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Table 1 Detailed descriptions of each proposed benefit of immunisation programmes

From: The broader economic impact of vaccination: reviewing and appraising the strength of evidence

Category Definition Outcome measures
A. Health-related benefits to vaccinated individuals
  A1. Health gains Reduction in morbidity and mortality Cases averted
Deaths averted
QALYs/DALYs saved
  A2. Health care cost savings Reduction in direct cost of health care borne by the public sector or private individuals Costs saved by health care provider
Health care costs saved by individuals
B. Productivity-related benefits
  B1. Productivity gains related to care Reduction in lost days of work due to caring for a sick patient Value of productivity
  B2. Productivity gains related to health effects Reduction in lost days of work due to sickness or death of a sick patient Friction costs
Potential lifetime earnings
  B3. Productivity gains related to non-utility capabilitiesa Increased lifetime productivity because of enhanced capabilities (such as improved cognition and educational attainment) not easily measured using utility-based preference measures Educational outcomes
Cognitive outcomes
Potential lifetime earnings
C. Community or health systems externalities
  C1. Ecological effects Health improvements in unvaccinated community members as a result of ecological effects such as herd immunity, eradication, and reduced antibiotic usage Indirect vaccine protection
Prevalence of antibiotic resistance
Future cost of disease control averted
  C2. Equity More equal distribution of health outcomes Distribution of health outcomes
  C3. Financial and programmatic synergies and sustainability Improved financial sustainability as a result of effects such as synergies with other health care programmes (e.g. delivery platforms), stimulation of private demand, and mechanisms to enhance group purchasing power (e.g. PAHO revolving fund) Financial benefits
Private demand estimates
  C4. Household security Improved financial security of households as a result of reduced risk of catastrophic expenditure Actuarial value of security
D. Broader economic indicators
  D1. Changes to household behaviour Economic improvements due to changes in household choices such as fertility and consumption/saving as a result of improved child health and survival Productivity
Female labour participation
Household investment
Child dependency ratio
  D2. Public sector budget impact Change to an individual’s net transfers to the national budget over his/her lifetime Return on investment
Net present value of investment
  D3. Short-term macroeconomic impact Changes to national income or production as a result of short-term exogeneous shocks to the economy Change in GDP (per capita)
Change in sectoral output
  D4. Long-term macroeconomic impact Changes to national income or production as a result of long-term changes to drivers such as labour supply and foreign direct investment Change in GDP (per capita)
  1. aMost cost-effectiveness evaluations focus on maximising individual preference-based measures of health. Capabilities refer to the ability of individuals to function in particular ways, and offer an alternative way to assess the value of health-altering interventions [46]
  2. DALY, Disability-adjusted life year; GDP, Gross domestic product; PAHO, Pan American Health Organization; QALY, Quality-adjusted life-year