Comparison criteria
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Question
Which comparison criteria should be used in the tendering process for the selection of a pneumococcal conjugate vaccine to be included in the national vaccination programme for children in Finland? The tendering process will be initiated during the autumn of 2014.
- Possible comparison criteria include price, benefits, safety and technical properties.
- Price refers to the bargaining price of the vaccine.
- Benefits refer to the decrease in disease burden caused by large scale use of the vaccine. As a result health care costs decrease and the quality of life attributed to improved health increases.
- Safety
- Technical properties
- The benefits of the pneumococcal conjugate vaccine are quantified by the decrease of disease caused by pneumococcus and Haemophilus influenzae -bacteria.
- The benefits are assessed in the entire Finnish population.
Answer
The tentative proposal is that the comparison is based on price and assessed benefits. Benefits are quantified as the expected decrease in invasive pneumococcal disease incidence due to vaccination. This tentative proposal is the basis for the conversation beginning in the summer of 2014.
Rationale
According to the public procurement law, comparison criteria related to differences in the products can be applied if (1) the differences are clearly demonstrated and (2) the differences can be quantified in terms of increased or decreased benefits. In particular, technical differences typically fall outside of this realm. So far no credible differences in safety among the currently licensed pneumococcal conjugate vaccines have been demonstrated.
To assess the health benefits of vaccination, the following items are taken into account:
- pneumococcal serotypes included in the vaccine
- decrease in pneumococcal disease incidence due to vaccination
- the structure of the so called carrier proteins included in the vaccine and the potential of the vaccine to protect against other than pneumococcal related diseases
- the potential ptotection of the vaccine against disease caused by the bacterium Haemophilus influenzae
The tentative assumption is that inclusion of a childhood pneumococcal conjugate vaccination (PCV10, PCV13) in the national immunization programme significantly reduces the disease incidence attributable to the serotypes included in the vaccine and that this protection extends to the population at large. This assumption may be modified s.t. a vaccination also reduces disease incidence caused by certain serotypes not included in the vaccine (cross protection). The predicted reduction in invasive pneumococcal disease due to vaccination is calculated using an epidemiological model.
The vaccine preventable pneumococcal disease incidence used in the model is assumed to correspond to
proven (blood culture-positive) invasive pneumococcal disease.
In view of recent knowledge (Palmu et al, 2014, in press) and
if deemed feasible, also estimates
of non-laboratory-confirmed IPD among children under 5 years of age can be included.
For other pneumococcal disease endpoints, reliable estimates of vaccine preventable disease incidences are not available.
See also
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