Objectives
The COVID-19 pandemic dramatically highlighted health inequities and the differential impact that vaccination can have on health, depending on social advantage. In a non-pandemic setting, vaccination can improve equity, but this broader value of vaccination is not currently considered in health economic analysis despite equity being a policy priority in many countries.
Methods
A panel of health economists and policy experts convened to discuss how to capture the equity dimension of the value of vaccination. This was conceptualized using a distributional cost-effectiveness analysis framework with four steps leading to differential health impact: (i) differences in vaccine preventable disease incidence; (ii) differences in the vaccination uptake; (iii) differences in health effects; and (iv) differences in health opportunity costs. The concept was illustrated by a retrospective modelling exercise of 4-component meningococcal serogroup B (4CMenB) infant vaccination against serogroup B invasive meningococcal disease (MenB) in England, for which an existing model was adapted. Five social groups were analysed based on Index of Multiple Deprivation Quintiles (IMDQ).
Results
4CMenB infant vaccination disproportionately prevented MenB cases among more deprived groups: of all prevented cases, 40.3% were among the most deprived IMDQ (accounting for 25.9% of the target population <5 years of age) and 78.1% among the three most deprived IMDQs. Vaccination had a positive, though small, net equity benefit, and the direction of equity impact was robust to sensitivity analyses varying the distribution of uptake, MenB carriage prevalence, and assumptions related to life expectancy and utility stratified by IMDQ.
Conclusions
Within a national immunisation programme, 4CMenB vaccination improves health equity by preventing disproportionately more cases in more socially disadvantaged groups. The health equity impacts of vaccination can be captured in health economic evaluation although there is a need to improve the evidence base and develop more user-friendly equity impact measures.