The analysis is based on a societal perspective on health effects and costs in the United States; that is, all significant health outcomes and costs are taken into consideration, regardless of who experiences them. Thus, if use of a vaccine reduces hospital care costs, the analysis does not have to distinguish between cost savings that accrue to individuals and savings that accrue to insurers.
The societal perspective is in contrast to a more selective perspective, such as that of a particular government agency, health plan, or vaccine manufacturer used to examine these factors in other analyses. For these more selective analyses, the assessment of health effects might be limited to the members of a health plan or to a particular age group such as the Medicare population. Similarly, the costs (or savings) included in the analysis would be limited to those that would be incurred by the particular agency or organization. Costs borne by individuals or other organizations would not be considered in the analysis. A societal perspective, however, examines all costs and the health experience of the entire population.
The committee intends this model to be used as a dynamic instrument. The basic model and the mathematics used to create the model are described in detail in the report. In order to facilitate such use of this model, it can be accessed electronically free of charge (see the IOM home page at www.iom.edu/vaccinepriorities for more information). The committee developed several examples of hypothetical candidate vaccines, which are discussed in the report. These simplified examples are useful both for understanding key components of the model (and the effects of changes in those key components) and for those who wish to access and manipulate the model itself. The committee believes that this model has great utility even for those not charged with prioritizing vaccine development. Because only part of the model accounts for vaccine development time and costs, the model can be used after licensure of a vaccine to study and plan for vaccination program implementation.
The committee will not recommend which vaccines should be accorded research and development priority; it was not charged with doing so. In fact, the committee offers a single recommendation:
Policymakers (government agencies, research coordinators, private industry, philanthropic groups) charged with prioritizing vaccine development and vaccination program implementation should use as an aid in that prioritization process a model, such as that developed for this report, that is quantitative and relatively unbiased toward a specific vaccine candidate. Such a model should use standardly accepted data and techniques such as measures of health impact, and discounting.