Formal economic evaluations (cost-effectiveness, cost-benefit, cost-utility) play a role in ACIP decision making. Published and unpublished economic

analyses relevant to vaccine recommendations are reviewed and presented routinely to the ACIP. ACIP also may use economic evaluations undertaken by international organizations or experts. All economic analyses must be peer-reviewed by a CDC health economist or other qualified economist before presentation to the ACIP to ensure that key methods are followed and if necessary to review underlying assumptions. Procedures for this process may be found on the ACIP website [9]. Economic analyses undertaken by the pharmaceutical industry can be used as well, subject to the same standards and procedures. The ACIP does not use a threshold value to determine selleck whether a vaccine is considered to be cost-effective. Cost-effectiveness is only one factor considered in the development Volasertib of immunization recommendations. Currently, although cost-effectiveness

and similar analyses are presented and discussed for the introduction of every new vaccine, there is no clear consensus on the weight that should be given to economic data. In practice, vaccine recommendations are made primarily on the basis of the burden of disease, vaccine effectiveness and safety. CDC and ACIP will take steps in the coming months and years to enhance ACIP’s ability to factor economic data into decision making. If no economic analyses relevant to the vaccine issues have been done, the ACIP may request that they be undertaken, either before or after issuing a recommendation. Currently it is held science by CDC and ACIP that economic analyses should be undertaken for all new vaccines being considered by the committee. In these times, economic analyses are routinely conducted for all new vaccines by any combination of CDC staff, academic researchers, and vaccine manufacturers. Following adoption of ACIP recommendations by CDC/HHS, decisions about sources of funds to pay for vaccine purchase

and administration are made at the level of other federal agencies, state health departments, and private insurers; ACIP has no direct role in vaccine financing. Implementation and evaluation of the impact of the recommendations is the responsibility of the relevant CDC program and not the ACIP. However, CDC programs develop an implementation and evaluation plan for each set of recommendations and periodically report information relevant to these activities to the ACIP. As mentioned earlier, most of the responsibility for implementation of ACIP recommendations lies with the state-level governments. Recommendations are subject to approval by the CDC Director and generally come to serve as standards of practice but do not serve as mandates that require vaccination of members of the civilian population.