Taking vaccine effectiveness into public health decision making: The ProVac Example

Transcription

1 Taking vaccine effectiveness into public health decision making: The ProVac Example Evaluating dengue effectiveness workshop June 12 th, 2014 Washington, DC Cara Bess Janusz Gabriela Felix Jon Andrus Immunization, PAHO

2 ProVac s Goal: strengthen national capacity to make informed, evidence-based decisions regarding vaccine introduction Current focus on 4 vaccines: Rotavirus Pneumococcal conjugate HPV Influenza (in the future: dengue, malaria, second generation & others)

3 Objectives of the ProVac Initiative Objective 1 Objective 2 Objective 3 Objective 4 Strengthen infrastructure and processes for decision making Develop tools for EE and provide training to multidisciplinary teams Collect data, perform analysis and gather the framework of evidence Advocate for evidence based decisionmaking NITAG strengthening Legal frameworks South-south academic network Cost-effectiveness models Program costing model Regional training workshops Direct country support Methodological guidelines Results presented to authorities Technical reports & policy briefs Objective 5 Support an effective & sustainable NUVI Costing exercises to inform new vaccine intro 2

4 Sustainable impact ProVac Models, OLIVES (Data/Evidence) National Vaccine Committees WHO Regional Training Workshops Country CEA study (MoH-led team) 3

5 ProVac s technical cooperation Countries have requested technical support from PAHO to help integrate economic studies into the national decision-making process for immunization Directing Council resolution (CD47.R10) Ministry of Health ProVac at PAHO (Washington DC) National Advisory Committee Surveill. Officers Nat l Consultant EPI Manager ProVac National Team Clinician PAHO Country Office Health Economist ProVac Centers of Excellence National level Regional level 4

6 Considerations for new vaccine policymaking at country-level Technical EVIDENCE PACKAGE Operational & Programmatic Social Source: Andrus, JK., Toscano, CM., Lewis, M., Oliveira, L., et al. 2007, A model for enhancing evidence-based capacity to make informed policy decisions on the introduction of new vaccines in the Americas: PAHO s ProVac Initiative, Public Health Reports, 122(6):

7 Considerations for new vaccine policymaking at country-level Disease burden Vaccine characteristics Immunogenicity Efficacy/effectiveness Duration of protection Type-specific protection Dosage Safety and adverse events (harms) Cost-effectiveness Technical EVIDENCE PACKAGE Operational & Programmatic Social Source: Andrus, JK., Toscano, CM., Lewis, M., Oliveira, L., et al. 2007, A model for enhancing evidence-based capacity to make informed policy decisions on the introduction of new vaccines in the Americas: PAHO s ProVac Initiative, Public Health Reports, 122(6):

8 Considerations for new vaccine policymaking at country-level Technical Vaccine supply Logistics & operational issues Financing strategies Partnerships EVIDENCE PACKAGE Operational & Programmatic Social Source: Andrus, JK., Toscano, CM., Lewis, M., Oliveira, L., et al. 2007, A model for enhancing evidence-based capacity to make informed policy decisions on the introduction of new vaccines in the Americas: PAHO s ProVac Initiative, Public Health Reports, 122(6):

9 Considerations for new vaccine policymaking at country-level Technical EVIDENCE PACKAGE Acceptability Perception of risk Political will Equity Operational & Programmatic Social Source: Andrus, JK., Toscano, CM., Lewis, M., Oliveira, L., et al. 2007, A model for enhancing evidence-based capacity to make informed policy decisions on the introduction of new vaccines in the Americas: PAHO s ProVac Initiative, Public Health Reports, 122(6):

10 Considerations for new vaccine policymaking at country-level Disease burden Vaccine characteristics Immunogenicity Efficacy/effectiveness Duration of protection Type-specific protection Dosage Safety and adverse events (harms) Cost-effectiveness Technical Vaccine supply Logistics & operational issues Financing strategies Partnerships EVIDENCE PACKAGE Acceptability Perception of risk Political will Equity Operational & Programmatic Social Source: Andrus, JK., Toscano, CM., Lewis, M., Oliveira, L., et al. 2007, A model for enhancing evidence-based capacity to make informed policy decisions on the introduction of new vaccines in the Americas: PAHO s ProVac Initiative, Public Health Reports, 122(6):

