On behalf of Philipp Lambach Considerations in decision making and planning processes for influenza vaccine introduction Disease What is influenza burden costing the society Vaccine Are there other ID: 616110
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Slide1
WHO's Influenza Economic assessment tools
On behalf of Philipp LambachSlide2
Considerations in decision making and planning processes for influenza vaccine introduction
Disease
What is influenza burden costing the society?
Vaccine
Are there other
effective interventions/strategies
to prevent & control
influenza? How
much do they
cost compared
to
influenza vaccine
?
Is influenza vaccine affordable
?
Cost-effective (total population – high risk groups)?
Impact
on national budget – any funding gap? What strategies (resource mobilization/
programme
efficiencies/other) are needed to achieve long-term financial sustainability
?
Roll out
What will the introduction
cost?
Which
strategies may be
financially
sustainability
at long-term
?Slide3
WHO's Influenza Disease/Economic analysis value chain
Disease
burden
analysis
Economic
Burden
analysis
Cost effectiveness
analysis
Costing of
Mat
.
Imm
. introduction (Flutool)
Decision to introduce influenza immunization
Planning roll
out
(informing cMYP)
Disease burden
manual
Economic burden
manual(Pilot draft)
Cost effectivenessguidance(Final draft)
"Flutool"Slide4
PurposePractical step-by-step guidance and toolkit outlines methods to evaluate disease burden attributable to influenza in LMICTarget audienceNational officials that want to carry out/commission economic burden analysis of seasonal influenza disease (e.g. before vaccine introduction)
OutputConservative disease burden estimates based on (lab confirmed) influenza associated ILI and SARI
WHO manual for estimating
disease burden
associated with seasonal influenzaSlide5
PurposePractical step-by-step guidance and toolkit to estimate economic burden associated with seasonal influenza in LMIC
Target audienceNational officials that want to carry out/commission economic burden analysis of seasonal influenza disease (e.g. before vaccine introduction)
Should be familiar
with the WHO manual for estimating disease burden associated with seasonal
influenza
Output
Cost of influenza disease based
on
disease burden estimates
WHO manual for estimating
economic burden
associated with seasonal influenzaSlide6
Estimating the economic burden
Direct non-medical costs
Direct medical costs
Indirect costs
(
eg
treatment-related costs)
- medical care providers
- outside of provider care
(Informal care)
(loss of productivity)
Patient (e.g. illness)
Caregiver (e.g. treating pat.)
(e.g. transport to treatment) Slide7
Piloting of the economic burden tool ongoing
Costa Rica
Colombia
Chile
Madagascar
Romania
Lao PDR
Mongolia
Indonesia
Israel
Full piloting for all countries planned in 2016!Slide8
PurposeOutline the key conceptual frameworks/best practice when costing an influenza vaccination programmeTarget audienceNational officials
that seek high-level guidance on influenza seasonal influenza vaccination adaptable to local contextsTechnically literate audience with basic knowledge about economic evaluationOutputSelection of methods and tools optimized for country context
WHO Guidance on the economic evaluation of influenza vaccination (=cost effectiveness guidance)Slide9
PurposePractical step-by-step manual and toolkit to estimate the additional costs of introducing influenza vaccination for pregnant womenTarget audience
Implementers that want to inform cost estimation for introduction planning or evaluate the vaccination of pregnant women to inform multiyear planningShould be familiar with the WHO cost effectiveness guidanceOutputAdditional costs of adding maternal influenza vaccination to the national immunization efforts
WHO
Maternal seasonal influenza vaccination
programme
planning and costing toolSlide10
Conclusions67th WHA identified need for globally adequate information available to guide rational policy decisions and
practicesTo address this WHO provides technical support and guidance to decision making stakeholders introducing influenza vaccineIn times of limited resources economic considerations are an increasingly relevant additional argument in decision making, and
planning processes to introduce influenza vaccine
WHO's "economic value chain" provides a toolbox to close information gaps from decision making, to implementation, to evaluation of introduction efforts
Countries are encouraged to use these tools should the piloting phase confirm their added valueSlide11
Additional slidesSlide12
Methodological
issueSpecification
Details
Seasonal influenza cases
Laboratory-confirmed SARI/ILI
Based on WHO disease burden estimation
Counterfactual
Incidence-based approach
WHO guideline for quantifying economic consequences of disease
and
injury
Perspective
Societal
Time horizon
1 year (maximum)
Illness symptoms span days to weeks. Capturing the consequences of influenza with 1-year time horizon would be sufficient.
Discounting
No discounting required
Time horizon is less than 1 year; there is no need for discounting for this estimation
Informal care cost (for those not seeking medical care)Not covered in main analysis
Non-medical provider care cost for those not seeking medical care is optional for data collection or for including in a sensitivity analysis
Economic burden manual and tool
Specifications of the economic burden estimationSlide13
Overall recommendations made in this manualSlide14
WHO Flutool Recurrent costs and Capital costs
Recurrent Procurement/Storage:vaccines, injection supplies, freight, clearance, insurance,
IEC:
Personnel and prod. time,
material
Service delivery & supervision:
Person-time, per diem, transport
M&E:
Vacc. cards., tally sheets…Waste management: Incin. fuel
Capital
costsProcurement and storage: additional
cold chain equipment, Introduction: micro planning, initial training,
IEC material development, sensitization meetings
Waste management: add
. incinerators, Other transport: add. vehiclesSlide15
WHO Flutool Financial and economic costs
Vaccination Activity
Financial Costs
Economic Costs
Procurement of Vaccines and injection supplies
Cost of vaccines and injection supplies to government
Cost of freight, clearance, insurance and taxes
Cost of vaccines and injection supplies
regardless of source of financing
Cost of freight, clearance, insurance and taxes
Micro-planning
Per diems and travel allowances
Venue rental, TransportAs in financial costs, PLUS Personnel
time spent in meetingsTraining
Development of training materials
Per diems and travel allowances, Venue rental, Transport, Training Materials, Stationery
As in financial costs, PLUS Value of personnel time spent on trainingIEC/Social Mobilization
Facilitator time in meetings, Per diems and travel allowances, Stationery, Printing of materials, Production of TV and/or radio spots
As in financial costs, PLUS Value of personnel, and volunteer time spent on material development and other activities
Service DeliveryTransport fuel
, Personnel per diems to travel to vaccination sites, Supplies – e.g. cottonAs in financial costs
, PLUS Value of personnel time spent on vaccination Monitoring and EvaluationTally sheets or registers, Pens
and pencils, Vaccination cards, Materials for surveillance
As in financial costsSupervision
Travel
allowances, Transport
fuel and
maintenance
,
Stationery
As in
financial costs
, PLUS Value
of personnel time spent on
supervision
Waste Management
Purchase of incinerators (
annualized), Fuel, Transport
As in
financial costs
Cold chain
equ
. Cold chain equipment (annualized)Cold chain equipment (annualized and discounted)