A visual approach to the economic evaluation of vaccines: opening the health economic black box

Objectives: The economic evaluation of vaccines has attracted a great deal of controversy. In the academic literature, several vaccination advocates argue that the evaluation frame for vaccines should be expanded to give a more complete picture of their benefits. We seek to contribute to the debate and facilitate informed dialogue about vaccine assessment using visualization, as able to support both deliberation by technical committees about the substance of evaluation and communication of the underlying rationale to non-experts. Methods: We present two visualizations, an Individual Risk Plot (IRP), and a Population Impact Plot (PIP), both showing the beneficiary population on one axis and the degree of individual benefit and cost of an individual dose on the second axis. We sketch out such graphs for 10 vaccines belonging to the UK routine childhood immunization schedule and present our own analysis for the rotavirus and meningitis B vaccines. Results: While the IRPs help classify diseases by morbidity and mortality, the PIPs display the health and economic loss averted after introducing a vaccine, allowing further comparisons. Conclusion: The visualizations presented, albeit open to provide an increasingly complete accounting of the value of vaccination, ensure consistency of approach where comparative judgments are most needed.