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Appendix D Overview of Commissioned Papers The IOM committee commissioned eight background papers as part of the collection of evidence to support this study. The commissioned pa- pers are briefly described below. 1. Trends In Vaccine Prices, 1992-2002. Provides a quantitative analy- sis of vaccine trends using two different data sources, and analyzes the impact of market structure variables on these trends. Frank Lichtenberg, Graduate School of Business, Columbia Univer- sity 2. An Overview of the Market for Vaccines in the United States. Presents a comprehensive industrial organization analysis of the market for vaccines in the United States, with a focus on production and licensing processes and the mixed public-private market for vaccines. Richard Arnould and Larry DeBrock, Department of Economics, University of Illinois at Urbana-Champaign 3. How Insurance Companies and Health Plans Are Planningfor New Vac- cines. Through interviews with health plans and state officials, considers how private and public insurance plans make decisions about insurance benefits for vaccine products and provider fees, with a focus on future strategies in light of rising vaccine costs. Kathy Swartz, School of Public Health, Harvard University 241

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242 FINANCING VACCINES IN THE 21ST CENTURY 4. Vaccine Purchase and Distribution: Proposed Changes in Vaccine Supply and Delivery Policies. Based on a series of interviews with key policy mak- ers, reviews proposals made by industry, government, medical profes- sional organizations, and other stakeholders to fix the current system through a wide range of proposed reforms. Gerry Fairbrother and Arfana Haidery, New York Academy of Medi- cine 5. Setting Prices for New Vaccines (in Advance). Presents an economic model for calculating a price for future vaccines in advance as a way to stimulate investment in vaccine development and determine an accept- able price in the absence of a functioning market. Thomas McGuire, Department of Health Care Policy, Harvard Medi- cal School 6. Vaccine Policy Perspectives: Market Strategies. Considers a wide array of strategic options for improving the financing of vaccines through mar- ket-based approaches such as price incentives, a voucher system to dis- tribute vaccines, and reduced barriers to global competition in the United States. Joel Hay and Danielle Zammit, Department of Economics, University of Southern California 7. Estimating the Need for Publicly Purchased Vaccine for Adults and Chil- dren. Provides estimates of the numbers and characteristics of child and adult populations that require assistance in purchasing vaccines and a description of how such assistance is currently received through state and federal public health and private health care systems. David Wood, Delmarva Foundation 8. Diphtheria, Tetanus, and Acellular Pertussis Vaccine (DTaP): A Case Study. Presents a case study analysis of the DTaP vaccine illustrating the changes in the vaccine market over time; based on structured interviews with regulators, industry executives, and providers. Amy Fine, Consultant, Washington, DC