Comparative value-based pricing of an Ebola vaccine in resource-constrained countries based on cost-effectiveness analysis
Creators: name: Obeng-Kusi, M.
name: Erstad, B.
name: Roe, D. J.
name: Abraham, I.
Publisher: name: Taylor & Francis
Year: 2022
Subjects: subject: Medicine
subject: Biotechnology
subject: Ecology
subject: FOS: Biological sciences
subject: Sociology
subject: FOS: Sociology
subject: Science Policy
subject: 110309 Infectious Diseases
subject: FOS: Health sciences

description: Pricing, affordability, and access are important deliberations around infectious disease interventions. Determining a fair price that not only incentivizes development but ensures value and access for patients is critical given the increasing global health crisis. Using Ebola virus disease (EVD) as an exemplar, we aim to elucidate the estimation of a jurisdiction-specific value-based price (VBP) for a vaccine package and to consider how prices compare across selected countries that have experienced EVD outbreaks. Using a dynamic transmission model, we assessed the cost-effectiveness of a vaccine package – composed of the vaccine, storage, maintenance, and administration – for vaccination toward herd immunity in 4 countries affected with EVD (Democratic Republic of Congo, Liberia, Sierra Leone, Uganda). Based on the cost-effectiveness metrics and using willingness-to-pay thresholds equal to varying percentages of the Gross Domestic Product (GDP), we demonstrated how a VBP is calculated using a cost-effectiveness-based approach. The VBP for the vaccine is directly proportional to effectiveness (DALYs prevented), cost-effectiveness (ICER) and GDP per capita. Higher effectiveness, greater cost-effectiveness, and higher GDP per capita resulted in higher price ceilings compared to lower cost-effectiveness and lower GDP. Despite the concerns with the cost-effectiveness-based approach, we illustrated that it is an easily comprehensible method for determining the VBP of a vaccine using cost-effectiveness analysis. Choice of data, population characteristics, and disease dynamics are among the factors that need to be considered when comparisons are made across countries. In infectious diseases, issues related to pricing, affordability and access to interventions are very important; particularly in low-income countries (LIC) because of the scarcity of resources coupled with several competing priorities. Pricing interventions fairly in LICs facilitates the prevention and management of infectious diseases, promotes innovation, and ensures patient access to valuable interventions. We were interested in determining a fair price of an intervention for an infectious disease (here, vaccination against Ebola virus disease) based on the cost-effectiveness (or value) of vaccination in four African countries. Using data from EVD outbreaks in Liberia, the Democratic Republic of Congo, Uganda, and Sierra Leone, we estimated the number of susceptible people who were exposed to the virus, became infected, recovered, or died. We did this for two scenarios: not vaccinating versus vaccinating to achieve herd immunity. We determined how many disability-adjusted life years (DALY; loss of the equivalent of a year of full health) would be prevented by vaccination; setting this as our value metric. Using this value metric and percentages of the gross domestic product (GDP) per capita as the willingness-to-pay (WTP) threshold (the price a payer might be prepared to pay for the intervention) we demonstrate how to calculate the maximum price for the vaccine package. The combination of greater effectiveness (DALYs averted), greater cost-effectiveness (value) and higher GDP per capita (WTP) resulted in different price ceilings in the four countries. The method proposed here is easy to understand and requires minimum data to determine a price for an intervention’s price based on its value.