Michele Discussion:
Dear Leadership Team:
As you may be aware, our local government is currently assessing the formation of a health effectiveness analysis program (HEAP) which includes childhood immunizations. This will require the evaluation of both the costs and health outcomes of childhood immunizations compared to other interventions. Before this program is implemented into the community, there are some questions that need to be addressed. These questions include do the costs outweigh the intended benefits, what are the total costs of implementing these immunizations within our community, are there alternatives to childhood immunizations which hold the same health benefits, how does this impact quality of life, and what resources will we have available to us to help carry out this initiative?
When faced with budget constraints that hinder the implementation of multiple treatments to enhance population health, a cost-effectiveness analysis (CEA) provides a means to compare various treatment options, highlighting the existence of multiple approaches for conducting an economic evaluation (Henderson, 2018). In addition, the cost-benefit analysis (CBA) presents an alternative approach by evaluating the monetary benefits and costs associated with a treatment, enabling a comparison to determine the treatment with the highest net benefit (Henderson, 2018). Given the historical positive impact of immunizations on public health, it is crucial to employ the most suitable analysis method. While a cost-effectiveness analysis (CEA) is commonly favored as the economic evaluation method for a program of significant magnitude, there is an ongoing debate regarding its ability to fully capture the value of a public health program. As an alternative, proponents suggest considering a cost-benefit analysis (CBA) to provide a more comprehensive assessment (Park et al., 2018). Both of these analysis methods, whether it is a cost-effectiveness analysis (CEA) or a cost-benefit analysis (CBA), will offer us a more comprehensive understanding of the economic challenges associated with this program. This includes assessing the costs related to treating the illnesses that the immunizations aim to prevent, as well as the expenses linked to providing the immunizations themselves. According to an article by Gibson et al. (2016), when evaluating the cost-effectiveness of vaccines, it is essential to consider their unique characteristics. These characteristics encompass various aspects such as herd immunity, quality-of-life losses in young children, parental care and associated work loss, time preference, uncertainty, eradication, macroeconomics, and tiered pricing. These factors necessitate special considerations in the assessment of the cost-effectiveness of vaccines.
The demand for immunizations is significantly impacted by parental opinions regarding the safety and efficacy of vaccines. Furthermore, factors such as declining provider reimbursement and rising immunization prices also play a crucial role in influencing the demand for immunizations (Muzumdar& Cline, 2009). If this program includes a focus on improving parental views and improving reimbursement and out-of-pocket costs, there should be an increase in demand. The issue of supply also greatly impacts the ability to meet demands, as an inability to maintain supply to meet demand will cause issues in the success of this program. Over the years, numerous factors have affected the supply of vaccines. These include challenges related to research and development, manufacturing complexities, distribution issues, safety concerns, and financing (Muzumdar& Cline, 2009). Each of these factors has played a role in shaping the availability and accessibility of vaccines over time. When parents receive current and comprehensive education about immunizations and develop an understanding of their long-term benefits, it can have a significant impact on consumer behavior. Parents will be well informed and aware that unvaccinated children can impose higher costs on both the community and organizations due to the potential for community outbreaks of diseases that vaccines are designed to protect against. These outbreaks not only pose health risks but also require additional resources and expenses to control and manage effectively. This increased awareness and knowledge often results in greater participation in childhood immunization programs.
Reference
Henderson, J. (2018). Health Economics and Policy (7th ed.). Boston, MA: Cengage
Gibson, E., Begum, N., Sigmundsson, B., Sackeyfio, A., Hackett, J., & Rajaram, S. (2016). Economic evaluation of pediatric influenza immunization program compared with other pediatric immunization programs: A systematic review. Human Vaccines &Immunotherapeutics, 12(5), 1202–1216. https://doi.org/10.1080/21645515.2015.1131369
Muzumdar, J. M., & Cline, R. R. (2009). Vaccine supply, demand, and policy: a primer. Journal of the American Pharmacists Association: JAPhA, 49(4), e87–e99. https://doi.org/10.1331/JAPhA.2009.09007
Park, M., Jit, M., & Wu, J. T. (2018). Cost-benefit analysis of vaccination: a comparative analysis of eight approaches for valuing changes to mortality and morbidity risks. BMC Medicine, 16(1), 139. https://doi.org/10.1186/s12916-018-1130-7
Ashley Discussion:
To Whom it May Concern:
Cost-benefit analysis (CBS) requires that health benefits and cost are measured in monetary terms. A CBA is comprehensive and measuring benefits can be complex. CBA benefits can be measured in pysical and cognitive health, productivity, treatment costs and life. However, there are some questions that arise when making economic evaluations on childhood immunizations.
