technologies, vaccines have the potential to affect both vaccinated and unvaccinated individuals. The guidelines detail population-level impacts including externalities (e.g., herd immunity, age-shifting of disease) and spillover effects. They also discuss equity considerations and non-health impacts of vaccines such as to productivity, consumption and education. An Impact Inventory adapted from the United States is available for users to consider the range of impacts. The guidelines recommend two perspectives as reference cases: publicly funded health system and societal.

CONCLUSIONS:

NACI’s first edition guidelines fill an unmet need and promote standardized economic evaluations. They advocate for transparency, allowing evidence to be used across different jurisdictions, even beyond Canada. They also encourage users to explore emerging methods such as for societal perspective analyses and equity-informed analyses. An outstanding gap to be addressed in subsequent iterations is incorporating Indigenous considerations.