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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
Meningitis and Septicaemia in Children and Adults
14 Nov 2017, 2
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
Meningitis and Septicaemia in Children and Adults
14 Nov 2017, 3
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
Meningitis and Septicaemia in Children and Adults
14 Nov 2017, 4
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
Meningitis and Septicaemia in Children and Adults
14 Nov 2017, 5
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
Meningitis and Septicaemia in Children and Adults
14 Nov 2017, 6
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
Meningitis and Septicaemia in Children and Adults
14 Nov 2017, 7
EQ-5D – a widely used measure
of quality of life
Meningitis and Septicaemia in Children and Adults
14 Nov 2017, 8
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)
Meningitis and Septicaemia in Children and Adults
14 Nov 2017, 9
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
Meningitis and Septicaemia in Children and Adults
14 Nov 2017, 10
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
Meningitis and Septicaemia in Children and Adults
14 Nov 2017, 11
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
Meningitis and Septicaemia in Children and Adults
14 Nov 2017, 12
Utility in anticipation
Time
Utility
(benefit)
A
t1 t2
B
Meningitis and Septicaemia in Children and Adults
14 Nov 2017, 13
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
Meningitis and Septicaemia in Children and Adults
14 Nov 2017, 14
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
Meningitis and Septicaemia in Children and Adults
14 Nov 2017, 15
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
Meningitis and Septicaemia in Children and Adults
14 Nov 2017, 16
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
Meningitis and Septicaemia in Children and Adults
14 Nov 2017, 17
To enquire about additional information and analyses, please contact
Koonal Shah at kshah@ohe.org
To keep up with the latest news and research, subscribe to our blog, OHE News
Follow us on Twitter @OHENews, LinkedIn and SlideShare
Office of Health Economics (OHE)
Southside, 7th Floor
105 Victoria Street
London SW1E 6QT
United Kingdom
+44 20 7747 8850
www.ohe.org
OHE’s publications may be downloaded free of charge from our website.
Thank you for listening

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Dr Koonal Shah @ Meningitis & Septicaemia in Adults & Children 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
  • 2. Meningitis and Septicaemia in Children and Adults 14 Nov 2017, 2 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
  • 3. Meningitis and Septicaemia in Children and Adults 14 Nov 2017, 3 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
  • 4. Meningitis and Septicaemia in Children and Adults 14 Nov 2017, 4 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
  • 5. Meningitis and Septicaemia in Children and Adults 14 Nov 2017, 5 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
  • 6. Meningitis and Septicaemia in Children and Adults 14 Nov 2017, 6 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
  • 7. Meningitis and Septicaemia in Children and Adults 14 Nov 2017, 7 EQ-5D – a widely used measure of quality of life
  • 8. Meningitis and Septicaemia in Children and Adults 14 Nov 2017, 8 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)
  • 9. Meningitis and Septicaemia in Children and Adults 14 Nov 2017, 9 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
  • 10. Meningitis and Septicaemia in Children and Adults 14 Nov 2017, 10 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
  • 11. Meningitis and Septicaemia in Children and Adults 14 Nov 2017, 11 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
  • 12. Meningitis and Septicaemia in Children and Adults 14 Nov 2017, 12 Utility in anticipation Time Utility (benefit) A t1 t2 B
  • 13. Meningitis and Septicaemia in Children and Adults 14 Nov 2017, 13 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
  • 14. Meningitis and Septicaemia in Children and Adults 14 Nov 2017, 14 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
  • 15. Meningitis and Septicaemia in Children and Adults 14 Nov 2017, 15 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
  • 16. Meningitis and Septicaemia in Children and Adults 14 Nov 2017, 16 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
  • 17. Meningitis and Septicaemia in Children and Adults 14 Nov 2017, 17 To enquire about additional information and analyses, please contact Koonal Shah at kshah@ohe.org To keep up with the latest news and research, subscribe to our blog, OHE News Follow us on Twitter @OHENews, LinkedIn and SlideShare Office of Health Economics (OHE) Southside, 7th Floor 105 Victoria Street London SW1E 6QT United Kingdom +44 20 7747 8850 www.ohe.org OHE’s publications may be downloaded free of charge from our website. Thank you for listening