- How does this benefit children in the present and future?
According to Barnighausen et al., (2011) vaccines protect children’s health and allows them to achieve full cognitive potential. Children that are physically and cognitively healthy can attend school, miss school less due to illness and finish college. There is an outcome related productivity gain because vaccinated children can grow up to be physically healthy and well-educated that permits to work and be productive members of society. For instance, Haemophilus Influenzae type b (Hib) vaccine protects against a bacterial form of meningitis that can cause blindness, mental retardation, epilepsy, paralysis and deafness. There is a relation between cognitive ability and educational achievements linked to labor productivity and income. Recent studies show that 15 to 35% of Hib meningitis survivors have a permanent disability that can reduce cognition (Barighausen et al., 2011).
- How does this affect the community?
Each state has its own vaccine requirements to enroll children in school. However,there are vaccine requirements. The vaccine exemptions are medical, philosophical or religious beliefs (NVIC, n.d.). Parents with immunosuppressed children may be advised by the pediatrician to opt out of vaccinations if the risks outweigh the benefits. Therefore, there are children attending school without being protected from certain diseases. However, children that are vaccinated can protect other unvaccinated children through herd effects. Vaccinated children cannot contract the disease and transmit it to other children that are not vaccinated. The herd effect can help reduce the transmission of disease in the community )Barnighausen et al., 2011).
- What are the cost associated with disease?
Cost associated with the disease can be direct or indirect. Direct costs include outbreak control, outpatient and inpatient visits for treatment of disease. Indirect cost includes productivity losses from premature mortality (CDC, 2014). According to the CDC (2015) before the introduction of the Hib vaccine about 20,000 children under the age of 5 contracted the Hib disease yeary and about 3% – 6% children died. After the introduction of the Hib vaccine, Hib disease decreased by 99%. The costs associated with disease can have a financial burden on society. In 2013, the cost per hospitalization from Sequeiae among meningitis cases was $4,111 for 2 days and 38,270 for 7 days that could have been prevented with the Hib vaccine (CDC, 2014).
Cost-benefit analysis can assist in measuring benefits in monetary terms and identify ways to distribute resources to maximize profit. This intervention can impact demand and consumer behavior. Parents that want to protect their children from Hib will vaccinate their children causing a higher demand for vaccines and medical personnel to administer them. The demand for vaccine can result in competition in the market. Health care providers can choose to purchase from private or public sector. However, the ultimate decision is determined by the patient’s insurance and what brand of vaccine it covers.
Please let me know your thoughts on this proposal.
All the best,
References
Barnighausen, T., Bloom, D., Canning, D., Friedman, A., Levine, O.S., O’Brein, J., …Privor-Dumm, L. (2011). Rethinking
the Benefits and Costs of Childhood Vaccinations: The Example of the Hemophilus Influenzae Type B Vaccine.
Retrieved from
https://www.who.nt/immunization/disease/hib/Macroeconomic_evaluation_Hib_vaccines.pdf
Centers for Disease Control and Prevention (CDC). (2014). Decision Analysis Model. Retrieved from
www.cdc.gov/vaccines/programs/vfc/pubs/methods/index.html.
Centers for Disease Control and Prevention (CDC). (2015). VFC Publications: Supplement. Retrieved from
https://www.cdc.gov/vaccines/programs/vfc/pubs/methods/index.html
National Vaccine Information Center (NVIC). (n.d.). State Law & Vaccine Requirements. Retrieved from
https://www.nvic.org/vaccine-laws/state-vaccine-requirements.aspx
