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New Vaccine Development: Establishing Priorities, Volume II, Diseases of Importance in Developing Countries
Estimating Aggregate Direct Costs of Diseases in the Developing World
The committee did not attempt to predict the cost associated with treating diseases included in this analysis. It would be extremely difficult and probably unrealistic to estimate, for the developing world as a whole, the proportion of cases, complications, and sequelae that receive treatment; the nature of those treatments; and their average costs. No data exist on these questions, and the committee judged that convening a group sufficiently large to develop reliable estimates of these costs would not be practical.
Estimating Costs for Diseases in Specific Countries or Regions
Although it was not feasible to include disease cost comparisons in this analysis, it might be possible to compare the costs of treating various diseases in a particular region or country in the developing world. The procedures used by the committee to estimate the direct costs (mostly treatment-related) associated with important diseases in the United States can be adopted for this purpose. Those procedures are described fully in the first volume of the committee’s report (Institute of Medicine, 1985). Excluded from those calculations are costs resulting from loss of work, loss of future earnings, and public health measures to prevent further spread of illness (e.g., contact tracing for sexually transmitted diseases).
How best to calculate indirect costs associated with disease, such as loss of work time or loss of future earnings, is quite controversial. For its analysis of vaccine priorities for the United States, the committee did not believe that monetization of health benefits was either necessary or appropriate. Reduction of the overall economic burden imposed by certain diseases is definitely an important health goal; however, if these indirect economic aspects of disease burden were included among the costs, then interpretation of the disease burden figures would have to be modified to ensure that health benefits were not double counted (because IMB and trade-off values already incorporate some psycho-social considerations). In contrast, costs associated with contact tracing, quarantine, etc., are not currently reflected in the disease burden figures; these could be addressed in future applications of the model. These considerations are also pertinent to the assessment described in this report.
Application of the procedures described above to derive burden estimates for the diseases that are candidates for accelerated vaccine