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TABLE 3.2 Rankings of Various Hypothetical Vaccinesa

Annualized Present Value of Potential Health Benefits

Annualized Present Value of Potential Expenditures on Vaccines ($ millions)

A

250

A

10

B, C

150

B

20

E, I

150

C

40

G

125

D

80

H

105

E

100

D, F

100

F

200

J

80

G

300

 

H

400

 

I

500

 

J

1,000

aGreater benefits and lower expenditures are preferred.

(either benefits or affordability) than vaccine y, and if x is as good as or better than y on the second dimension, then the choice of vaccine x dominates y. The first step in this procedure is to rank vaccine candidates on the basis of health benefit (greater is preferable) and on expenditure (lower is preferable). For the vaccines A through J listed in Table 3.1, the rankings are shown in Table 3.2.

GUIDELINES

Applying the test for dominance noted above to these candidate vaccines produces the results shown in Table 3.3 and summarized below:

  • vaccine A dominates all others

  • vaccine B dominates all except A

  • vaccine C dominates all except A and B

  • vaccine D dominates F and J

  • vaccine E dominates F, G, H, I, and J

  • vaccine F dominates J

  • vaccine G dominates H and J

  • vaccine H dominates J

  • vaccine I dominates J

By the rule of dominance, the top three social investments (as judged by these criteria) are vaccines A, B, and C, and the least attractive of the listed vaccines is J. The need to proceed further depends on the number of alternatives to be selected for development: if only one, two, or three were desired, we could identify the priorities as vaccines A, A and B, or A and B and C, respectively. The procedures for further selections are outlined below.



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