Developing a new vaccine can cost between $200 and $400 million before it's put on the market. At that price, policy-makers need to choose their targets carefully, and a report released yesterday by the National Academy of Sciences' Institute of Medicine (IOM) offers some help: a comparison of the estimated costs and expected health benefits of more than two dozen candidate vaccines that could be developed within the next 10 to 20 years. At the top of the list, in value-for-money, are vaccines against influenza and cytomegalovirus and therapeutic vaccines for diabetes and multiple sclerosis.
New tools, such as recombinant DNA technology and genomics, have changed the way vaccines are developed. So the National Institutes of Health asked the IOM to develop a quantitative model to compare the cost effectiveness of various vaccines in development. "The landscape had changed significantly, so we felt it was a good time to evaluate where we need to go," says Regina Rabinovich, chief of the clinical and regulatory affairs branch at the National Institute of Allergy and Infectious Diseases (NIAID). The IOM focused on vaccines for diseases with a high impact in the U.S. and included so-called therapeutic vaccines for chronic diseases such as autoimmune disorders and cancer.
The 26 vaccines under scrutiny were ranked in four categories, based on their estimated development costs and the anticipated payoff for public health. The cost of the seven candidates in the top tier would be more than repaid by added productivity and savings in health care. Focusing resources on these "is a real no-brainer," says Howard Lawrence of the Johns Hopkins School of Public Health in Baltimore, Maryland, and chair of the committee. The lower tiers, including hepatitis C and enterotoxic Escherichia coli, require more and more money to reduce mortality. The report did not recommend which vaccines should be developed and which shouldn't.
The findings "will help us recognize important targets," says NIAID's Rabinovich. She says the model will also make it possible to compare vaccines to other kinds of health interventions such as drug development or the provision of clean water, the cost-effectiveness of which can also be quantified. "It's a way to compare apples to oranges," Rabinovich says.