Economic perspectives on the advance market commitment for pneumococcal vaccines

Health Affairs

Volumn 30, Issue 8, 2011, Pages 1508-1517

  Snyder, Christopher M ^a   Begor, Wills ^a   Berndt, Ernst R ^b  

^a Lamont Doherty Earth Observatory   (United States)

^b MASSACHUSETTS INSTITUTE OF TECHNOLOGY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

HAEMOPHILUS INFLUENZAE TYPE B VACCINE; PNEUMOCOCCUS VACCINE; ROTAVIRUS VACCINE;

ADVANCE MARKET COMMITMENT PROGRAM; ARTICLE; COST UTILITY ANALYSIS; DEVELOPING COUNTRY; DRUG COST; DRUG MARKETING; ECONOMIC ASPECT; FUNDING; HEALTH CARE QUALITY; HEALTH PROGRAM; HUMAN; PILOT STUDY; PNEUMOCOCCAL INFECTION; VACCINE PRODUCTION; DRUG EFFECT; DRUG INDUSTRY; ECONOMICS; PROGRAM DEVELOPMENT; STREPTOCOCCUS PNEUMONIA; STREPTOCOCCUS PNEUMONIAE;

DEVELOPING COUNTRIES; DRUG INDUSTRY; HUMANS; PNEUMOCOCCAL VACCINES; PNEUMONIA, PNEUMOCOCCAL; PROGRAM DEVELOPMENT; STREPTOCOCCUS PNEUMONIAE;

EID: 82555168681     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2011.0403     Document Type: Article

References (22)

