Compare and contrast their memo with your own. What additional questions or issues would you include that they did not? Based on the analysis in their memo, would you recommend initiati

Michele Discussion:

Dear Leadership Team:  

As you may be aware, our local government is currently assessing the formation of a health effectiveness analysis program (HEAP) which includes childhood immunizations. This will require the evaluation of both the costs and health outcomes of childhood immunizations compared to other interventions. Before this program is implemented into the community, there are some questions that need to be addressed. These questions include do the costs outweigh the intended benefits, what are the total costs of implementing these immunizations within our community, are there alternatives to childhood immunizations which hold the same health benefits, how does this impact quality of life, and what resources will we have available to us to help carry out this initiative?  

When faced with budget constraints that hinder the implementation of multiple treatments to enhance population health, a cost-effectiveness analysis (CEA) provides a means to compare various treatment options, highlighting the existence of multiple approaches for conducting an economic evaluation (Henderson, 2018). In addition, the cost-benefit analysis (CBA) presents an alternative approach by evaluating the monetary benefits and costs associated with a treatment, enabling a comparison to determine the treatment with the highest net benefit (Henderson, 2018). Given the historical positive impact of immunizations on public health, it is crucial to employ the most suitable analysis method. While a cost-effectiveness analysis (CEA) is commonly favored as the economic evaluation method for a program of significant magnitude, there is an ongoing debate regarding its ability to fully capture the value of a public health program. As an alternative, proponents suggest considering a cost-benefit analysis (CBA) to provide a more comprehensive assessment (Park et al., 2018). Both of these analysis methods, whether it is a cost-effectiveness analysis (CEA) or a cost-benefit analysis (CBA), will offer us a more comprehensive understanding of the economic challenges associated with this program. This includes assessing the costs related to treating the illnesses that the immunizations aim to prevent, as well as the expenses linked to providing the immunizations themselves. According to an article by Gibson et al. (2016), when evaluating the cost-effectiveness of vaccines, it is essential to consider their unique characteristics. These characteristics encompass various aspects such as herd immunity, quality-of-life losses in young children, parental care and associated work loss, time preference, uncertainty, eradication, macroeconomics, and tiered pricing. These factors necessitate special considerations in the assessment of the cost-effectiveness of vaccines.  

The demand for immunizations is significantly impacted by parental opinions regarding the safety and efficacy of vaccines. Furthermore, factors such as declining provider reimbursement and rising immunization prices also play a crucial role in influencing the demand for immunizations (Muzumdar & Cline, 2009). If this program includes a focus on improving parental views and improving reimbursement and out-of-pocket costs, there should be an increase in demand. The issue of supply also greatly impacts the ability to meet demands, as an inability to maintain supply to meet demand will cause issues in the success of this program. Over the years, numerous factors have affected the supply of vaccines. These include challenges related to research and development, manufacturing complexities, distribution issues, safety concerns, and financing (Muzumdar & Cline, 2009). Each of these factors has played a role in shaping the availability and accessibility of vaccines over time. When parents receive current and comprehensive education about immunizations and develop an understanding of their long-term benefits, it can have a significant impact on consumer behavior. Parents will be well informed and aware that unvaccinated children can impose higher costs on both the community and organizations due to the potential for community outbreaks of diseases that vaccines are designed to protect against. These outbreaks not only pose health risks but also require additional resources and expenses to control and manage effectively. This increased awareness and knowledge often results in greater participation in childhood immunization programs.  

Reference  

Henderson, J. (2018). Health Economics and Policy (7th ed.). Boston, MA: Cengage 

Gibson, E., Begum, N., Sigmundsson, B., Sackeyfio, A., Hackett, J., & Rajaram, S. (2016). Economic evaluation of pediatric influenza immunization program compared with other pediatric immunization programs: A systematic review. Human Vaccines & Immunotherapeutics, 12(5), 1202–1216. https://doi.org/10.1080/21645515.2015.1131369 

Muzumdar, J. M., & Cline, R. R. (2009). Vaccine supply, demand, and policy: a primer. Journal of the American Pharmacists Association: JAPhA, 49(4), e87–e99. https://doi.org/10.1331/JAPhA.2009.09007  

Park, M., Jit, M., & Wu, J. T. (2018). Cost-benefit analysis of vaccination: a comparative analysis of eight approaches for valuing changes to mortality and morbidity risks. BMC Medicine, 16(1), 139. https://doi.org/10.1186/s12916-018-1130-7 

Ashley Discussion:

To Whom it May Concern:

Cost-benefit analysis (CBS) requires that health benefits and cost are measured in monetary terms.  A CBA is comprehensive and measuring benefits can be complex.  CBA benefits can be measured in pysical and cognitive health, productivity, treatment costs and life.  However, there are some questions that arise when making economic evaluations on childhood immunizations.

