In low- and middle-income countries, budget impact is an important criterion for funding new interventions, particularly for large public health investments such as new vaccines. Decision makers need estimates of the real financial consequences of introducing a new intervention within a defined budget rather than relying on anticipated savings in economic costs alone. Yet fewer budget impact analyses (BIAs) are published compared with cost-effectiveness analyses (CEAs).
A recent study has developed a framework that incorporates the latest ISPOR recommendations into a BIA quality assessment checklist. This framework can be turned into a scoring system to critically assess the quality of a BIA. A scoring system for vaccines was developed as an illustrative example.
As CEAs are more common than BIAs, particularly in LMICs. it would be helpful if they could be adapted to provide budget impact information without requiring much additional data or analysis. Such pragmatic adaptations could be immediately useful to policy makers seeking to fill the gap in stand-alone BIAs. A modified BIA checklist and scoring system was developed for CEAs, to evaluate whether, and if so, the extent to which, a CEA can be used to provide sufficient information for a BIA.
The authors applied the checklists and scoring systems to a systematic review of rotavirus vaccine economic evaluations conducted in LMICs. They examined the extent to which existing evaluations provide sufficient evidence about budget impact to enable decision making, and identified key areas where BIA and CEA reporting could be improved for this purpose.
The study findings reveal that published budget impact analyses do not meet current best-practice recommendations such as not discounting future costs, providing annual or budget relevant financial streams of costs, model validation, and sensitivity and scenario analyses among others.
The proposed framework through which cost-effectiveness analyses could be used as a tool to provide useful budget impact information could facilitate the uptake and improvement of good quality BIA for decision makers.
For further details and to access the (open access) article, see link below.
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Senior Economics, WHO