1. Kremer M. Creating markets for new vaccines-part I: rationale. In: Jaffe AB, Lerner J, Stern S, editors. Innovation policy and the economy. Vol. 1. Cambridge (MA): MIT Press; 2001. p. 35-72.
2. To access the Appendix, click on the Appendix link in the box to the right of the article online.
3. Levine R, Kremer M, Albright A. Making markets for vaccines: ideas to action [Internet]. Washington (DC): Center for Global Development; 2005 [cited 2011 May 13]. (Report of the Center Advance Market Commitment Working Group). Available from: http://www.cgdev.org/doc/books/vaccine/MakingMarkets-complete.pdf.
4. O'Brien KL, Wolfson L, Watt JP, Henkle E, Deloria-Knoll M, McCall N, et al. Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. Lancet. 2009;374(9693): 893-902.
5. We computed the proportion of deaths in countries eligible for GAVI's assistance from country-level data from World Health Organization. Estimated Hib and pneumococcal deaths for children under 5 years of age [Internet]. Geneva: WHO; 2011 [last updated 2011 Feb 7; cited 2011 May 13]. Available from: http://www.who.int/immunization_monitoring/burden/Pneumo_hib_estimates/en/index2.html
6. GlaxoSmithKline [Internet]. London: GSK. Press release, World Health Organization grants prequalification for global use to GSK's 10-valent Synflorix™ vaccine; 2009 Nov 6 [cited 2011 May 13]. Available from: http://www.gsk.com/media/pressreleases/2009/2009_pressrelease_10126.htm
7. Wyeth [Internet]. Collegeville (PA): Wyeth. Press release, Wyeth submits marketing application to FDA for its 13-valent vaccine for the prevention of pneumococcal disease in infants and toddlers; 2009 Mar 31 [cited 2011 July 13]. Available from: http://phx.corporate-ir.net/phoenix.zhtml?c=78193&p=irol-newsArticle&ID=1271479&highlight=
8. GAVI Alliance Secretariat. Advance market commitment for pneumococcal vaccines: annual report, 12 June 2009-31 March 2010 [Internet]. Geneva: The Secretariat; [cited 2011 Jul 29]. Available from: http://www.gavialliance.org/library/documents/amc/2011-pneumococcal-amc-annual-report
9. A more detailed model and calibrations are provided in Kremer M, Levin J, Snyder C. Designing advanced market commitments for new vaccines. Paper presented at: International Industrial Organization Conference; 2009 Apr 4; Boston, MA.
10. Accounting for mortality benefits and some reduction in hospitalizations, vaccination with PCV-7 would have a cost-effectiveness ratio of $80 per disability-adjusted life-year, a standard measure of health benefits, assuming Gambian efficacy rates held across countries eligible for GAVI assistance. The assumed cost per dose was around $5.62 (adding the $5 price and the sixty-two-cent midpoint of the range of administration costs considered by the study).
11. See Sinha A, Levine O, Knoll MD, Muhib F, Lieu TA. Costeffectiveness of pneumococcal conjugate vaccination in the prevention of child mortality: an international economic analysis. Lancet. 2007; 369(9559):389-96.
12. To arrive at our final estimate of an $8.50 health benefit from a dose of the vaccine, two additional steps are needed, described in this note and in Note 12. First, if a vaccine that costs $5.62 generates a $80 per disabilityadjusted life-year cost-effectiveness ratio, as the study in Note 10 found, then a vaccine generating a $100 per disability-adjusted life-year costeffectiveness ratio must therefore cost $7.03. We can interpret the $7.03 as a donor's willingness to pay for the vaccine because this costeffectiveness ratio is the threshold for highly cost-effective health interventions. See World Health Organization. World health report 2002: reducing risks, promoting healthy life. Geneva: WHO; 2002.
13. We scaled up the $7.03 willingness to pay by 1.2 times, to account for the greater coverage of PCV-13 relative to PCV-9 in countries eligible for GAVI assistance. The 1.2 coverage ratio is based on computations from GAVI Alliance, PneumoADIP. Pneumococcal global serotype project: summary report of stage 1/version 1 analysis [Internet]. Geneva: GAVI Alliance; 2007 Oct 18 [cited 2011 Jul 18]. Available from: http://www.preventpneumo.org/pdf/GSP_Summary_for_SAGE_Nov6-8_2007_Oct_19-07.pdf
14. Economic Expert Group. Advance market commitment for pneumococcal vaccines [Internet]. Geneva: GAVI Alliance; 2008 Apr 1 [cited 2011 June 1]. Available from: http://www.vaccineamc.org/timeline_media/Expert_Group_Report.pdf
15. For a theoretical analysis of optimal contracts when firms have private cost information, see Laffont J-J, Tirole J. A theory of incentives in procurement and regulation. Cambridge (MA): MIT Press, 1993.
16. For a theoretical analysis applied to vaccines, see McGuire TG. Setting prices for new vaccines (in advance). Int J Health Care Finance Econ. 2003;3(3):207-24.
17. GAVI Alliance. GAVI Alliance revised co-financing policy, version No. 1.0 [Internet]. Geneva: GAVI Alliance; 2010 Oct [cited 2011 May 2]. Available from: http://www.gavialliance.org/resources/Co_financing_Policy_final.pdf
18. Kremer M, Williams H. Incentivizing innovation: adding to the tool kit. In Lerner J, Stern S, editors. Innovation policy and the economy. Vol. 10. Chicago (IL): University of Chicago Press; 2010. p. 1-17.
19. The Pneumococcal Vaccine Advance Market Commitment Program has planned a self-assessment for 2014. A baseline study commissioned by GAVI has been published: Swiss Centre for International Health. GAVI baseline study for pneumococcal vaccine AMC [Internet]. Geneva: GAVI Alliance; 2010 Oct 29 [cited 2011 May 13]. Available from: http://www.vaccineamc.org/files/AMCbaseline2010.pdf
20. Levine OS, Knoll MD, Jones A, Walker DG, Risko N, Gilani Z. Global status of Haemophilus influenzae type b and pneumococcal conjugate vaccines: evidence, policies, and introductions. Curr Opin Infect Dis. 2010;23(3):236-41.
21. World Health Organization. State of the world's vaccines and immunizations: 2003 revised edition [Internet]. Geneva:WHO; 2003 [cited 2011 May 4]. Available from: http://www.who.int/vaccines-documents/DocsPDF04/wwwSOWV_E.pdf
22. GAVI Alliance. Board meeting, 30 November-1 December 2010: doc #11e, AVI progress report [Internet]. Geneva: GAVI Alliance Secretariat; 2010 Nov 16 [cited 2011 May 4]. Available from: http://www.gavialliance.org/resources/DOC__11e_AVI_Progress_Report.pdf