Gesundheitsökonomische Evaluation von Impfungen

Zusammenfassung

Zielsetzung: Entscheidungsträger in Europa beziehen im Rahmen des Empfehlungs- und Erstattungsprozesses von Impfungen zunehmend Studien zur Kosteneffektivität in ihre Entscheidung mit ein. Der steigende Stellenwert erfordert demzufolge eine kritische Auseinandersetzung mit den in gesundheitsökonomischen Evaluationen von Impfungen angewendeten Methoden.

Methodik: Im vorliegenden Beitrag werden die Besonderheiten und Herausforderungen im Zusammenhang mit der gesundheitsökonomischen Evaluation von Impfungen zusammengefasst und anhand von Beispielen veranschaulicht.

Ergebnisse: Die Besonderheiten von gesundheitsökonomischen Evaluationen von Impfungen basieren einerseits auf dem präventiven Charakter von Impfungen und andererseits darauf, dass es sich bei impfpräventablen Erkrankungen um Infektionskrankheiten handelt. Daraus resultieren besondere methodische Ansätze, wie etwa alternative Diskontierungsmethoden, die Verwendung dynamischer Modelle, um indirekte Effekte wie Herdenschutz oder Serotypen-Replacement abzubilden, sowie spezielle Evaluationsstrategien.

Schlussfolgerung: Die Anwendung konventioneller Standards der gesundheitsökonomischen Evaluation bei Impfungen kann zu einer Fehleinschätzung der Kosteneffektivität führen. Dieser Fehleinschätzung kann teilweise mit der Anwendung modifizierter Methoden begegnet werden. Hinsichtlich einiger Besonderheiten besteht jedoch weiterer Forschungsbedarf.

Abstract

Aim: Economic evaluations have been increasingly considered in the process of recommendation and reimbursement of vaccines by decision-makers in Europe. This increased importance demands a critical discussion about the methods used in health economic evaluations of vaccines.

Method: This paper discusses and summarises the particularities and challenges of health economic evaluations of vaccines illustrated by examples.

Results: The particularities of health economic evaluations of vaccines are based on the preventive character of vaccines and on the fact that vaccine-preventable diseases are infectious diseases. These characteristics require particular methods like alternative discounting approaches, dynamic models to analyse the impact of herd effects or serotype replacement as well as specific evaluation strategies.

Conclusion: The use of common methods of health economic evaluation for assessing the cost-effectiveness of vaccines might lead to a misinterpretation of the true economic value. This problem can partly be solved by use of specific methodological approaches. However, further research is needed to address some remaining issues.

Schlüsselwörter

Impfung - Kosteneffektivität - gesundheitsökonomische Evaluation - Modellierung - Methoden

Key words

vaccination - cost-effectiveness - health economic evaluation - modelling - methods

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