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The committee selected 26 candidate vaccines (in addition to the hypothetical examples) to illustrate the conceptual framework and the analytic model that it developed. The committee struggled early in its deliberations to select the candidate vaccines to be analyzed in this report. These 26 candidate vaccines are of interest to many people, could be developed within the next two decades, are directed against conditions of domestic importance, and illustrate important components of the model.

The committee was guided in their choices by a set of exclusion criteria. The following were bases for exclusion: (1) potentially vaccine-preventable conditions for which other preventive interventions were deemed more appropriate; (2) conditions for which basic science information was insufficient to predict vaccine development and licensure within 20 years; and (3) diseases of primarily non-domestic health importance. These exclusion criteria were used in the analysis undertaken for this report in order to limit the task in front of the committee. The exclusion criteria were not intended to guide public policy on vaccine R&D investments by either the public or private sector.

The primary analysis used by the committee is the annualized present value of the costs per quality-adjusted life year (QALY) gained by a vaccine strategy. The committee strongly cautions against focusing on a single ranking of candidate vaccines. In fact, the committee has deliberately chosen not to present a detailed ranking for the candidate vaccines. Any such ranking taken out of context of the rest of the report would assume an importance that is inappropriate given the uncertainty surrounding the data and the caveats about the modeling assumptions. The committee has placed candidate vaccines within general levels that reflect the results of the total analysis. The candidate vaccines fall into four reasonably distinct groupings or levels. That is, use of some of the candidate vaccines would save money while also saving QALYs and some of the candidate vaccination strategies would incur costs for each QALY gained. The four groups are:

Level I

Most Favorable

Saves money and QALYs

Level II

More Favorable

Costs<$10,000 per QALY saved

Level III


Costs>$10,000 and<$100,000 per QALY saved

Level IV

Less Favorable

Costs>$100,000 per QALY saved.

Seven candidate vaccines fall into the most favorable (I) category: those with which a vaccination strategy would save money. The Level I candidate vaccines are as follows (in alphabetical order):

  • cytomegalovirus (CMV) vaccine administered to 12-year-olds,

  • influenza virus vaccine administered to the general population (once per person every 5 years or one-fifth of the population per year),

  • insulin-dependent diabetes mellitus therapeutic vaccine,

  • multiple sclerosis therapeutic vaccine,

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