This book examines vaccines in the widest sense, including prophylactic for infectious diseases and therapeutic vaccines for conditions for which no infectious aetiology has been demonstrated, e.g. diabetes, rheumatoid arthritis (RA), multiple sclerosis (MS) and melanoma.

The introductory chapters cover some of the background to economic evaluations, including quality adjusted life years (QALYs) and analytical modelling, which are then demonstrated using a hypothetical vaccine. The ethical considerations, which have become more complex, are well reviewed.

The organism-specific analyses are presented as appendices and each is considered in terms that will allow priority setting for development and implementation. The economic burden of each disease is considered along with morbidity and mortality. For each vaccine the target populations and costs of delivery are considered against the likely benefits of disease prevention using well considered 'disease scenarios'.

I found one of the most interesting areas was the review of the first report by this group, produced in 1985. The priorities which would save money (treating those with disease), and give significant outcomes in terms of QALYs, were for CMV vaccine, influenza vaccine used on the general population, and therapeutic vaccines for diabetes, MS and RA, and group B streptococcus and streptococcus pneumoniae vaccines. All other vaccines would cost money for each QALY gained. Many of the developments prioritized in 1985 have come into regular use; others are still undergoing clinical trials. It would have been interesting to have an analysis of the economics of the development of an HIV vaccine, but although HIV was referred to as a confounding factor in many other infections it was not includied in the appendices.

This book should be compulsory reading for all who are involved in decision making both at the development and implementation stages.