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7
Calculation and Comparison of the Health Benefits and Costs Associated with Candidate Vaccines

This chapter presents the method used to calculate and compare the reductions in morbidity and mortality that could be produced by the 20 vaccine candidates evaluated in this report, and the costs associated with their development and use. The proposed method has two principal components: (a) calculation of values for the health benefits and costs that would occur at a time when the annual yield of such benefits has reached a steady state, and (b) adjustment of these values for factors such as the probability of successful development and the number of years required to achieve the steady state.

A central analysis is presented in this chapter. Sensitivity analyses involving some of the factors used in the base case are discussed in Chapter 9.

Procedures

The steps for calculating expected health benefits and morbidity cost reductions from the vaccine candidates are listed below and illustrated in Figures 7.1 and 7.2.

  1. Estimation of vaccine preventable illness (VPI) for each vaccine candidate. This is defined as the number of cases, complications, sequelae, and deaths that could be prevented (in the steady state) by immunization of the entire target population with a hypothetical vaccine that is 100 percent effective.

  2. Calculation of the direct (treatment) cost imposed by the VPI, using methods described in Chapter 4.

  3. Calculation of vaccine preventable illness values for each vaccine. These values incorporate both VPI estimates and a factor expressing the undesirability of the conditions prevented by the vaccine. Infant mortality equivalence (IME) values, described in Chapter 4, are used to quantify these value judgments. The calculations are identical to those used to produce disease burden values. Two sets of IME values are employed throughout this report: one expresses a median of committee member perspectives and the other is an age-neutral perspective. The effects of adopting alternative



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