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TABLE 9.4 The Effect of Resource Constraints on the Ranking of Various Vaccine Candidates

 

Rank Based on Annualized Present Value of Potential Health Benefits Adjusted for Opportunity Costsa

 

Willingness to Pay (dollars) per IME Averted

Vaccine

Unrestricted

100,000

10,000

1,000

500

S. pneumoniae

1

1

1

5

b

Rotavirus (HPBRV)

2

2

2

Malaria (monovalent)

3

3

6

Rotavirus (LPBRV)

4

4

4

Rotavirus (RMRV)

5

5

5

S. typhi (Ty21a)

6

6

3

3

Malaria (multivalent)

7

7

7

Shigella

8

8

8

1

2

Hepatitis B

9

13

H. influenzae b

10

9

10

S. typhi (aa-strain)

11

10

9

6

Streptococcus group A

12

11

12

E. coli (attenuated live)

13

12

11

2

3

E. coli (purified antigens)

14

14

16

V. cholera (attenuated live)

15

15

13

4

1

M. leprae

16

16

14

V. cholera (inactivated)

17

17

15

7

RSV (attenuated live virus)

18

18

RSV (glycoprotein)

19

21

Parainfluenza viruses

20

22

Rabies (Vero cell derived)

21

19

17

Rabies (glycoprotein)

22

20

18

Hepatitis A (attenuated live virus)

23

27

Hepatitis A (polypeptide)

24

N. meningitidis

25

26

Yellow fever virus

26

23

20

Dengue virus

27

25

Rabies (live vector virus)

28

24

19

Japanese encephalitis virus

29

aRankings are based on values shown in Table 9.3.

b– denotes not affordable at indicated willingness to pay.

equivalent to potential health benefits. In this case the principle of dominance applies: vaccines yielding greater potential benefits and lower expenditures are preferred. Procedures are discussed in Chapter 3. However, because the expenditures do not reflect overall net costs, the committee believes that initial rankings of candidates should be based on their potential health benefits.

Disease Burden Assumptions

A major factor in determining the ultimate ranking of a vaccine candidate is the total disease burden value (TDBV) used as the starting point in the calculations of potential benefit. The central analysis rankings reflect the committee’s best efforts, within its resources and the reliability and quantity of available data, to generate disease



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