Cost-benefits of vaccination programmes.

Decision-makers are increasingly demanding hard economic data as a basis for the allocation of limited healthcare resources. The main types of evaluation that are available are cost-benefit analysis, cost-effectiveness analysis and cost-utility analysis. Cost-effectiveness analysis is a tool that helps decision-makers to decide on the best use of allocated resources, whereas cost-benefit analysis is a tool that helps policy-makers decide on the overall allocation of resources. The basis of the cost-utility analysis is the quality-adjusted life year (QALY), which allows a direct comparison of a wide range of medical interventions. The cost per QALY for a range of childhood vaccinations can be compared in order to plan a vaccination programme. Public health vaccines warrant a cost-benefit approach, in order to determine if they are worthwhile, whereas recommended vaccines might be more usefully assessed by cost-effectiveness analysis. It is also important to look at combinations of vaccines, which offer large economic advantages by reducing costs (time and equipment) and ensuring better acceptance (improved coverage and reduced risk of disease). Although cost-savings do not necessarily equate with cost-effectiveness, cost-savings are achieved in many vaccination programmes.