We need to harmonize investment cases for vaccines

Governments and funders face high demand for health investments to achieve progress toward national health objectives and Sustainable Development Goals. In recent years, there have been an increasing number of reports described as “investment cases” that aim to articulate the need for specific investments in health.

But with the great diversity of investment cases being created, governments and funders may have difficulty interpreting the results. To respond to this challenge, Sim et al published a scoping review of existing investment cases for vaccines and immunization programs  in Value in Health. The authors aimed to answer the following questions: what are common characteristics that define self-described investment cases, and what is the role of these investment cases within the broader context of vaccine development and introduction? 


What types of investment cases have been produced over three decades?

  • Through a systematic search from January 1980 to November 2017, the research team identified 24 investment cases from gray literature and electronic bibliographic databases.

  • Most of them aim to provide information for decisions (12 cases) or advocate for a specific agenda (9 cases) associated with vaccine procurement, delivery, research or development, or comprehensive disease control strategies.

  • 67 outcomes identified from these investment cases fall into four broad categories—burden of disease, cost of investment, impact of investment, and other considerations for implementation.

  • The most frequently reported outcome measures for impact of investment were number of deaths averted (70%), incremental cost-effectiveness ratios (67%), and reduction in health and socioeconomic inequalities (54%). 

  • The most common considerations for implementation were health system capacity (79%) and vaccine financing landscape (75%). 


Based on the main findings, authors present recommendations for how the field can work to harmonize investment cases in order to increase the transparency, comparability, and usability of investment cases as a tool for decision making and priority setting. 


How can investment cases be more comparable?

  • Standardized definition and content based on four categories (burden of disease, cost of investment, impact of investment, and other considerations for implementation);

  • Consistent reporting of the key assumptions in health and economic impact models used for investment cases;

  • Transparency in stating aims, intended audience, and funding sources of investment cases;

  • Tracking of the final decisions on proposed investments;

  • Extensive review and comparative analysis of investment cases in the health sector;

  • Development of an umbrella investment case that provides:

    • guidance on choosing among the existing guidelines and reference cases for each outcome;

    • endorsement that investment cases be used for priority setting and that they incorporate efficiency measures such as those based on cost-effectiveness analysis (CEA) or benefit-cost analysis (BCA); and

    • guidelines for assessing opportunity costs and trade-offs of the proposed investment (ie, investment on other health or non-health sector interventions)

Read the full scoping review [link] in Value in Health.

For more information, please contact Raymond Hutubessy at hutubessyr@who.int or So Yoon (Yoonie) Sim at ssim@jhu.edu