The Value of Vaccines in Maintaining Health System Capacity in England

Objectives: In situations of excess demand for healthcare, treating one patient means losing the opportunity to treat another. Therefore, each decision bears an opportunity cost. Nevertheless, when assessing the value of health technologies, these opportunity costs are not always fully considered. We present a pragmatic approach for conceptualizing vaccines' health Methods: Our approach proxies opportunity costs through the net monetary benefit forgone as scarce healthcare resources are used to treat a vaccine-preventable disease instead of a patient from the waiting list. We apply this approach to cost the resource hospital beds for 3 different scenarios of excess demand. Empirically, we estimate the opportunity costs saved for 4 selected vaccination programs from the national schedule in England during a hypothetical scenario of long-lasting excess demand induced by the pandemic. Results: The opportunity cost avoided through vaccination rises with excess demand for treatment. When treating an acute vaccine-preventable outcome is a suboptimal choice compared with treating elective patients, preventing a vaccinepreventable disease from blocking a hospital bed generates opportunity cost savings of approximately twice the direct costs saved by avoiding vaccine-preventable hospitalizations. Conclusions: Policy makers should be aware that, in addition to preventing the outcome of interest, vaccines and other preventative health technologies deliver value in maintaining regular healthcare services and clearing the pent-up demand from the pandemic. Therefore, health system capacity value should be a key-value element in health technology assessment. Existing and potential future vaccination programs deliver more value than hitherto quantified.

Automated summary

In situations of excess demand for healthcare, the opportunity costs of treating vaccine-preventable diseases instead of patients from waiting lists are not fully considered when assessing the value of health technologies. A pragmatic approach is presented to conceptualize the health benefits of vaccines, proxying opportunity costs through the net monetary benefit forgone as scarce healthcare resources are used to treat a vaccine-preventable disease. The study estimates the opportunity costs saved by vaccination programs, emphasizing the importance of considering health system capacity value in health technology assessment.