MSD (Switzerland)

Background Human papillomavirus (HPV) is associated with a range of cancers that pose a considerable public health burden, considerable medical costs, and productivity losses. This study aims to assess the societal and fiscal gains from increasing vaccine coverage rates (VCRs) to 90% by 2030 for both sexes and all eligible age groups (higher VCR scenario) compared to present coverage rates in Switzerland. Methods A previously published dynamic transmission model was used to project gains from higher VCRs of the nonavalent vaccine compared to current coverage trends on vaccine-preventable HPV-related mortality, morbidity, and direct costs. Prevented deaths and morbidity, from cancers and genital warts were converted into averted loss of productive output and tax revenue, avoided disability and healthcare costs savings. Using evidence from the literature on the impact of HPV-related diseases on absenteeism, employment and disability rates, the averted economic burden was estimated and was compared with vaccination costs to assess the benefit-cost ratio (BCR) of higher VCRs. Economic effects were discounted at 3%, and the analytic time horizon was 100 years. Results Compared to current coverage rates, the higher VCR scenario results in healthcare cost savings of CHF834 million. Moreover, higher VCR scenarios likely generate societal gains of CHF218 million and CHF181 million from averted deaths and prevented morbidity, respectively. Averted absenteeism is expected to increase productive output by CHF147 million. Fiscally, the higher VCR scenario generates CHF100 million in tax revenue and CHF85 million in averted disability costs. Considering the incremental costs of vaccination, the resulting societal and fiscal BCRs are 1.5 and 1.2, respectively. Conclusion Attaining the 90% VCR targets by 2030 is projected to generate favorable economic returns for the Swiss government. Specifically, over the lifetime of the vaccinated cohorts, a CHF1 investment is estimated to yield societal and fiscal returns of CHF1.5 and 1.2, respectively.

Background Triple Negative Breast Cancer (TNBC) is an aggressive subtype of breast cancer that can impact patients’ employment and workforce participation. This study estimates how the employment effects of TNBC impact government tax revenue and public benefits expenditure in Switzerland, representing the fiscal burden of disease (FBoD), and likely consequences of introducing new treatment options. Methods A four-state cohort model was used to calculate fiscal effects for two treatments: Neoadjuvant pembrolizumab plus chemotherapy followed by adjuvant pembrolizumab monotherapy (P + C→P) and neoadjuvant chemotherapy alone (C). Lifetime present values of tax revenue, social benefit payments, and healthcare costs were calculated for the average population and those undergoing treatment to assess the FBoD. Results An average TNBC patient treated with C and P + C→P is expected to generate CHF128,999 and CHF97,008 less tax than the average population, respectively, and require increased social benefit payments. Compared to C, 75% of the incremental healthcare costs of P + C→P are estimated to be offset through tax revenue gains. Conclusions This analysis demonstrates that 75% of the additional costs of a new TNBC treatment option can be offset by gains in tax revenue. Fiscal analysis can be a useful tool to complement existing methods for evaluating new treatments.

Operationalization guidance is needed to support health technology assessment (HTA) bodies considering implementing lifecycle HTA (LC-HTA) approaches. The 2022 Health Technology Assessment International (HTAi) Global Policy Forum (GPF) established a Task Force to develop a position paper on LC-HTA. In its first paper, the Task Force established a definition and framework for LC-HTA in order to tailor it to specific decision problems. This second paper focused on the provision of practical operational guidance to implement LC-HTA. Detailed descriptions of the three LC-HTA operational steps are provided (defining the decision problem, sequencing of HTA activities, and developing optimization criteria) and accompanied by worked examples and an operationalization checklist with 20 different questions for HTA bodies to consider when developing an LC-HTA approach. The questions were designed to be applicable across different types of HTA and scenarios, and require adaptation to local jurisdictions, remits, and context.