selected attributes and weighting input by each user. Therefore, the model evaluation and sensitivity analyses are designed to isolate computational submodel results independent of user preferences. As such, this appendix describes sensitivity analysis scenarios exclusively for attributes of health and economic considerations.

Table D-1 presents the calculated health and economic measures for six vaccine candidates in the United States using data available as accompanying datasets. All attributes included in the health and economic measures are calculated within the model using this baseline input data. The calculated health measures specify the following attributes: premature deaths averted per year, incident cases prevented per year, quality-adjusted life years (QALYs) gained per year, and disability-adjusted life years (DALYs) averted per year. The economic measures are the net direct costs (savings) of vaccine use per year, workforce productivity gained per year, one-time costs, cost-effectiveness in costs per QALY, and cost-effectiveness in costs per DALY.

The computational submodel calculates the health and economic burden due to a disease. Among the six vaccine candidates tested for the United States, influenza vaccine had the highest health impact. Compared to other hypothetical vaccine candidates, a seasonal influenza vaccine candidate with 1-year immunity was shown to potentially avert 11,233 deaths, prevent the incidence in 6,119,401 cases, and produce a gain of 115,665 QALYs per year. Because of its annual administration costs, the net direct costs for the influenza vaccine were considerably higher than the costs of a two- or three-dose vaccine conferring lifetime immunity, such as a human papillomavirus (HPV) vaccine. The model found that a vaccine candidate for HPV was most cost-effective of all the evaluated vaccines because preventing this infection in young women provides them with improved health for the remainder of their lifetimes. In particular, the calculation indicated a gain of 11,238 QALYs per year with minimal costs for administration. Consequently, in this example, vaccine for HPV is a beneficial investment in the long run because its effects are long lasting unlike a seasonal influenza vaccine that only confers health benefits for a year. For some women, the HPV vaccine can result in health gains for as long as their lifetimes, which has an added economic benefit of reduction in the amount of health services otherwise used to treat HPV-associated disease.

Similarly, the computational submodel was also tested for vaccine candidates in the context of South Africa. Table D-2 presents four vaccine candidates with calculated health and economic measures for human papillomavirus, rotavirus, tuberculosis, and pneumococcal vaccine candidates in the South African population using data available online. The



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