11 Scenario 1 Scenario 2 Scenario 3 CEA/impact not considered (political decision) Agency-led CEA/impact (Hib vaccine in India) MoH-led CEA/impact (ProVac) (PCV in Argentina) lide courtesy of Andrew Clark, ProVac Modeller TRIVAC model used Outside agency presented to NITAG Outside agency led publication of results No MoH training GAVI finance available but significant delays in adoption TRIVAC model used MoH presented to NITAG MoH-led publication of results MoH trained and led subsequent CEA of RV/HPV PCV quickly financed/adopted 10

12 TRIVAC: Impact/CEA of Hib, RV and PCV

13 CERVIVAC: impact/cea of HPV vaccine and/or screening

14 Effectiveness important driver of cost-effectiveness analysis results Numerator = total costs to implement new vaccine program health services cost savings associated with disease prevention Denominator = life years lost due to premature mortality + life years lost due to disability (in presence of vaccination) Incremental cost-effectiveness ratios (Cost per DALY averted) are compared to cost-effectiveness threshold, generally GNI per capita Other outcomes: Lives saved, cases prevented, sequaela prevented, hospitalizations averted

15 Step-wise calculations to estimate vaccine impact (effectiveness): Example childhood vaccine Number of life-years 1-59 months per cohort x Incidence of cases 1-59 months per 100,000 per year x % of cases by age (<3m, 3-5m, 6-8m, 9-11m, 12-23m, 24-35m, 36-47m, 48-59m) x Efficacy by dose (1, 2, 3, booster) x Vaccine Type Coverage (SP and Rota) & replacement effects x Coverage by dose (1, 2, 3, booster) x Timeliness by dose (1, 2, 3, booster) x Relative coverage (% of coverage reaching high risk children) x Decrease in protection due to Waning x Herd Effect multiplier.includes options for one-way sensitivity analysis, scenario analysis and PSA

16 Methods published 15

17 ProVac direct technical support to countries to conduct a cost-effectiveness analysis TRIVAC Model Country Study Request Status Publication Decision Argentina CEA pneumo 2010 Finished Published Introduced Argentina CEA rota 2011 Finished Drafting Pending Bolivia CEA pneumo 2011 Finished Drafting Introduced Costa Rica CEA pneumo 2012 Finished - Introduced Ecuador CEA pneumo 2011 Finished Drafting Introduced El Salvador CEA pneumo 2011 Finished Drafting Introduced Guatemala CEA pneumo 2011 Finished Drafting Introduced Guatemala CEA rota 2011 Finished Drafting Introduced Nicaragua CEA pneumo 2010 Finished - Introduced Paraguay CEA pneumo 2010 Finished For submission Introduced Peru CEA pneumo 2012 Finished Drafting Introduced Venezuela CEA pneumo 2013 Request received - Pending CERVIVAC Model Country Study Request Status Publication Decision Argentina CEA HPV 2011 In progress - Introduced Belize CEA HPV 2013 Request received - Pending Bolivia CEA HPV 2011 Finished Drafting Pending Costa Rica CEA HPV 2013 Request received - Pending Ecuador CEA HPV 2012 Finished Drafting Pending Guatemala CEA HPV 2012 In progress - Pending Honduras CEA HPV 2012 In progress - Pending Jamaica CEA HPV 2011 Finished Drafting Pending Paraguay CEA HPV 2011 In progress - Pending Peru CEA HPV 2013 Request received - Pending Uruguay CEA HPV 2012 In progress - Pending

18 ProVac Initiative: models, data and guides Models (Impact and costeffectiveness) Model (EPI Costing) Model (Disease Cost) PCV (TRIVAC) RV (TRIVAC) HPV (CERVIVAC) UNIVAC COSTVAC COSTCARE Training workshop Ongoing country studies. Training workshop Ongoing country studies. Training workshop Ongoing country studies. Pilot and develop Training workshop Country studies Data/Evidence OLIVES Maintenance of database of evidence used in models On-line Launch Methods WHO GUIDELINES Development of Guides On-line Launch Dissemination Templates REPORTING TEMPLATES Development of Templates On-line Launch 17

19 Future direction Model development: UNIVAC o o o Integrate Hib, Rotavirus, Pneumococcal and HPV modules Expand to include Hepatitis A Other vaccines different transmission mechanisms and dynamics malaria, dengue Share framework and lessons learnt with other WHO Regions Further strengthening of country capacity to incorporate equity metrics and financing implications, i.e. long term vision

20 How can I learn more about ProVac? For general information, technical documents and articles go to: To request for direct technical support contact: Cara Janusz (januszc@paho.org), ProVac Technical Officer Gabriela Felix (felixg@paho.org), ProVac IWG Coordinator Or this address: provac@paho.org