Combination vaccines combine several components in a single dose administration. They offer programmatic and public health advantages, particularly as vaccine schedules become increasingly crowded. They are often more expensive to develop and produce, which discourages manufacturer investment without clear market signals. Hence their benefits need to be captured with existing health economic evaluation reference cases used by decision-makers to guide vaccine investments. We propose that the value of combination vaccines can be captured through at least four domains: (i) reductions in tangible and intangible costs to caregivers; (ii) operational efficiencies to the health system; (iii) opportunity costs of vaccine schedule slots; and (iv) more streamlined vaccine schedules. We demonstrate the practicality of our framework by comparing the value of introducing a hypothetical vaccine to a crowded schedule as a standalone formulation, a replacement for a vaccine already in the schedule, or a combination product. The framework could also be applied to estimate the value of reducing the number of separate administrations needed for a standalone vaccine. Applying it in real-world situations could be facilitated by further data collection, particularly on collating results on the value of existing vaccines in the schedule, and estimating willingness-to-pay for fewer vaccine administrations.

This work was supported by the Gates Foundation. CG works for the Gates Foundation who funded this work. Apart from his involvement, the funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

This work was supported by grants INV-086830 (MJ, AP) and INV-074429 (CP, WPH) from the Gates Foundation.

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