Literature review to identify evidence of secondary transmission of pentavalent human-bovine reassortant rotavirus vaccine (RV5) strains to unvaccinated subjects.

BACKGROUND: Rotavirus is the leading cause of severe diarrhea in infants and young children. Live attenuated vaccines can lead to horizontal transmission with the risk of vaccine-derived disease in contacts. Transmission of pentavalent human-bovine reassortant rotavirus vaccine (RV5) strains leading to clinical disease was not well evaluated in the pivotal clinical trials, and only a few case reports have been described in the literature. METHODS: We performed a systematic literature review to investigate secondary transmission of RV5 strains to unvaccinated subjects globally. We searched Embase, Medline for English papers, CNKI, Wan Fang for Chinese papers, and other resources (i.e., conference papers with full text) from January 2005 to June 2021. Eligibility criteria for inclusion were original articles based on non-interventional studies (case-control studies, cohort studies, cross-sectional studies) using RV5 strain transmission as outcomes. Other study or publication types were excluded, such as pre-clinical studies, interventional studies and case reports. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used, and study quality was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies and the JBI checklist for cross-sectional studies to assess the risk of bias. RESULTS: The search generated 2,089 articles in total. Seven articles met all inclusion criteria, including six cohort studies and one cross-sectional study. All studies underwent quality assessment and complied with the quality criteria of the NOS or JBI checklist, respectively. Overall, none of the seven studies identified RV5 vaccine-type transmission to an unvaccinated population, in either hospitals or nurseries under a close contact environment. One study reported that 1% of unvaccinated infants had gastrointestinal symptoms, but all symptoms were attributed to other clinical conditions. CONCLUSIONS: We found no evidence of horizontal transmission of RV5 strains to unvaccinated infants in a context of a limited amount and the descriptive nature of the identified studies.

Health impact and cost effectiveness of implementing gender-neutral HPV vaccination in Japan.

OBJECTIVE: To assess the public health impact and cost effectiveness of gender-neutral vaccination (GNV) versus female-only vaccination (FOV) with human papillomavirus (HPV) vaccination in Japan. METHODS: We modeled the public health impact and cost effectiveness of GNV versus FOV to prevent HPV-associated diseases in Japan over the next 100 years. We used one-way sensitivity analyses to examine the impact of varying key model input parameters and conducted scenario analyses to explore the effects of varying the vaccination coverage rate (VCR) of each cohort. RESULTS: In the base-case analysis, GNV averted additional cancer cases (17,228 female/6,033 male) and deaths (1,892 female/1,849 male) compared to FOV. When all HPV-associated diseases were considered, GNV had an incremental cost-effectiveness ratio of ¥4,732,320 (US$35,987)/quality-adjusted life year gained compared to FOV. The model was most sensitive to the discount rate and the disutility associated with HPV-related diseases. GNV had greater relative public health benefits when the female VCR was lower and was cost effective at a female VCR of 30%. CONCLUSIONS: Immediate implementation of GNV would reduce the disease burden and mortality associated with HPV in Japan, and would be cost effective compared to FOV if the female VCR remains low (30%).

Human papillomavirus (HPV) is a common sexually transmitted infection and, in Japan, the prevalence of HPV infection and the incidence of its associated diseases are high among both men and women. In the present manuscript we modeled the public health impact and cost effectiveness of gender-neutral vaccination versus female-only vaccination to prevent HPV-associated diseases in Japan over the next 100 years and found that immediate implementation of a gender-neutral vaccination strategy would reduce the burden and mortality associated with HPV in Japan.

Cost-effectiveness analysis of COPD screening programs in primary care for high-risk patients in China.

We built a decision-analytic model to compare the cost-effectiveness of using portable spirometer and questionnaire to screen chronic obstructive pulmonary diseases (COPD) with no screening (i.e. usual care) among chronic bronchitis patient in China. A lifetime horizon and a payer perspective were adopted. Cost data of health services including spirometry screening and treatment costs covered both maintenance and exacerbation. The result indicated that portable spirometer screening was cost-saving compared with questionnaire screening and no screening, with an incremental cost-effectiveness ratio (ICER) of -5026 and -1766 per QALY, respectively. Sensitivity analyses confirmed the robustness of the results. In summary, portable spirometer screening is likely the optimal option for COPD screening among chronic bronchitis patients China.

The new cooperative medical scheme in China.

