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Home > Standards & Guidances > Methodological Guide

ENCePP Guide on Methodological Standards in Pharmacoepidemiology

 

 

9.2.2.8. Impact assessment

A generic study protocol to assess the impact of rotavirus vaccination in EU Member States has been published by the ECDC. It recommends the information that needs to be collected to compare the incidence/proportion of rotavirus cases in the period before the introduction of the vaccine to the incidence/proportion of rotavirus cases in the period following the introduction of the vaccine. These generic protocols need to be adapted to each country/regions and specific situation.

 

The impact of vaccination can be quantified in children in the age group targeted for the vaccine (overall effect) or in children of other age groups (indirect effect). The direct effect of a vaccine, however, needs to be defined by the protection it confers given a specific amount of exposure to infection and not just a comparable exposure. Direct and indirect effects in vaccine efficacy and effectiveness (Am J Epidemiol 1991; 133(4):323-31) describes how parameters intended to measure direct effects must be robust and interpretable in the midst of complex indirect effects of vaccine intervention programmes.

 

Impact of rotavirus vaccination in regions with low and moderate vaccine uptake in Germany (Hum Vaccin Immunother 2012; 8(10):1407-15) describes an impact assessment of rotavirus vaccination comparing the incidence rates of hospitalisations before, and in seasons after, vaccine introduction using data from national mandatory disease reporting system.

First year experience of rotavirus immunisation programme in Finland (Vaccine 2012; 31(1):176-82) estimates the impact of a rotavirus immunisation programme on the total hospital inpatient and outpatient treated acute gastroenteritis burden and on severe rotavirus disease burden during the first year after introduction. The study may be considered as a vaccine-probe-study, where unspecific disease burden prevented by immunisation is assumed to be caused by the agent the vaccine is targeted against.

 

Individual Chapters:

 

1. General aspects of study protocol

2. Research question

3. Approaches to data collection

3.1. Primary data collection

3.2. Secondary use of data

3.3. Research networks

3.4. Spontaneous report database

3.5. Using data from social media and electronic devices as a data source

3.5.1. General considerations

4. Study design and methods

4.1. General considerations

4.2. Challenges and lessons learned

4.2.1. Definition and validation of drug exposure, outcomes and covariates

4.2.1.1. Assessment of exposure

4.2.1.2. Assessment of outcomes

4.2.1.3. Assessment of covariates

4.2.1.4. Validation

4.2.2. Bias and confounding

4.2.2.1. Choice of exposure risk windows

4.2.2.2. Time-related bias

4.2.2.2.1. Immortal time bias

4.2.2.2.2. Other forms of time-related bias

4.2.2.3. Confounding by indication

4.2.2.4. Protopathic bias

4.2.2.5. Surveillance bias

4.2.2.6. Unmeasured confounding

4.2.3. Methods to handle bias and confounding

4.2.3.1. New-user designs

4.2.3.2. Case-only designs

4.2.3.3. Disease risk scores

4.2.3.4. Propensity scores

4.2.3.5. Instrumental variables

4.2.3.6. Prior event rate ratios

4.2.3.7. Handling time-dependent confounding in the analysis

4.2.4. Effect modification

4.3. Ecological analyses and case-population studies

4.4. Hybrid studies

4.4.1. Pragmatic trials

4.4.2. Large simple trials

4.4.3. Randomised database studies

4.5. Systematic review and meta-analysis

4.6. Signal detection methodology and application

5. The statistical analysis plan

5.1. General considerations

5.2. Statistical plan

5.3. Handling of missing data

6. Quality management

7. Communication

7.1. Principles of communication

7.2. Guidelines on communication of studies

8. Legal context

8.1. Ethical conduct, patient and data protection

8.2. Pharmacovigilance legislation

8.3. Reporting of adverse events/reactions

9. Specific topics

9.1. Comparative effectiveness research

9.1.1. Introduction

9.1.2. General aspects

9.1.3. Prominent issues in CER

9.1.3.1. Randomised clinical trials vs. observational studies

9.1.3.2. Use of electronic healthcare databases

9.1.3.3. Bias and confounding in observational CER

9.2. Vaccine safety and effectiveness

9.2.1. Vaccine safety

9.2.1.1. General aspects

9.2.1.2. Signal detection

9.2.1.3. Signal refinement

9.2.1.4. Hypothesis testing studies

9.2.1.5. Meta-analyses

9.2.1.6. Studies on vaccine safety in special populations

9.2.2. Vaccine effectiveness

9.2.2.1. Definitions

9.2.2.2. Traditional cohort and case-control studies

9.2.2.3. Screening method

9.2.2.4. Indirect cohort (Broome) method

9.2.2.5. Density case-control design

9.2.2.6. Test negative design

9.2.2.7. Case coverage design

9.2.2.8. Impact assessment

9.2.2.9. Methods to study waning immunity

9.3. Design and analysis of pharmacogenetic studies

9.3.1. Introduction

9.3.2. Identification of genetic variants

9.3.3. Study designs

9.3.4. Data collection

9.3.5. Data analysis

9.3.6. Reporting

9.3.7. Clinical practice guidelines

9.3.8. Resources
Annex 1. Guidance on conducting systematic revies and meta-analyses of completed comparative pharmacoepidemiological studies of safety outcomes