Most value assessments of vaccination programs are carried out by taking the perspective of the health system. To stimulate the debate concerning the broader value of vaccination beyond this perspective, this report quantifies the related return on investment to the UK government.
A sample of three vaccination programs from the UK vaccination schedule was selected for a form of fiscal health modelling. The model is intended to complement the regular cost-effectiveness assessment of vaccines from a health-system perspective. The results demonstrate that a significant part of the value generated by vaccination programs accrues outside the healthcare system’s perspective.
The UK has a world-leading vaccination program. A comprehensive understanding of the returns generated by the investments made is needed to inform appropriate funding decisions today and in the future. Therefore, this study aimed to quantify the return on investment of vaccination to the UK government for a sample of three vaccination programs from the UK vaccination schedule.
To do so, we used a form of fiscal health modelling, which considers not only the relevant direct medical costs but also the loss in direct and indirect tax contributions due to morbidity and mortality of vaccine-preventable diseases, the associated pay-outs for sick days and the loss in informal care.
The analysis is conducted from a government perspective, and therefore the target audience, besides health economists, includes ministers of finance and treasury.
A lifetable-based, closed cohort model was used to estimate the return on investment (ROI) per £1 spent on the following selected vaccination programs from a governmental perspective in the United Kingdom (UK), compared with a scenario of no vaccination.
- The human papillomavirus (HPV) vaccine that has been routinely offered to girls aged 12-13 years.
- The shingles vaccination program offered to senior citizens when they turn 70.
- The pneumococcal disease vaccination program which protects against 13 types of pneumococcal bacteria and which is administered to infants in their first year of life.
Each sub-model is populated with a hypothetical, gender-specific cohort of patients with a starting age equal to the eligible age for the specific vaccines and follows the individual until death. The average ROI per £1 spent on these three vaccination programs over the lifetime of each cohort is £2.18. Across these three models, the ROI per £1 spent (discounted at 3.5%) ranged from £0.23 to £4.45.
As expected, vaccination programs that address a young population and prevent fatal events generate a high ROI from a government perspective, most of which are not captured within the health care system but rather accrues as tax income (which could be redistributed to any department).
This fiscal health model is intended to serve as a complement to other (often more complex) types of models that aim to assess the cost-effectiveness of a single vaccine from a health-system perspective. Its results demonstrate that a significant part of the value generated by vaccination programs accrues outside the healthcare system’s perspective.
Therefore, if the concern is mainly a financial one, policymakers should consider basing their investment decisions for future vaccination programs not only on cost-effectiveness evaluations but also on a complementary fiscal analysis.