1.  How does this benefit children in the present and future?

According to Barnighausen et al., (2011) vaccines protect children's health and allows them to achieve full cognitive potential.  Children that are physically and cognitively healthy can attend school, miss school less due to illness and finish college.  There is an outcome related productivity gain because vaccinated children can grow up to be physically healthy and well-educated that permits to work and be productive members of society.  For instance, Haemophilus Influenzae type b (Hib) vaccine protects against a bacterial form of meningitis that can cause blindness, mental retardation, epilepsy, paralysis and deafness.  There is a relation between cognitive ability and educational achievements linked to labor productivity and income.  Recent studies show that 15 to 35% of Hib meningitis survivors have a permanent disability that can reduce cognition (Barighausen et al., 2011).  

2.  How does this affect the community?

Each state has its own vaccine requirements to enroll children in school.  However,there are vaccine requirements.  The vaccine exemptions are medical, philosophical or religious beliefs (NVIC, n.d.).  Parents with immunosuppressed children may be advised by the pediatrician to opt out of vaccinations if the risks outweigh the benefits.  Therefore, there are children attending school without being protected from certain diseases.  However,  children that are vaccinated can protect other unvaccinated children through herd effects.  Vaccinated children cannot contract the disease and transmit it to other children that are not vaccinated.  The  herd effect can help reduce the transmission of disease in the community )Barnighausen et al., 2011).

3.  What are the cost associated with disease?

Cost associated with the disease can be direct or indirect.  Direct costs include outbreak control, outpatient and inpatient visits for treatment of disease.  Indirect cost includes productivity losses from premature mortality (CDC, 2014).  According to the CDC (2015) before the introduction of the Hib vaccine about 20,000 children under the age of 5 contracted the Hib disease  yeary and about 3% – 6% children died.  After the introduction of the Hib vaccine, Hib disease decreased by 99%.  The costs associated with disease can have a financial burden on society.  In 2013, the cost per hospitalization from Sequeiae among meningitis cases was $4,111 for 2 days and 38,270 for 7 days that could have been prevented with the Hib vaccine (CDC, 2014).

Cost-benefit analysis can assist in measuring benefits in monetary terms and identify ways to distribute resources to maximize profit.  This intervention can impact demand and consumer behavior.  Parents that want to protect their children from Hib will vaccinate their children causing a higher demand for vaccines and medical personnel to administer them.  The demand for vaccine can result in competition in the market.  Health care providers can choose to purchase from private or public sector.  However, the ultimate decision is determined by the patient's insurance and what brand of vaccine it covers.

Please let me know your thoughts on this proposal.

All the best,

References

Barnighausen, T., Bloom, D., Canning, D., Friedman, A., Levine, O.S., O'Brein, J., …Privor-Dumm, L. (2011).  Rethinking 

          the Benefits and Costs of Childhood Vaccinations: The Example of the Hemophilus Influenzae Type B Vaccine.

          Retrieved from

           https://www.who.nt/immunization/disease/hib/Macroeconomic_evaluation_Hib_vaccines.pdf

Centers for Disease Control and Prevention (CDC).  (2014).  Decision Analysis Model.  Retrieved from

           www.cdc.gov/vaccines/programs/vfc/pubs/methods/index.html.

Centers for Disease Control and Prevention (CDC).  (2015).  VFC Publications: Supplement.  Retrieved from

           https://www.cdc.gov/vaccines/programs/vfc/pubs/methods/index.html

National Vaccine Information Center (NVIC).  (n.d.).  State Law & Vaccine Requirements.  Retrieved from

          https://www.nvic.org/vaccine-laws/state-vaccine-requirements.aspx

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2

MEMORANDUM

To: [Organization's Leadership] From: [Your Name] Date: [Current Date] Subject: Health Effectiveness Analysis Program (HEAP): Economic Evaluations of Childhood Immunizations

I am penning this correspondence to furnish you with a comprehensive outline of the prospective difficulties and inquiries that may ensue during the execution of economic appraisals, encompassing cost-benefit or cost-effectiveness analyses, of healthcare interventions, with a particular emphasis on immunizations administered during the early stages of human development. As the municipal administration contemplates the implementation of a Health Effectiveness Analysis Program (HEAP), it behoves our organization to acquire a comprehensive understanding of the prospective obstacles and ramifications associated with such assessments.

