Angela Devine’s journal round-up for 22nd February 2021

Every Monday our authors provide a round-up of the latest peer-reviewed journal publications. We cover all issues of major health economics journals as well as some other notable releases. If you’d like to write one of our weekly journal round-ups, get in touch.

Value in Health

Volume 24, Issue 1

This issue includes a systematic review on equity-informative cost-effectiveness analyses, two economic evaluations (on prostate cancer and a complex intervention to reduce bullying in schools), and a themed section on vaccines with 13 articles. This section includes economic evaluations of infant vaccination for meningococcal disease in England, dose timing of chickenpox vaccination in Canada, pediatric influenza vaccination in Germany, and two studies on influenza vaccination in The Netherlands. A third study from the Netherlands estimates the proportion of GP visits attributable to influenza.

Since it redistributes illness amongst different age groups, the varicella-zoster virus vaccination is used as an example of how to integrate alternative social value judgments into CEAs as a sensitivity analysis. The authors found this to be reasonably simple to conduct, finding a 98% change in net impact with increased importance on the QALYs gained by children.

A commentary explores issues with capturing the value of preventing rare but catastrophic health outcomes beyond a CEA, using the example of vaccinating for invasive meningococcal disease. Another study reports on a roundtable meeting in Belgium, suggesting ways to improve economic evaluations of vaccines. I think that many of these suggestions, such as the inclusion of equity considerations, will not be a surprise.

The final four studies are related to low and middle income countries (LMICs). A commentary on knowledge gaps on immunization costs in LMICs proposes some ideas on how to improve our understanding, such as collecting cost data on efforts to improve vaccination programs. The following article estimates the costs of immunization programs for 10 vaccines across 94 countries for the next decade. Building on that study, the next study expands the time horizon to 20 years and uses three different methods to estimate the economic benefits: the cost of illness averted; the value of statistical life; and the value of statistical life-year. The final study examines whether a relationship could be seen between countries vaccinating for HPV and a cost-effectiveness threshold, finding that 60-65% of GDP per capita had the best ability to discriminate between countries that did or did not vaccinate. This dropped to 30-40% for low income countries. I will be interested to see if these methods are used for other interventions and whether this may be used to justify the choice of thresholds for future studies in other disease areas.

The Lancet Global Health

Volume 9, Issue 2

Of the nine articles in this issue of The Lancet Global Health, two studies are cost-effectiveness analyses. Perhaps unsurprisingly, the first is on COVID-19. This microsimulation modelling study compares public health strategies in KwaZulu-Natal province, South Africa. Five interventions were combined in various permutations to evaluate the impact on life years saved, resource use in the public and private health sector, and budget impact over a time horizon of 360 days. These interventions included (1) health care testing, (2) contact tracing, (3) use of isolation centres, (4) mass community screening of symptomatic individuals, and (5) use of quarantine centres. They found that implementing all five interventions resulted in an ICER of $390 per life year saved. The large initial investment resulted in longer-term savings by averting infections, hospitalizations, and deaths.

The other cost-effectiveness analysis is on a large-scale distribution of intermittent seasonal chemoprevention of malaria for young children across seven countries in the Sahel subregion of Africa. This prophylactic treatment resulted in cost savings by reducing diagnostic and treatment costs, potentially resulting in overall cost savings.

A further three studies provide estimates of the burden of disease. The first examined the burden of cervical cancer associated with HIV, finding a relative risk of 6.1 for women with HIV. The other two papers are from the Global Burden of Disease Study; these report trends and causes of blindness and vision impairment.

The final article that may be of interest to health economists looks at the relationship between health security and budgets from The Global Fund to Fight AIDS, Tuberculosis and Malaria. After examining 37 budgets for vertical programs in 10 countries, they found that around a third of the Global Fund’s work supports health security. The authors assert that these results imply that we need to rethink the dichotomy between vertical programs and health systems strengthening, particularly in light of COVID-19 and pandemic preparedness.

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