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New Vaccine Development: Establishing Priorities: Volume II, Diseases of Importance in Developing Countries (1986)
Board on Population Health and Public Health Practice (BPH)

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. "2. Priority Setting for Health-Related Investments: A Review of Methods." New Vaccine Development: Establishing Priorities: Volume II, Diseases of Importance in Developing Countries. Washington, DC: The National Academies Press, 1986.

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New Vaccine Development: Establishing Priorities, Volume II, Diseases of Importance in Developing Countries

The fifth step—the ranking itself—is left to the judgment of the decision makers or panels and is not an inherent part of the methodology. The only constraint imposed by the methodology is that dominance between pairs be preserved in the final rankings. The rest is left to intuitive judgment, which may be viewed either as an advantage or a limitation of the method.

MULTIATTRIBUTE SCORING

The method of multiattribute scoring goes beyond multiattribute accounting by generating a composite score for each candidate project. This requires three additional steps: (1) entry of a quantitative score (xij) in each cell in the matrix corresponding to the jth criterion (objective) and the ith project (vaccine candidate); (2) specifying a set of weights, wj, by which the individual factor scores will be combined; and (3) computing the weighted scores (si),

Projects are ranked according to these scores. As an intermediate step, scores for groups of criteria are often combined into subscores (e.g., a “disease impact” subscore composed of the first three criteria in Table 2.1), and then the subscores are combined. Also, the individual scores are often “normalized” to a 0–100 scale before weighting for computational convenience. Sometimes, multiplicative rather than additive aggregation rules are used.

A hypothetical example of the process of multiattribute scoring is shown in Table 2.2. The end result is that vaccine candidate A is ranked highest, followed by vaccines B, D, and C. If desired, a sensitivity analysis can be performed in which the weights are varied to see whether the rankings change. If only one of the four vaccine candidates in Table 2.2 could be developed, a sensitivity analysis would be desirable because the scores of A and B are so close. However, if two vaccines could be developed, vaccines A and B probably would come out on top for most plausible sets of weights.

Multiattribute scoring and decision analysis with multiple objectives (see below) may incorporate implicit (subjective) judgments about expected outcomes. The committee believes that every effort should be made to use available data in an explicit fashion and to clearly identify and define areas in which personal values may influence the choices.

DECISION ANALYSIS WITH MULTIPLE OBJECTIVES

One obvious limitation of the multiattribute scoring method just described is that the weights are arbitrary. This is especially disconcerting, considering that one is adding such disparate items as likelihood of success and disease mortality.

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Front Matter (R1-R16)
1. Summary (1-18)
2. Priority Setting for Health-Related Investments: A Review of Methods (19-29)
3. Overview of the Analytic Approach (30-43)
4. Comparison of Disease Burdens (44-62)
5. Predictions of Vaccine Development (63-75)
6. Assessing the Likely Utilization of New Vaccines (76-81)
7. Calculation and Comparison of the Health Benefits and Differential Costs Associated with Candidate Vaccines (82-105)
8. Additional Issues in the Selection of Priorities for Accelerated Vaccine Development (106-120)
9. Findings, Conclusions, and Recommendations (121-142)
Appendix A: Selection of Vaccine Candidates for Accelerated Development (143-148)
Appendix B: The Burden of Disease Resulting from Acute Respiratory Illness (149-158)
Appendix C: The Burden of Disease Resulting from Diarrhea (159-169)
Appendix D-1: The Prospects for Immunizing Against Dengue Virus (170-177)
Appendix D-2: The Prospects for Immunizing Against Escherichia coli (178-185)
Appendix D-3: The Prospects for Immunizing Against Hemophilus influenzae Type b (186-196)
Appendix D-4: The Prospects for Immunizing Against Hepatitis A Virus (197-207)
Appendix D-5: The Prospects for Immunizing Against Hepatitis B Virus (208-222)
Appendix D-6: The Prospects for Immunizing Against Japanese Encephalitis Virus (223-240)
Appendix D-7: The Prospects for Immunizing Against Mycobacterium leprae (241-250)
Appendix D-8: The Prospects for Immunizing Against Neisseria meningitidis (251-266)
Appendix D-9: The Prospects for Immunizing Against Parainfluenza Viruses (267-274)
Appendix D-10: The Prospects for Immunizing Against Plasmodium spp. (275-286)
Appendix D-11: The Prospects for Immunizing Against Rabies Virus (287-298)
Appendix D-12: The Prospects for Immunizing Against Respiratory Syncytial Virus (299-307)
Appendix D-13: The Prospects for Immunizing Against Rotavirus (308-318)
Appendix D-14: The Prospects for Immunizing Against Salmonella typhi (319-328)
Appendix D-15: The Prospects for Immunizing Against Shigella spp. (329-337)
Appendix D-16: The Prospects for Immunizing Against Streptococcus Group A (338-356)
Appendix D-17: The Prospects for Immunizing Against Streptococcus pneumoniae (357-375)
Appendix D-18: The Prospects for Immunizing Against Vibrio cholerae (376-389)
Appendix D-19: The Prospects for Immunizing Against Yellow Fever (390-402)
Appendix E: Questionnaire for Assessing Morbidity-Mortality Trade-Offs (403-411)
Appendix F: Technical Notes (412-412)
Appendix G: Biographical Notes on Committee Members (413-417)
Appendix H: Additional Sources of Advice to the Committee (418-419)
Appendix I: Contents of Supplement to Volume II (420-420)
Appendix J: Preface to Volume I (421-422)
Appendix K: Contents to Volume I (423-423)
Index (424-432)