Abstract
Background
A large number of economic evaluations have already confirmed the cost-effectiveness
of different human papillomavirus (HPV) vaccination strategies. Standard analyses
might not capture the full economic value of novel vaccination programs because the
cost-effectiveness paradigm fails to take into account the value of active management.
Management decisions can be seen as real options, a term used to refer to the application
of option pricing theory to the valuation of investments in nonfinancial assets in
which much of the value is attributable to flexibility and learning over time.
Objective
The aim of this article was to discuss the potential advantages shown by using the
payoff method in the valuation of the cost-effectiveness of competing HPV immunization
programs.
Methods
This was the first study, to the best of our knowledge, to use the payoff method to
determine the real option values of 4 different HPV vaccination strategies targeting
female subjects aged 12, 15, 18, and 25 years. The payoff method derives the real
option value from the triangular payoff distribution of the project's net present
value, which is treated as a triangular fuzzy number. To inform the real option model,
cost-effectiveness data were derived from an empirically calibrated Bayesian model
designed to assess the cost-effectiveness of a multicohort HPV vaccination strategy
in the context of the current cervical cancer screening program in Italy. A net health
benefit approach was used to calculate the expected fuzzy net present value for each
of the 4 vaccination strategies evaluated.
Results
Costs per quality-adjusted life-year gained seemed to be related to the number of
cohorts targeted: a single cohort of girls aged 12 years (€10,955 [95% CI, –1,021
to 28,212]) revealed the lowest cost among the 4 alternative strategies evaluated.
The real option valuation challenged the cost-effectiveness dominance of a single
cohort of 12-year-old girls. The simultaneous vaccination of 2 cohorts of girls aged
12 and 15 years yielded a real option value (€17,723) equivalent to that attributed
to a single cohort of 12-year-old girls (€17,460).
Conclusions
The payoff method showed distinctive advantages in the valuation of the cost-effectiveness
of competing health care interventions, essentially determined by the replacement
of the nonfuzzy numbers that are commonly used in cost-effectiveness analysis models,
with fuzzy numbers as an input to inform the real option pricing method. The real
option approach to value uncertainty makes policy making in health care an evolutionary
process and creates a new “space” for decision-making choices.
Keywords
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Article info
Publication history
Published online: June 26, 2013
Accepted:
May 8,
2013
Identification
Copyright
© 2013 Elsevier HS Journals, Inc. Published by Elsevier Inc. All rights reserved.