A comparative examination of the merits and drawbacks of Cost-Benefit Analysis (CBA) and Cost-Effectiveness Analysis (CEA) is warranted. These analytical frameworks, frequently employed in decision-making processes, offer distinct perspectives on evaluating the efficiency and efficacy of various interventions or policies. One of the foremost difficulties in economic evaluation pertains to whether to undertake a meticulous cost-benefit analysis (CBA) or a comprehensive cost-effectiveness analysis (CEA) when appraising the domain of childhood immunizations (Kyeremanteng et al., 2019). Cost-benefit analysis (CBA) is a method that quantifies both the costs and benefits of a given endeavour in monetary units, facilitating a straightforward comparison. Conversely, cost-effectiveness analysis (CEA) evaluates costs in monetary terms and benefits in non-monetary units, such as lives preserved or instances averted. Engaging in a comprehensive discourse regarding the most suitable methodology for evaluating the economic ramifications of immunization initiatives becomes imperative, as it necessitates a thorough examination of various factors, including enduring advantages, indirect consequences, and external influences (Kyeremanteng et al., 2019).

The task of precisely gauging the expenses and advantages linked to childhood immunizations poses a formidable challenge. Regarding the financial aspect, it is imperative to consider various factors. These factors encompass the direct expenses associated with medical procedures, namely the production, administration, and monitoring of vaccines (Teisberg et al., 2020). Additionally, indirect costs must be considered, encompassing caregiver time and transportation expenditure. Furthermore, one must not overlook the opportunity costs incurred due to allocating time towards immunization rather than engaging in alternative activities. When contemplating the advantages, one must consider various factors, such as the potential diminishment of healthcare expenditures resulting from the prevention of ailments, the augmentation of productivity, and the enhancement of one's overall quality of life (Teisberg et al., 2020). It is imperative to ascertain a comprehensive and precise compilation of data to facilitate a rigorous economic assessment.

Considering time horizon and discounting is a pivotal facet when discerning the suitable duration for assessing the economic ramifications of childhood immunizations. Certain advantages, such as the mitigation of illnesses and the curtailment of healthcare expenditures, may materialize over an extended period, requiring a more protracted temporal perspective (Holtz, 2013). Furthermore, the notion of discounting emerges when assessing forthcoming expenditures and gains. The concept of discounting considers the temporal aspect of monetary value and assigns greater significance to immediate costs and benefits in contrast to those that may arise in the future. The discount rate selection holds substantial sway over the outcomes of economic evaluations, thus necessitating the careful consideration of an appropriate rate in collaboration with pertinent experts.

Impact on Demand and Consumer Behaviour: Implementing a childhood immunization program via the Health and Education Assistance Program (HEAP) is anticipated to exert a significant influence on demand dynamics and consumer behaviour over an extended period. Immunizations can potentially improve health in many ways, especially by helping promote health and prevent diseases (Holtz, 2013). This could reduce the need for expensive medical care. This phenomenon may yield fiscal benefits for the government and citizens, potentially resulting in reduced healthcare premiums or tax burdens. Furthermore, as societal consciousness regarding the economic advantages and the favourable influence on personal and communal well-being deepens, it is foreseeable that the request for immunizations will experience a surge (Teisberg et al., 2020). The heightened demand in question has the potential to facilitate a more optimal distribution of resources and the realization of economies of scale, thereby resulting in a further reduction of expenses linked to immunization initiatives.

In summation, the economic assessments of health interventions, specifically those concerning childhood immunizations, encompass many pivotal factors that necessitate careful examination. We can do thorough evaluations that help us make better decisions by carefully comparing the different cost-benefit and cost-effectiveness analysis methods, accurately estimating costs and benefits, and determining the right timeframes and discounting rates (Kyeremanteng et al., 2019). Also, implementing a childhood immunization program through HEAP can have positive and long-lasting effects on demand dynamics and consumer behaviour, leading to better health outcomes and possible financial benefits for both the state and its people.

Should you need additional information or any further inquiries arise, I implore you not to hesitate to reach out to me.

I express my gratitude for your kind acknowledgment.

Thank you.

Sincerely,

[Your Name] [Your Position] [Your Organization]

References

Holtz, C. (Ed.). (2013).  Global health care: Issues and policies. Jones & Bartlett Publishers.

Kyeremanteng, K., Robidoux, R., D’Egidio, G., Fernando, S. M., & Neilipovitz, D. (2019). An analysis of pay-for-performance schemes and their potential impacts on health systems and outcomes for patients.  Critical Care Research and Practice,  2019.

Teisberg, E., Wallace, S., & O’Hara, S. (2020). Defining and implementing value-based health care: a strategic framework.  Academic Medicine,  95(5), 682.

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