OBJECTIVES: The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (CDC ACIP) is a group of medical and public health experts responsible for vaccination recommendations in the US. A key criteria in ACIP decision-making is “reasonable and efficient allocation of resources,” typically assessed by a cost-effectiveness analysis (CEA). The objective was to determine the role of CEA in ACIP decision-making and incremental cost-effectiveness ratios (ICER) based on which vaccines are likely to be recommended.

METHODS: All online meeting minutes for ACIP meetings from 2010-2017 were reviewed. For each meeting, data such as meeting date, population sub-group, basic assumptions, ICERs (various scenarios), and associated recommendation (routine, permissive or no recommendation) were abstracted. A qualitative assessment was made regarding the likelihood of receiving a routine recommendation based on a threshold of $100,000/QALY.

RESULTS: From 2010 to 2017, 47 ICERs were assessed by ACIP, ranging from $1,583/QALY to $5million/QALY, depending on the vaccine and population considered. Assessments targeted Hepatitis B (26% of ICERs), HPV (23%), Meningococcal (15%), Pneumococcal (15%), Tetanus, Diphteria, Pertussis (Tdap) (13%) and Herpes Zoster (11%) vaccines. All routine recommendations for HPV, Pneumococcal and Herpes Zoster vaccines were for use in populations with ICERs below $100,000/QALY. All ICERs above $100,000/QALY had a negative or permissive recommendation. Tdap vaccine strategies showed a wide heterogeneity in ICERs with a threshold around $500,000/QALY. Meningococcal and Hepatitis B proposals had high ICERs (above $100,000/QALY) for the majority of scenarios, however ACIP routinely recommended these vaccination strategies.

CONCLUSIONS: Vaccines with ICERs below $100,000/QALY are likely to receive a routine recommendation at the ACIP. Vaccines with ICERs above $100,000/QALY may also be recommended for routine vaccination, based on factors other than cost-effectiveness analysis.