3.3.4. Health and Non-Health Benefits of Vaccination Programs

Outcomes captured in these studies were chosen according to the health and nonhealth benefits of a particular vaccine to demonstrate the distributional impact of vaccination programs across equity-relevant subpopulations. The health benefits of vaccines included the prevention of deaths [6–9,11,13,23,27–35], cases [12,24,26,31,32], hospitalizations and outpatient/clinic visits [10,34], disability-adjusted life years (DALYs) [23,27–30,34], the gain in years of life saved [26], quality-adjusted life years (QALYs) [25,31,32], and health-adjusted life years (HALYs) [33].

Non-health benefits of vaccines, captured specifically in extended cost-effectiveness analyses, were quantified as financial risk protection in terms of household out-of-pocket (OOP) expenditures averted [6–13], catastrophic health expenditures (CHE) averted [6,10,12], the money-metric value of insurance [8,13], and impoverishment averted [10,35]. The definitions and components of financial risk protection differed across studies. For example, CHE was defined differently across three studies. CHE was defined as a proportion of disease-related expenditure exceeding a specific threshold of household income or expenditures, including 10% of monthly household income [10], 40% of total household consumption expenditures [12], and 10% of total household consumption expenditures or 40% of non-food total household consumption [6]. Impoverishment was defined as household income falling below the World Bank poverty line [35] or country-specific poverty line due to medical expenditures [10]. The money-metric value of insurance or risk premium was defined as the difference between the expected value of the individual's income and the income the individual is willing to have in order to have an outcome that is certain [8,13].
