Evaluating the Impact of Population-Based and Cohort-Based Models in Cost-Effectiveness Analysis: A Case Study of Pneumococcal Conjugate Vaccines in Infants in Germany
Notice bibliographique
Résumé
Abstract Introduction Cost-effectiveness analysis (CEA) is crucial when evaluating the health and economic value of vaccines compared to the current standard of care (SoC) and provides essential information to assist decision-makers in maximizing health gains when allocating resources. The design of the CEA should address the specific policy questions, disease area, vaccine characteristics, and consider all relevant vaccination effects on the population. Areas covered We presented a case study on the CEA of pneumococcal conjugate vaccines (PCVs) in infants in Germany using a closed single cohort-based approach versus a population-based approach. Except for the design of the modelled population/cohort, all other inputs and characteristics were kept identical in the cost-effectiveness model. We contrasted model results, inferences, and conclusions between both design approaches. Expert Opinion CEA must carefully consider the included population in the analysis based on their specific policy questions and the characteristics of the vaccine being evaluated. The choice between population-based and closed single-cohort models fundamentally depends on whether the vaccine affects disease transmission dynamics. Population models are essential for vaccines that disrupt transmission patterns across population groups, such as PCVs in infants, while closed single-cohort models are suitable for vaccines impacting only vaccinated individuals without affecting disease transmission. Article highlights Identifying the appropriate model design is crucial for conducting cost-effectiveness analyses (CEAs) of vaccines, particularly when addressing vaccine technical committee (VTC) policy questions, which aim to optimize individual and population health benefits. Closed single cohort-based designs track a group of individuals, while population-based designs evaluate an entire cross-sectional population, making the choice between the two designs vital when vaccines have secondary, indirect effects. We presented a case study comparing PCV20 with PCV13 and PCV15 in infants in Germany using a closed single cohort-based approach and a population-based approach. Modelled results highlighted that the closed single cohort-based approach substantially underestimated public health benefits and economic advantages associated with PCV20, whereas the population-based approach demonstrated PCV20 as cost-saving strategy while offering superior health outcomes, indicating it as a dominant vaccination option when accounting for Germany’s entire population. Selecting an inappropriate model design for CEAs of vaccines could result in unintended consequences, such as adversely affecting national recommendations, policies, and programs, leading to suboptimal decision-making for population health. Researchers and policymakers must carefully select appropriate population frameworks and adhere to methodological guidelines to ensure accurate inferences in vaccine economic evaluations.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,014 | 0,025 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,003 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».