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Dr Hannah Christensen @ MRF's Meningitis & Septicaemia in Children & Adults 2017


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Vaccine decision making –are we asking the right questions? Discrete choice experiments

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Dr Hannah Christensen @ MRF's Meningitis & Septicaemia in Children & Adults 2017

  1. 1. How do the public think we should prioritise vaccination programmes? Results from qualitative interviews and a discrete choice experiment Hannah Christensen Gemma Lasseter, Hareth Al-Janabi, Caroline L Trotter, Fran E Carroll Health Protection Research Unit (HPRU) in Evaluation of Intervention 27 November 2017 1MRF conference 2017
  2. 2. Is the current approach ok? 2
  3. 3. Are all QALYs equal? 3 = ?
  4. 4. The plan • Identify factors which the population may consider relevant in prioritising different vaccination programmes • Use a discrete choice experiment to determine population preferences >> ‘weights’ that could be used to prioritise vaccination programmes against childhood diseases 4
  5. 5. Identifying factors the population think are relevant when considering vaccine decisions • Qualitative study • 320 postal invites to adults in Bristol & S Gloucestershire (200 March, +120 June 2016) • 4 rounds of semi-structured interviews – thematic analysis • 21 interviews; 17♀ 4♂ age range 35-75+ 5
  6. 6. 6 Age Disease severity How common Social group Carer impact Side effects Herd effects Peace of mind  infection Factors
  7. 7. 7 “I think 1 year old or less is a vulnerable age group from health wise and you know within considering possible death, causes of death. Once they get a bit older, say two year olds, they’re a bit more robust…” Age
  8. 8. 8 “If it’s something that you can get over without any long-term consequences then I’m not sure there’s a real need to be vaccinated against it, but if it could result in death or long- term health consequences then I think it’s a different case.” Disease severity
  9. 9. 9 [J]ust considering the impact on families or, children with diseases that they could’ve been immunised against…it’s a way of making policymakers think about the effects, because they tend to think in financial terms, not necessarily in effects on the family, on parents, on siblings and psychological effects...depression, anxiety, self-harming, any, any of those kind of things that can be triggered by extreme circumstances. Carer impact
  10. 10. Using a DCE to determine population preferences • Developed DCE using 5 attributes from qualitative study • 32 questions split into 2 blocks – each person answers 16 questions • Respondents given a scenario and asked to choose between 2 vaccine options • Representative sample of 2002 UK adults 10
  11. 11. 11 27 November 2017 “Imagine that you are a policy maker and that you have been given a limited amount of money to fund a new vaccination programme in the UK. You have been asked to choose between two different vaccination programmes, but there is only enough money to fund one. Each vaccination programme costs the same amount of money and will be given to same number of people (to be exact 650,000 people). The vaccination programme is publically funded, so there will be no charge for those people receiving the vaccine and it will not be possible to buy the vaccine privately. The different vaccination programmes have different benefits for the people vaccinated.” Question 1 Vaccination Programme A Vaccination Programme B Age group 12 to 17 years ≤1 year old Disease severity Severe Moderate How common Rare (65 people) Uncommon (650 people) Carer impact Moderate Severe Social group Socially advantaged Socially disadvantaged  I would choose Vaccination Programme A  I would choose Vaccination Programme B
  12. 12. DCE results 12 -0.800 -0.600 -0.400 -0.200 0.000 0.200 0.400 0.600 0.800 Vaccine A (left hand side) Vaccine B (right hand side) -0.800 -0.600 -0.400 -0.200 0.000 0.200 0.400 0.600 0.800 Very common Common Uncommon Rare -0.800 -0.600 -0.400 -0.200 0.000 0.200 0.400 0.600 0.800 Mild Moderate Severe Very severe -0.800 -0.600 -0.400 -0.200 0.000 0.200 0.400 0.600 0.800 Mild Moderate Severe Very severe -0.800 -0.600 -0.400 -0.200 0.000 0.200 0.400 0.600 0.800 Advantaged Disadvantaged Age group How common Carer impact Disease severity Social (dis)ad Alternative -0.800 -0.600 -0.400 -0.200 0.000 0.200 0.400 0.600 0.800 ≤1 year old 2 to 11 years 12 to 17 years 18 years+ Vaccine A (left hand side) CoefficientCoefficient Vaccine B (right hand side)
  13. 13. Conclusions • The UK general public do have preferences for characteristics relevant to vaccine decision making • Early evidence to suggest these preferences differ from ‘weight’ currently used • Future CE analysis should consider these population preference ‘weights’ 13
  14. 14. Acknowledgements 14 With thanks to the individuals who took part in the qualitative interviews and DCE survey. This study was funded by the Meningitis Research Foundation. HC is supported by the NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England. Research team Dr Gemma Lasseter University of Bristol Dr Hareth Al-Janabi University of Birmingham Dr Caroline L Trotter University of Cambridge Dr Fran E Carroll Royal College of Obstetricians and Gynaecologists