First a note: I am fully in support of vaccines in general and have kept both my children up to date. The MMR and autism scares make me furious.
That said, I think we can all agree that not all vaccines are appropriate for all populations all the time. Some vaccines are more dangerous than others and it would be ridiculous to give a vaccine with a 1 in 1000 risk of serious reaction for a disease that has a 1 in 10000 risk serious harm. Targeting vaccines to specific at risk populations is also done, but this is currently done only considering medical risk/benefit.
But as medical science advances, the cheaper vaccines with high impacts are already done. Newer vaccines are becoming more expensive and address lower risk afflictions. This has lead the group that advises on vaccines in the U.S. to begin to debate considering cost in its recommendations (which affect which vaccines are paid for by government programs). Consider the newly introduced meningitis booster shot:
That would mean a cost of over $16 million per life saved. And that does not include the cost borne by those paying into the insurance system.
I think that no one would argue with $100 per life saved is completely justified. And we could also, I think agree that $1 trillion dollars per life is not feasible. But where should the limit be put?
Just to be pedantic, while the figure might be $16 million per life saved, it’s not just a matter of living or dying. You can survive meningitis and suffer life long physical problems - brain damage, hearing damage, etc. The benefit of preventing the disease for one healthy adult is potentially huge.
Imagine the difference between a healthy adult and somebody who needs to be taught to deal with hearing loss? Or somebody who requires at least some level of moderate medicare care for the rest of their life? Is it worth the money if several hundred or thousand people don’t suffer life long physical impairment?
I’m not sure how to calculate the benefit for fractions of a life, but the cost of the vaccine is almost surely less than $16 million per life affected.
And that’s the hardest part about any of these calculations. Nobody actually has a good way of measuring the actual bottom line impact.
Just my $0.02, but it’s a worthwhile debate. We can talk about death panels and rationed care all day, but we already ration care based on cost and some treatments can end up costing lives. There can be expensive treatments for the few that take resources away from less expensive treatments for the many. Where to draw the line? I’m not sure, but it seems like the UK and other countries with single payer type systems provide at least a good starting point for the debate.
Not just vaccines, but lots of healthcare needs to be evaluated. But we also need to decide what counts towards the benefits side of the equation. Treatment divided by lives saved doesn’t tell the whole story.
I knew a young woman who got meningitis while in college. After a long hospital stay, she ended up wheelchair bound, unable to live on her own. About 7 years later, she died, not attributed to meningitis, but definately weakened by it. I’m sure that in those 7+ years, her medical care totalled up to multiple hundreds of thousands of dollars.
I’m going to assume (probably making an ass out of me) that if the linked article talks about 23 lives saved / year (about 1/5 of the number of US deaths that I found) due to government paid vaccination, then about 1/5 of the cases in the US are in people that would be covered by the US governemt.
So what if the medical care savings / case avoided was $100k-$200k? Does it make sense to spend $387 million, if 300 people don’t get ill. That’s probably closer to the total cost/infected person value.
Yup, $387 million divided by 23 lives saved is $16 million. Except that, as you say, that’s for only ~1/5 of the US populace who dies from this, as per your earlier inks. So, really, it’s $16 million / 5, or about $3.2 million per life saved.
And, as others have pointed out, there are a lot more effects than just death. Your ink said only about 10% of those afflicted die, so we could potentially be saving 10x a many people – that’s only 0.32 million, or $320,000 per case prevented.*
Going by Zephyur’s reported metric, that seems well worth it.
*These calculations assume that the vaccine is 100% effective. I’m aware that’s unlikely. Even if it’s only 90% effective, that means it’s about $3.52 million per life saved, or $352,000 per case prevented.
The basic question is a good one. Yes, we should be concerned about cost and cost effectiveness should be part of the decision process before a vaccine is advised. And the numbers get crunched, but often policy makers decide that it is not them to decide if the money is worth it, just if it would work.
Here is a power point from the CDC site that summarized some discussion about meningococcal vaccination with information on other vaccine cost effectiveness thrown in. Note the meaningful metric is generally not number of lives saves, but “life-years” or even more so “quality adjusted life-years” (QALY) - saving a life at age 18 saves more years of life than saving one at 80 and a poor quality of life year is worth less than one with good health.
For the current two shot meningococcal vaccine series the estimate is that it will cost $157K/QALY.
Here is a review that puts it into some context. HepA cost savings to society. HepB $9K/QALY. Influenza $119/QALY gained for 12- to 17-year-olds who were not at high risk (not factoring in the secondary benefits to higher risk populations from avoiding exposure, which is where the benefit actually accrue; universal influenza vaccine expected to come in at only $15.9K/QALY over targeted vaccination) and $10K targeting high risks only. HPV vaccination of females at age 12 $15 to 24/QALY. Of males the value varies according to the female vaccination rate. Under conditions of high vaccination of females little additional benefit but under lower vaccination rates more cost effective. That study quotes $88K/QALY for a catch up meningococcal vaccine program. The standard childhood vaccines all pretty much cost savings, some dramatically so. How they put the broad discussion:
In other areas, administrations use a “bureaucratic” estimate of the value of a life saved. For instance, for major safety works on roads or such things. I don’t remember the figure at all (and besides, it probably changes somewhat from one country to another) but it’s significantly lower than the 16 millions you mentioned (could be 1 million, $ 5 millions, something in this range).
But it’s true that when it comes to medical expenses this concept isn’t generally applied, as far as I can tell (or else some major surgeries, and probably even some life-long drug treatments would never be proposed).