Proposed Conceptual and Experience-Based Framework for Reaching an Optimal Vaccine Launch Strategy

Abstract

Obtaining market approval and reimbursement are necessary but not sufficient conditions for the implementation of new vaccines in high-income countries to maximize their long-term preventative value. Comprehensive pre-launch and launch-phase economic evaluations of the disease and the vaccine are necessary to support long-term public health improvement by the vaccination program. This review highlights the construction of these evaluations conceived as a plan, methods, and a tool. They can be generated by different stakeholders (e.g., payers, producers, target groups) interested in the value success of vaccination. A Vaccine Launching Value Project (VLVP) has been developed based on the experience gained from helping to launch 10 new vaccines worldwide over 15 years (2005-2020). It comprises information on the following: (1) identification of new vaccines that should require a VLVP approach; (2) country-specific characteristics of healthcare; (3) methods to assess economic values for specific stakeholders; (4) identification of the money flow in managing the disease and infection spread; and (5) optimal implementation strategies at the initiation of new vaccination programs. The benefits of applying the VLVP are illustrated using rotavirus vaccination as an example. The VLVP program starts with the development of a Broad Country Linked Inventory (Brocoli) Plan that interconnects eight baskets of information specifying a framework of activities. This is followed by the Cauliflower and Artichoke Methods to assess the vaccine value for additional key stakeholders (e.g., employers, hospital managers, working mothers, the Ministry of Finance) and the money flow amongst the payers (who pays what to whom, when, for what, and how). The evaluation process finishes with the Total Management Tool (Tomato) to identify the optimal implementation conditions at the start of a new vaccination program necessary to obtain the best long-term value for the stakeholders selected. The critical interconnections between these information blocks are discussed. This improves the positioning of a new vaccine by articulating its total economic value within a societal and public health environment over time, outside the conventional Health Technology Assessment box. The Tomato Tool emerges as the most pivotal component of the VLVP. It provides the best assurance of long-term economic value with strong sustainability support.