Abstract

Objective

The Australian Pharmaceutical Benefits Advisory Committee (PBAC) makes recommendations to the government on the listing of vaccines on the National Immunisation Program. This health technology assessment body considers evidence on comparative effectiveness, safety, cost-effectiveness, financial implications, and other factors such as equity. This study aimed to identify which aspects of equity have been considered and how they are incorporated in PBAC recommendations.

Methods

We reviewed vaccine public summary documents published by PBAC from 2005 to 2024. We extracted and summarized information from the submissions including variables reflecting equity-specific dimensions mentioned or considered in the evaluation and quantitative equity-informative methods used.

Results

Equity-related dimensions mentioned were presence of special healthcare needs and past health loss (55% of reviewed public summary documents); race, denoting Aboriginal and Torres Strait Islander peoples (47%); gender (14%); pregnancy (6%); parental status (4%); geographic location (6%); socioeconomic status (3%); culturally and linguistically diverse groups (1%); sexual orientation (1%); and refugee status (1%). Subgroup analysis, in 21% of the vaccine submissions, was the only quantitative method used to address distributional concerns. Equity dimensions and subgroup analysis appeared more frequently in resubmissions and from 2021 to 2024.

Conclusions

Despite increasing mentions of many equity-relevant dimensions, limited equity-informative economic evaluation methods are being used in vaccine submissions. This review provides a pivotal opportunity to advocate for (1) a better understanding of decision makers’ needs and preferences around the integration of equity-informative methods, (2) greater transparency and more detailed documentation of deliberations, and (3) clearer guidance on presenting equity-relevant evidence in submissions.