City Research Online

Abstract

The thesis has two broad aims. The first aim is to evaluate the effectiveness and “cost-effectiveness” of routine childhood varicella vaccination in the UK. To do so, a deterministic realistic age-structured model was built which incorporated herd- immunity effects and the indirect impact of varicella vaccination on zoster. The model predicts that although the overall morbidity due to varicella is likely to decrease following infant vaccination, these benefits will be offset by a significantly increase in zoster cases. These modelling results were used to explore the possible economic desirability of mass varicella vaccination. To do so, we perform the three major types of economic evaluation. The economic analysis predicts that using cost-utility and cost-effectiveness analysis, routine infant varicella vaccination is unlikely to be ’’cost- effective” and may produce an overall increase in morbidity. On the other hand, varicella is highly cost-beneficial when using £ as the outcome measure. Finally, we show that results are less sensitive to parameter estimates than model and methodological assumptions

The second aim of the thesis is to address the major methodological issues related to the economic evaluation of vaccination programs using varicella vaccination as an example. Firstly, we compare results from a dynamic model with those of a static model to illustrate the impact of including herd-immunity and to help provide guidance on which model should be used when assessing the impact of vaccination. Secondly, we assess the average willingness to pay for varicella vaccination and the QALY lost due to chickenpox using various elicitation techniques. We then identify important attributes of vaccination and what elicitation techniques can capture these components. Results are compared to investigate what valuation techniques should be used in the economic evaluation of vaccine programmes. Thirdly, we assess the sensitivity of economic analysis to the choice of model, methodological assumptions and parameter estimates. Finally, we propose guidelines for the economic evaluation of vaccination programmes based on the various findings of the thesis.

Publication Type:	Thesis (Doctoral)
Additional Information:	EThOS request
Subjects:	H Social Sciences > H Social Sciences (General)
Departments:	Doctoral Theses City, University of London (-2022) > School of Arts & Social Sciences School of Arts & Social Sciences School of Policy & Global Affairs > Economics School of Policy & Global Affairs > School of Policy & Global Affairs Doctoral Theses

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