Value of life and health: valuing the true impact of preventing life-threatening illnesses https://www.meningitis.org/mrf-conference-2017

1. Koonal Shah, Office of Health Economics
Meningitis and Septicaemia in Children and Adults
British Museum, London  14 November 2017
Value of life and health
Valuing the true impact of preventing
life-threatening illnesses

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Acknowledgements
• This presentation reports selected methods and findings
from an OHE Consulting study conducted for Pfizer
• MRF contributed to the original scope of the study
• OHE Consulting study team: Karla Hernandez-Villafuerte,
Koonal Shah, Paula Lorgelly, Mike Herdman
• Views expressed are my own, unless otherwise indicated

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Brief introduction to
cost-effectiveness analysis
+ effect
+ cost
- effect
-  cost
Intervention less
effective and
more costly
Intervention
more effective
and less costly



x
x
x

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Aims of study
• To document the current evidence base available to
inform vaccine adoption decisions
• To summarise the decision making criteria used for
vaccine reimbursement internationally
• To suggest methodological improvements, given the
nature of the benefit derived from vaccines

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Study methods
• Rapid evidence assessment
• Review of economic evaluations of meningococcal vaccine
strategies in three databases
• Reviewed 27 studies undertaken in 13 different countries
• Country comparison
• Semi-structured interviews with experts from seven
countries
• Review of ‘reference case’ approaches in each country

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Economic evaluation studies:
summary of findings
Finding Men B Men C
Men
ACYW
Total
Cost-effective 2 4 2 8
Not cost-effective 4 0 2 6
Mixed results 7 1 3 11
Unclear 0 0 2 2
Total 13 5 9 27

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EQ-5D – a widely used measure
of quality of life

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Consideration of quality of life
(utility)
• 78% of evaluations considered health utility losses
• 33% of evaluations specified the health utility losses by
type of sequelae
• Variation in types of sequelae considered across studies
• Common issue: lack of country-specific data for relevant
sequelae and complications
• Only 22% of evaluations reported the measure used to
capture health utility data (e.g. EQ-5D)
• In England, the JCVI’s solution has been to apply a QALY
adjustment factor (QAF)

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Model parameters and assumptions
• Future costs and benefit streams are typically reduced or
‘discounted’ to reflect the fact that cost/benefits in the
future should not weight as heavily as cost/benefits today
• Many evaluations used a single, constant discount rate
• Alternative approaches often reported in sensitivity
analyses, which showed important changes in conclusions
when the discount rate is altered
• Minority (26%) of evaluations included a dynamic model
capable of intrinsically accounting for herd immunity
• Very few studies considered the health and/or
productivity losses of caregivers

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Decision criteria
Considered in all countries Considered in most countries
Considered in some countries Rarely/never considered
• Clinical outcomes
• Cost-effectiveness
analysis (albeit often
informally)
• Disease burden
• National health system
priorities
• Equity
• Budget impact
• Peace of mind benefits
• Public/societal
preferences

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Peace of mind benefits
• Vaccines are often described as offering ‘peace of mind’
benefits to patients and their caregivers
• Relates to benefit from knowledge of reduced risk of
illness and reduced anxiety linked to disruptions to
normal daily life
• Very difficult to measure, so tend to be ignored in
standard economic evaluation approaches
• But stated preference research may help us to
understand the value of these kinds of intangible benefits

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Utility in anticipation
Time
Utility
(benefit)
A
t1 t2
B

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Public/societal preferences
• Findings in the stated preference literature suggest that
the public would place considerable value on the
availability on vaccines for meningococcal disease
• Evidence suggests that people place greater value on:
• Preventing severe illness vs. preventing mild illness
• Health and survival of younger people vs. older people
• Preventive interventions vs. curative treatments
• Failure to consider these factors in decision making
processes may lead to an underestimation of the value of
vaccines to society

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Some conclusions from the OHE study
• Clear need for better health utility data
• Existing measures may not capture the full burden and
impact of disease on patients’ health (or on caregivers)
• Lack of consensus and consistency, e.g. with respect to
use of discount rates
• Potentially important aspects of value are not formally or
routinely considered in decision making
• Some cause for optimism: the last 15 years have seen a
considerable strengthening in methodological practices
and expanded notions of the value of health interventions

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MRF asks
• Consider alternatives to the EQ-5D to measure the
impact of meningococcal disease
• Promote a list of essentials to be included in a robust
cost-effectiveness analysis for meningococcal disease –
which includes dynamic modelling
• Consider the use of adjustment factors when it is clear
that models cannot fully capture the benefits of vaccines
• Based on suitable research, formally incorporate public
preferences and peace of mind benefits
• Encourage wider debate around discounting rules

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Next steps
• MRF are working with Pfizer to convene a meeting of experts in
Sociology, Anthropology, Meningococcal Epidemiology, Health
Economics, Disease Modelling, Clinical Medicine and Public Health
• Aims of the meeting:
• Explore the present value placed on health and life by society
• Explore existing decision making criteria for meningococcal vaccines
• Discuss factors that should be considered in future decision making
frameworks
• Identify existing research which can be used to inform future evaluations
• Identify gaps in research which need to be filled to strengthen future
meningococcal vaccine evaluations
• Minutes from the meeting will be transformed into a report

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To enquire about additional information and analyses, please contact
Koonal Shah at kshah@ohe.org
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