On Discounting of Health Gains from Human Papillomavirus Vaccination: Effects of Different Approaches

Department of Medical Microbiology, Molecular Virology Section, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Value in Health (Impact Factor: 3.28). 05/2012; 15(3):562-7. DOI: 10.1016/j.jval.2012.01.005
Source: PubMed


Discounting has long been a matter of controversy in the field of health economic evaluations. How to weigh future health effects has resulted in ongoing discussions. These discussions are imminently relevant for health care interventions with current costs but future benefits. Different approaches to discount health effects have been proposed. In this study, we estimated the impact of different approaches for discounting health benefits of human papillomavirus (HPV) vaccination.
An HPV model was used to estimate the impact of different discounting approaches on the present value of health effects. For the constant discount approaches, we varied the discount rate for health effects ranging from 0% to 4%. Next, the impact of relevant alternative discounting approaches was estimated, including hyperbolic, proportional, stepwise, and time-shifted discounting.
The present value of health effects gained through HPV vaccination varied strongly when varying discount rates and approaches. The application of the current Dutch guidelines resulted in a present value of health effects that was eight or two times higher than that produced when using the proportional discounting approach or when using the internationally more common 4% discount rate for health effects, respectively. Obviously, such differences translate into large variations in corresponding incremental cost-effectiveness ratios.
The exact discount rate and approach chosen in an economic evaluation importantly impact the projected value of health benefits of HPV vaccination. Investigating alternative discounting approaches in health-economic analysis is important, especially for vaccination programs yielding health effects far into the future. Our study underlines the relevance of ongoing discussions on how and at what rates to discount.

Download full-text


Available from: Toos Daemen,
  • [Show abstract] [Hide abstract]
    ABSTRACT: Despite childhood vaccination programs, pertussis remains endemic. To reduce the burden of pertussis, various extended pertussis vaccination strategies have been suggested. The aim of this article is to evaluate dynamic models used to assess the cost-effectiveness of vaccination. In total, 16 studies using a dynamic model were included, of which four also studied the cost-effectiveness of extended pertussis vaccination strategies. Generally, adolescent vaccination was found to be cost effective, but not highly effective in protecting infants too young to be vaccinated. The models also predicted that owing to age shifts, reduced pertussis disease in adolescents and young adults comes with an increase in later stages of life. This underpins the use of dynamic transmission models for interventions directed against pertussis. In future, dynamic transmission models for pertussis should be used widely to further enhance understanding of pertussis epidemiology and of extended pertussis vaccination programs that are currently considered in various countries.
    Expert Review of Vaccines 12/2012; 11(12):1415-28. DOI:10.1586/erv.12.130 · 4.21 Impact Factor

  • Vaccine 12/2012; 31(16). DOI:10.1016/j.vaccine.2012.11.082 · 3.62 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In this chapter, we focus on health technology assessment (HTA) processes targeted at genetic and genomic strategies in personalized medicine, particularly regarding economic evaluations. In general, we conclude that an adequate approach for evaluating personalized medicine would be to follow the economic guidelines developed for clinical pharmacology as a set of standards, although some modifications and specific foci should be made to optimize applicability in testing strategies. These specific foci should comprise optimal evidence synthesis of associations between disease and characteristic tested for, analysis of the related pharmacotherapy, accuracy and predictive values, clinical utility, representativeness of the available studies on the technology, study perspective, and scope of the sensitivity analysis. Although recent use of HTAs in personalized medicine is increasing, the field is still in its infancy with few full-scale assessments. If the specific steps listed are adopted in the coming years with further applications, HTAs in personalized medicine may greatly benefit from the abundance of experience that has been gathered with clinical pharmacological HTAs.
    Pharmacogenomics: Challenges and Opportunities in Therapeutic Implementation, 1 edited by Yui-Wing Francis Lam, Larisa H. Cavallari, 01/2013: chapter 12: pages 429-450; Academic Press., ISBN: 978-0-12-391918-2
Show more