The study examines the cost-effectiveness of Swedish national vaccination programs

Immunizing children against chickenpox would save money, but offering shingles vaccination to all 65-year-olds would not. These are examples of findings in a thesis by the University of Gothenburg that explores the cost-effectiveness of Swedish national vaccination programs.

The issue of vaccination is obviously topical now that a pandemic is underway. The thesis now presented at the Sahlgren Academy, University of Gothenburg, does not include immunization against COVID-19. Author Ellen Wolff, a health economist from the Swedish Public Health Agency, is still thinking about the current situation.

It has become clear that the development of new vaccines can be rapid. But new vaccines usually cost more per dose than those already established on the market. “

Ellen Wolff, Health Economist, Swedish Health Agency

In general, immunization is one of the key instruments of public health policy. Many diseases that previously caused a great burden of disease and premature death have been more or less eradicated. Vaccination has a direct effect on the recipient and helps protect others in the community by reducing the spread of the infection.

Incorporating vaccination into national programs, however, requires economic prioritization. Although the demand for health care is unlimited, resources in the form of labor, equipment and resources in the protection sector are limited.

The cost-effectiveness analysis of a vaccination program compares the health effects and costs of two or more alternative programs, on the one hand, and does not provide vaccination on the other. Results are usually presented in terms of price per year adjusted for quality (QALY), an indicator that combines the effects of length related to health and quality of life. The analysis includes not only costs such as vaccination doses, but also care costs.

Already during her doctorate, Ellen Wolff’s research provided knowledge that influenced Swedish national vaccination programs. This includes the sex-neutral vaccination against human papilloma virus (HPV), which includes both boys and girls from autumn 2020. This vaccine provides protection not only against cervical cancer, but also against forms of cancer that affect both sexes.

In addition, she studied the cost-effectiveness of different vaccination strategies to protect newborns from whooping cough (pertussis). It turns out that the most cost-effective strategy is to immunize babies at the right time – at the age of 3, 5 and 12 months – without delay. Vaccination of pregnant women or parents or guardians of newborn babies (“Congo strategy”) was less cost-effective.

In another study that is part of Wolff’s thesis, she investigated the cost-effectiveness of pneumococcal vaccination for 65- and 75-year-olds. The results indicate that vaccinating 65-year-olds is not cost-effective, while vaccination of 75-year-olds may be.

Vaccination against chickenpox (varicella) is not yet included in the Swedish public vaccination program for children. However, according to the thesis, this measure would be cost-effective and even save money. On the other hand, vaccinating a 65-year-old against herpes zoster (herpes zoster), which can affect people who have contracted chickenpox at some stage, does not achieve cost-effectiveness.

When asked, in the research of the questionnaire in the thesis, whether they believe that society should spend more resources on the implementation of preventive vaccination programs or treatment of the disease after it occurs, respondents clearly gave a clear priority to prevention. There were more than 1,900 of these respondents, based on a representative sample of the Swedish population.

“Preventive measures such as immunization may involve high costs in the present, while health effects appear in the future. Therefore, it may be difficult to persuade decision makers to prioritize prevention, compared to treating a disease that is already manifesting,” concludes Ellen Wolff .