The New Cooperative Medical Scheme (NCMS) is a heavily subsidized voluntary health insurance program established in 2003 to reduce the risk of catastrophic health spending for rural residents in China. In this review, we present the current collection of knowledge available regarding the performance of NCMS on the aspects of revenue collection, risk pooling, reimbursement rules and provider payment. The available evidence suggests that NCMS has substantially improved health care access and utilization among the participants; however, it appears to have no statistically significant effect on average household out-of-pocket health spending and catastrophic expenditure risk. As NCMS is rolled out to other counties, it must be careful to generalize the findings reported in the published papers and reports, because the early pilot counties were not randomly selected and there are a lot of local adaptations. In addition, we expect that NCMS could be an important opportunity to establish some trust-based institutions in the best interest of the participants to monitor provider quality and control cost inflation. Rigorous evaluations, based on richer and latest micro-level data, could considerably strengthen the evidence base for the performance and impact of NCMS.

Comparative analysis of medical expenditure with nebulized budesonide versus systemic corticosteroids in hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease in China.

Purpose: Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and is a leading cause of disability in China. Acute exacerbations of COPD (AECOPD) are a leading cause of hospitalizations, and account for a substantial proportion of medical expenditure. Corticosteroids are commonly used to manage AECOPD in hospitalized patients, so our objective was to analyze the total medical expenditure associated with nebulized budesonide (nBUD) vs. systemic corticosteroids (SCS) in this population. Patients and methods: A post-hoc analysis was carried out in 1,577 and 973 patients diagnosed with COPD who had received "any" nBUD or SCS regimen for AECOPD during hospitalization, respectively. Regimens included monotherapy, sequential therapy, and sequential-combination therapy. Comparative total medical expenditure was analyzed using a generalized linear model controlling for age, gender, comorbidities, smoking history, and respiratory failure or pneumonia on admission. Results: The total medical expenditure per capita with any nBUD or SCS regimen was CN¥11,814 (US$1,922) and CN¥12,153 (US$1,977), respectively. Any nBUD regimen was associated with a significant saving of 5.1% in expenditure compared with any SCS regimen (P=0.0341). Comorbidities, Type II respiratory failure, or pneumonia were patient factors associated with higher total medical expenditure (P<0.0001). In a subgroup analysis of the patients who received monotherapy, total medical expenditure was CN¥10,900 (US$1,773) for nBUD and CN¥11,581 (US$1,884) for SCS; nBUD was associated with a significant saving of 8.7% in expenditure compared with SCS (P=0.0013). Similarly, in patients with respiratory failure, treatment with any nBUD regimen was associated with a 10.6% saving in expenditure over any SCS regimen (P=0.0239); however, the same comparison was not significant in patients without respiratory failure (3.4%; P=0.2299). Conclusion: AECOPD is a leading cause of hospitalization in China, which places substantial burden on the healthcare system. This post-hoc analysis suggests that nBUD regimens are associated with lower medical expenditure than SCS regimens in hospitalized patients with AECOPD, and may reduce the financial burden of COPD. However, prospective studies evaluating the effectiveness of nBUD therapies are warranted.

Determinants of out-of-pocket health expenditure in China: analysis using China Health and Nutrition Survey data.

BACKGROUND: within total health expenditure, the share of out-of-pocket health expenditure by individuals has increased in the past 25 years in China, from 20% in 1980 to 49% in 2006, with a peak of 59% in 2000. Medical issues have become a larger concern than any other issue for households. OBJECTIVE: to estimate the determinants of individual out-of-pocket health expenditure in China. METHODS: we used a subsample of 9860 adults aged ≥ 18 years from the 2004 China Health and Nutrition Survey. To control for potential sample selection bias, the Heckman selection model was used to analyse individuals' health expenditure decisions, which is based on a sample that excludes individuals who do not report paying for healthcare. RESULTS: of the sampled population, 24.6% reported recent illness, 80.6% of whom sought care; 82.3% of those who sought care reported the amount of health spending. The average out-of-pocket health expenditure was Chinese Yuan (Y) 502 (Y100 = $US12.2 in 2004). Illness perceived as 'quite serious' and self-reported poor health status had the highest coefficients (2.012 [p < 0.01] and 3.351 [p < 0.01], respectively). People spent more on healthcare with increasing age, especially over the age of 65 years, with a coefficient of 1.171 (p < 0.01). Those who had chronic disease, earned higher incomes, resided in urban areas, lived in the middle or eastern region, or lived in a household with a head having a middle school or higher education paid more for healthcare. In the model examining disaggregated effects of insurance programmes, the coefficients were positive, except for commercial insurance, and the coefficient for labour insurance was significant. CONCLUSION: perceived severity of illness and self-reported health status are the most important factors when determining out-of-pocket health expenditure. The effect of aging is substantial. China should develop appropriate medical relief policies for the elderly to help them gain access to necessary healthcare services. Certain types of insurance programmes tend to increase out-of-pocket health expenditures, which highlights the need to continuously monitor and rigorously evaluate the impact of ongoing health insurance reform in China.