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Results

Presented below are the results of the central analysis, which assumes the probability of successful vaccine development and other vaccine characteristics (e.g., cost) described in Chapter 5, the predicted utilization rates (with no combination or promotion) presented in Chapter 6, the mixed public-private vaccination program described above, and a discount rate of 0.05.

Health Benefits

Table 7.4 shows values representing the health benefits that could result from the development of each vaccine candidate. Values are shown for two perspectives to illustrate the influence of judgments involved in developing IME values.

Vaccine preventable illness values represent the burden of illness that could be averted by delivering a hypothetical vaccine that is 100 percent effective to the whole target population.

The values for the possible reduction in morbidity and mortality take into account the vaccine’s predicted efficacy, and the expected annual health benefit values are adjusted for the anticipated utilization. The annualized present value of the expected health benefits incorporates the probability of successful development and the time at which benefits would occur. Use of these values to compare health benefits from these vaccines is discussed in Chapter 9.


An Illustration of the Process Figure 7.4 illustrates the sequence of calculations involved in the proposed method for comparing the health benefits expected from two vaccine candidates using the committee median IME perspective. Chapter 3 and the foregoing text describe the specific computations involved at each stage.

If an age-neutral IME perspective such as that shown in Table 4.6 is adopted in place of the committee median the relationship between values indicating the health benefits of the two vaccines changes. The annualized present value for expected health benefits of the gonococcal vaccine becomes 201 and that for parainfluenza virus vaccine becomes 117. This change is predominantly due to the fact that the age-neutral IME perspective (shown in Table 4.6) equates a first trimester fetal death with all other deaths. If, in the age-neutral perspective, the value for the relative undesirability of fetal deaths is changed to 100 (its value in the committee median perpsective) the relative values for annualized present value of expected health benefits become 5 for the N. gonorrhoeae vaccine, and 117 for the parainfluenza vaccine.

This case clearly illustrates how the relative importance attached to certain conditions or events can, in some cases, change the ranking on health benefits. Other differences in the rankings on health benefits with the committee median and age-neutral perspectives (generally not as dramatic as that just described) are shown in Table 7.4, and the rank orders presented in Table 9.2. The potential effect



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