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PP07 Vaccine Decision-making In Canada: Processes And Guidelines For Using Economic Evidence
- Beate Sander, Murray Krahn, Stirling Bryan, Werner Brouwer, Mark Jit, Karen Lee, Monika Naus, Sachiko Ozawa, Lisa Prosser, Nina Lathia, Man Wah Yeung, Austin Nam, Ashleigh Tuite, Althea House, Matthew Tunis
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 39 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 14 December 2023, p. S53
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- Article
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- You have access Access
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Introduction
Canada’s National Advisory Committee on Immunization (NACI) makes recommendations on the use of human vaccines. Provinces and territories subsequently use the advice to make decisions on public funding and program implementation. Traditionally, NACI reviewed vaccine characteristics and burden of illness.
With its recent expanded mandate, NACI now considers cost-effectiveness via economic evaluations, among other decision determinants. As such, new processes and guidelines were needed to formalize the incorporation of economic evidence into federal vaccine decision-making.
MethodsTwo task groups were convened respectively to develop NACI’s “Economic Process” and “Guidelines for the Economic Evaluation of Vaccination Programs in Canada”. The groups conducted environmental scans to inform their work, as well as engaged with government partners, decision-makers, academics, national immunization technical advisory groups from other countries, health technology assessment agencies, industry, patient groups, among others.
ResultsThe Economic Process outlines when and how NACI incorporates economic evidence for vaccine recommendation. For instance, it describes how policy questions are prioritized given institutional capacity constraints for generating economic evidence. It also describes how policy questions are assessed to determine the appropriate type of economic evidence required (i.e., systematic review, economic evaluation, multi-model comparison of external models).
The Economic Guidelines provide recommendations in 15 chapters on how to conduct economic evaluations (i.e., from defining the decision problem to reporting). Unlike other health technologies, vaccines have the potential to affect both vaccinated and unvaccinated individuals. Hence, the Guidelines consider population-level impacts such as externalities (e.g., herd immunity, age-shifting of disease) and spillover effects. They also discuss equity considerations and non-health impacts of vaccines such as to productivity, consumption and education.
ConclusionsThe Economic Process and Economic Guidelines promote the generation and use of credible and standardized economic evidence. They advocate for transparency, allowing evidence to be used across jurisdictions beyond Canada. Next steps include documentation of user feedback, incorporation of Indigenous considerations, and formal evaluations.
15 - Villagers’ Evaluation of a Community-based Health Insurance Scheme in Thmar Pouk, Cambodia
- from Part V - Health Service Consumer Behaviour
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- By Sachiko Ozawa, Johns Hopkins University, the United States, Damian Walker, Johns Hopkins University, the United States
- Edited by Hossein Jalilian, Vicheth Sen
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- Book:
- Improving Health Sector Performance
- Published by:
- ISEAS–Yusof Ishak Institute
- Published online:
- 21 October 2015
- Print publication:
- 12 September 2011, pp 365-384
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Summary
INTRODUCTION
Community-based health insurance (CBHI), also known as health insurance for the informal sector or microinsurance, is “a voluntary health insurance scheme organized at the level of the community” (Carrin et al. 2005). The population coverage, services offered, regulation, management, and objectives vary widely. Two main characteristics that distinguish CBHI from national or social health insurance are that the schemes are run by, and for, a specific community, and that enrolment is voluntary. Many CBHI schemes tend to be “not-for-profit prepayment plans for health care with community control and voluntary membership” (Gottret & Schieber 2006) in which a local non-governmental organization (NGO) or a trusted community group administers the enrolment and funds. Jakab and Krishnan (2004) identified three features common to most existing CBHI schemes: (1) affiliation based on community membership and strong community involvement in system management, (2) exclusion of beneficiaries from other kinds of health coverage, and (3) shared social values among members.
Akin to other health insurance, CBHI schemes are based on the fundamental idea that there is uncertainty about a future health outcome, and that this risk can be transferred to another party. Prepayment is made to transfer the risk to the insurer, in exchange for an agreement that the insurer will reimburse the insured for covered losses in the future. The strengths of CBHI include the ability to provide some financial protection and improve access to health care for low-income populations. CBHI can act as a stepping stone to extend health insurance to the informal sector or rural communities (GTZ 2004) and to prevent people from being driven into poverty by catastrophic health expenditures.
High out-of-pocket financing of care and a largely rural and informal sector population in many low- and middle-income countries have made CBHI quite popular in recent years (Ekman 2004). Large informal sectors constrain government capacity to raise taxes where limited government revenue is available to finance health care. Communities have filled in this gap by mobilizing local resources. CBHI schemes have gained international support as part of a solution to health care financing problems, growing from 200 schemes in 2000 (Bennett et al. 2004) to a few thousand worldwide in 2010. While most CBHI schemes operate in sub-Saharan Africa, those in Asia can be located in Bangladesh, China, India, Nepal, Cambodia, Laos, and the Philippines.