Several factors make cost-effectiveness analysis particularly well-suited to the committee’s assessment of vaccine development priorities. It is a well-established tool for informing decisions regarding the allocation of resources related to health and health care. Comparisons of the benefits of preventing or treating very different forms of illness are made possible by measuring all health benefits in terms of QALYs. Cost-benefit analysis is similar in many respects to cost-effectiveness analysis but relies on valuing benefits in monetary terms. Cost-effectiveness analysis values health consequences in terms of their impact on the health of a community, while cost-benefit analysis values those consequences in terms of the monetary willingness of citizens to pay for them. Cost-effectiveness analysis is generally preferred for health-related studies because many health policymakers and analysts question the appropriateness of measuring the value of additional life expectancy or other health benefits in monetary terms, and because they have ethical qualms about using willingness to pay (and, implicitly, ability to pay) as a basis for guiding resource allocation.
The cost-effectiveness approach also provides a framework within which the components of the analysis can be specified in detail and evaluated by those who use the results. This is particularly helpful for the committee’s analysis, which, of necessity, rests on many estimates and assumptions about the characteristics of future vaccines and their likely impact on health and costs. The detailed specification of the components of the model also facilitates sensitivity analyses for the testing of alternative estimates and assumptions, either for individual patients or for a population. Sensitivity analyses are discussed later in the chapter.
The cost-effectiveness analysis used by the committee can provide an estimate of the cost of achieving the anticipated health benefit for each of the vaccines studied, but it cannot determine whether that health benefit is worth the cost. That decision is a value judgment and should reflect consideration of many factors that are not included in the analysis. For example, the committee’s analysis does not consider what resources will or should be available for vaccine development or how many vaccine candidates should be given priority for development. Moreover, the analysis does not address the allocation of resources between vaccine development and the development and use of other forms of prevention or treatment. Although priority setting and resource allocation can be informed by economic analyses, they require value judgments that cannot be captured by a cost-effectiveness model.
It is also important to note that the results of the analysis depend on the accuracy and appropriateness of the data and the assumptions that are used, a point