Vaccines also have provided immunity against infectious diseases such as measles, diphtheria, whooping cough, tetanus, rubella, maps, pneumoccal pneumonia, hepatitis B and rabies.

Analgesics

Aspirin-introduced just after the turn of the century was the first safe and effective non-narcotic analgesic, but its potency was limited. Although analgesics do not cure or appreciably alter the course of a disease, they can relieve pain and bring a sense of well-being in the presence of disease. The first non-opiate drug to match the opium alkaloids in analgesic potency was meperidine, synthesized in 1939. Some of the recently-discovered non-steroidal anti-inflammatory drugs also have excellent analgesic properties.

Cardiovascular Drugs

During the last 25 years, new medicines helped produce a substantial reduction in the death rate for what had become the leading killer in the United States and throughout the industrialized world-cardiovascular disease. In just the last 10 years, deaths from strokes declined by 43 percent, while deaths from heart attacks decreased by 25 percent. New medicines, including the thiazide class of diuretic hypotensives, beta blockers and calcium antagonists, were partly responsible for the improvement.

Anti-Cancer Drugs

Medicines also have become increasingly effective in treating the disease Americans fear the most-cancer. The first anti-cancer drugs, the nitrogen mustards, were introduced in 1942. Since that time, more than 50 other anti-cancer drugs have been developed. In late 1983, the National Cancer Institute reported that more than 50 percent of all cancer patients are surviving for at least five years--up from 33 percent in the mid 1950s--and that most of this group are cured of the disease.

Medicines have helped treat a wide range of other diseases-including mental illnesses, epilepsy, diabetes, glaucoma and Parkinson's disease--and, in all, have helped prolong and greatly improve the quality of life for millions of people throughout the world.

REVIEW OF LITERATURE ON COST-EFFECTIVENESS OF VACCINES

(Reports 2 and 3)

Reviews of the literature on vaccines and vaccination programs both in developed and developing countries result in the same conclusion: their benefits generally exceed their costs, despite differences in evaluative approaches and in the data used.

Vaccines in Developed Countries

In Report 2, Burton A. Weisbrod and John H. Huston of the University of Wisconsin reviewed cost-effectiveness studies of 10 vaccines and vaccination programs in developed countries. The results of their review follow.

Measles: All seven studies of measles vaccine showed that its benefits far exceeded its costs. The unanimity of results was found even though the studies were conducted over many years-from 1963 to 1975-and in many regions of several countries-Austria, Finland and the United States. Of the two studies reporting results that can be expressed in benefit-cost ratios, one found that benefits were more than 10 times costs over a nine-year period (a benefit-cost ratio of 10.4:1), the other that benefits were almost five times costs over a six-year period (a benefit-cost ratio of 4.9:1). And in another study, benefits were shown to exceed costs by $1.3 billion from 1963 to 1972.

Mumps: Four evaluations of mumps vaccine found benefit-cost ratios ranging from 3.6:1 to 7.4:1 as well as significant net benefits. One study, for example, calculated a net benefit of $5 million for each cohort of 1 million children, while another found a net benefit of about $50 per immunization.

Rubella: Three studies found that benefits greatly exceeded costs when rubella vaccine was routinely given to children. For females from 2 to 12 years old, benefits ranged from eight to 27 times costs (that is, benefit-cost ratios ranged from 8:1 to 27:1).

Pneumococcal Pneumonia: Four studies of pneumococcal vaccine concluded that benefits exceeded costs for persons in high-risk groups, such as the elderly and chronically ill. This conclusion was reached even though no attempt was made to include the value of lives saved by the vaccine. The benefits from immunizing low-risk groups were less

clear.

Pertussis:

There is only one evaluation of pertussis vaccine, and

it found that benefits exceeded costs by more than 150 percent.

The vaccine is given as part of the DPT (diphtheria, pertussis and tetanus) trivalent vaccine, so the costs of patient and physician time for administering the vaccine are minimal. The major costs arise from the infrequent side effects of the vaccine, which can include convulsions and encephalitis.

Adenovirus: A study of military recruits found that the benefits of adenovirus vaccine exceeded costs by 1.56:1.

One

Tuberculosis: The results of the studies of the BCG (bacille Calmette Guerin) vaccination for tuberculosis are contradictory. study, using Austrian data, found that the benefits of the vaccine substantially exceeded costs regardless of the age of those vaccinated. Another study, using British data, found that costs exceeded benefits using a wide range of vaccine costs and many methods of treating tuberculosis. More than anything, the different findings of the two studies probably reflect disparities in methodology.

Polio: Two studies of polio vaccine found it cost-beneficial by a ratio as great as 10:1, with net benefits estimated to be about $1 billion a year in the United States. As with most vaccine studies (and, in fact, all evaluations of medical technology), however, the social benefits were understated because the better health of people for whom the disease was prevented was not taken into account. This is especially significant in the case of polio because of the crippling effects of the disease and the youth of its victims.

Influenza:

The evaluations of flu vaccine have focused on the benefits and costs of vaccinating people in various age groups. That is because the consequences of contracting influenza appear to be related to age and to a person's health immediately before infection.