Optimising the introduction of multiple childhood vaccines in Japan: A model proposing the introduction sequence achieving the highest health gains

• Published in: Health policy (Amsterdam) Vol. 121; no. 12; pp. 1303 - 1312
• Main Authors: Standaert, Baudouin, Schecroun, Nadia, Ethgen, Olivier, Topachevskyi, Oleksandr, Morioka, Yoriko, Van Vlaenderen, Ilse
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.12.2017; Elsevier Science Ltd
• Subjects: Budget; Budget constraint; Child, Preschool; Childhood; Children & youth; Cost-Benefit Analysis - methods; Decision makers; Health administration; Health care; Health services; Humans; Immunization; Immunization Programs - economics; Immunization Programs - organization & administration; Infant; Infectious diseases; Influenza; Japan; Models, Statistical; Mumps; Objective function; Objectives; Optimisation model; Optimization; Pediatrics; Pneumococcal disease; Portfolio; Prioritizing; Public health; Quality adjusted life years; Ratings & rankings; Rotavirus; Vaccination - economics; Vaccine; Vaccines; Vaccines - economics; Japan; Infectious diseases; Japan; Portfolio; Budget; Vaccine; Objective function; Optimisation model
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/j.healthpol.2017.08.010

•When several new vaccines are available, the sequence of vaccine introduction affects health gains.•A new model is presented that can help decision-makers to optimize vaccine introduction.•For Japan, the model estimates that 500 billion Yen achieve a QALY gain of 72,288.•Without optimization, the same budget would achieve a 20% lower QALY gain. Many countries struggle with the prioritisation of introducing new vaccines because of budget limitations and lack of focus on public health goals. A model has been developed that defines how specific health goals can be optimised through immunisation within vaccination budget constraints. Japan, as a country example, could introduce 4 new pediatric vaccines targeting influenza, rotavirus, pneumococcal disease and mumps with known burden of disease, vaccine efficacies and maximum achievable coverages. Operating under budget constraints, the Portfolio-model for the Management of Vaccines (PMV) identifies the optimal vaccine ranking and combination for achieving the maximum QALY gain over a period of 10 calendar years in children <5 years old. This vaccine strategy, of interest and helpful for a healthcare decision maker, is compared with an unranked vaccine selection process. Results indicate that the maximum QALY gain with a fixed annual vaccination budget of 500 billion Japanese Yen over a 10-year period is 72,288 QALYs using the optimal sequence of vaccine introduction (mumps [1st], followed by influenza [2nd], rotavirus [3rd], and pneumococcal [4th]). With exactly the same budget but without vaccine ranking, the total QALY gain can be 20% lower. The PMV model could be a helpful tool for decision makers in those environments with limited budget where vaccines have to be selected for trying to optimise specific health goals.