Public health impact and return on investment of the pediatric immunization program in Poland.

BACKGROUND: This study aims to evaluate the epidemiological impact and return on investment of the pediatric immunization program (PIP) in Poland from the healthcare-sector and societal perspectives. RESEARCH DESIGN AND METHODS: A health-economic model was developed focusing on the nine vaccines, targeting 11 pathogens, recommended by the public health authorities for children aged 0-6 years in Poland. The 2019 birth cohort (388,178) was followed over their lifetime, with the model estimating discounted health outcomes, life-years gained, quality-adjusted life-years, and direct and indirect costs with and without the PIP based on current and pre-vaccine - era disease incidence estimates, respectively. RESULTS: Across 11 targeted pathogens, the Polish PIP prevented more than 452,300 cases of disease, 1,600 deaths, 37,900 life-years lost, and 38,800 quality-adjusted life-years lost. The PIP was associated with vaccination costs of €54 million. Pediatric immunization averted €65 million from a healthcare-sector perspective (benefit-cost ratio [BCR], 2.2) and averted €358 million from a societal perspective (BCR, 7.6). The BCRs from both perspectives remained >1.0 in scenario analyses. CONCLUSIONS: The Polish PIP, which has not previously been systematically assessed, brings large-scale prevention of disease-related morbidity, premature mortality, and associated costs. This analysis highlights the value of continued investment in pediatric immunization in Poland.

Public health impact and return on investment of Belgium's pediatric immunization program.

Objective: We evaluated the public health impact and return on investment of Belgium's pediatric immunization program (PIP) from both healthcare-sector and societal perspectives. Methods: We developed a decision analytic model for 6 vaccines routinely administered in Belgium for children aged 0-10 years: DTaP-IPV-HepB-Hib, DTaP-IPV, MMR, PCV, rotavirus, and meningococcal type C. We used separate decision trees to model each of the 11 vaccine-preventable pathogens: diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b, measles, mumps, rubella, Streptococcus pneumoniae, rotavirus, and meningococcal type C; hepatitis B was excluded because of surveillance limitations. The 2018 birth cohort was followed over its lifetime. The model projected and compared health outcomes and costs with and without immunization (based on vaccine-era and pre-vaccine era disease incidence estimates, respectively), assuming that observed reductions in disease incidence were fully attributable to vaccination. For the societal perspective, the model included productivity loss costs associated with immunization and disease in addition to direct medical costs. The model estimated discounted cases averted, disease-related deaths averted, life-years gained, quality-adjusted life-years gained, costs (2020 euros), and an overall benefit-cost ratio. Scenario analyses considered alternate assumptions for key model inputs. Results: Across all 11 pathogens, we estimated that the PIP prevented 226,000 cases of infections and 200 deaths, as well as the loss of 7,000 life-years and 8,000 quality-adjusted life-years over the lifetime of a birth cohort of 118,000 children. The PIP was associated with discounted vaccination costs of €91 million from the healthcare-sector perspective and €122 million from the societal perspective. However, vaccination costs were more than fully offset by disease-related costs averted, with the latter amounting to a discounted €126 million and €390 million from the healthcare-sector and societal perspectives, respectively. As a result, pediatric immunization was associated with overall discounted savings of €35 million and €268 million from the healthcare-sector and societal perspectives, respectively; every €1 invested in childhood immunization resulted in approximately €1.4 in disease-related cost savings to the health system and €3.2 in cost savings from a societal perspective for Belgium's PIP. Estimates of the value of the PIP were most sensitive to changes in input assumptions for disease incidence, productivity losses due to disease-related mortality, and direct medical disease costs. Conclusion: Belgium's PIP, which previously had not been systematically assessed, provides large-scale prevention of disease-related morbidity and premature mortality, and is associated with net savings to health system and society. Continued investment in the PIP is warranted to sustain its positive public health and financial impact.

Economic Evaluation of Vaccination Programs: A Guide for Selecting Modeling Approaches.

OBJECTIVES: Illustrate 3 economic evaluation methods whose value measures may be useful to decision makers considering vaccination programs. METHODS: Keyword searches identified example publications of cost-effectiveness analysis (CEA), fiscal health modeling (FHM), and constrained optimization (CO) for economic evaluation of a vaccination program in countries where at least 2 of the methods had been used. We examined the extent to which different value measures may be useful for decision makers considering adoption of a new vaccination program. With these findings, we created a guide for selecting modeling approaches illustrating the decision-maker contexts and policy objectives for which each method may be useful. RESULTS: We identified 8 countries with published evaluations for vaccination programs using >1 method for 4 infections: influenza, human papilloma virus, rotavirus, and malaria. CEA studies targeted health system decision makers using a threshold to determine the efficiency of a new vaccination program. FHM studies targeted public sector spending decision makers estimating lifetime changes in government tax revenue net of transfer payments. CO studies targeted decision makers selecting from a mix of options for preventing an infectious disease within budget and feasibility constraints. Cost and utility inputs, epidemiologic models, comparators, and constraints varied by modeling method. CONCLUSIONS: Although CEAs measures of incremental cost-effectiveness ratios are critical for understanding vaccination program efficiency for all decision makers determining access and reimbursement, FHMs provide measures of the program's impact on public spending for government officials, and COs provide measures of the optimal mix of all prevention interventions for public health officials.

Pest Prevalence and Evaluation of Community-Wide Integrated Pest Management for Reducing Cockroach Infestations and Indoor Insecticide Residues.

Pest infestations in residential buildings are common, but community-wide pest survey data are lacking. Frequent insecticide applications for controlling indoor pests leave insecticide residues and pose potential health risks to residents. In this study, a community-wide pest survey was carried out in a housing complex consisting of 258 units in 40 buildings in New Brunswick, New Jersey. It was immediately followed by implementation of an integrated pest management (IPM) program in all the cockroach-infested apartments and two bed bug apartments with the goal of eliminating pest infestations, reducing pyrethroid residues, and increasing resident satisfaction with pest control services. The IPM-treated apartments were revisited and treated biweekly or monthly for 7 mo. Initial inspection found the top three pests and their infestation rates to be as follows: German cockroaches (Blattella germanica L. [Blattodea: Blattellidae]), 28%; rodents, 11%; and bed bugs (Cimex lectularius L. [Hemiptera: Cimicidae]), 8%. Floor wipe samples were collected in the kitchens and bedrooms of 20 apartments for pyrethroid residue analysis before the IPM implementation; 17 of the 20 apartments were resampled again at 7 mo. The IPM program reduced cockroach counts per apartment by 88% at 7 wk after initial treatment. At 7 mo, 85% of the cockroach infestations found in the initial survey were eliminated. The average number of pyrethroids detected decreased significantly from 6 ± 1 (mean ± SEM) and 5 ± 1 to 2 ± 1 and 3 ± 1 in the kitchens and bedrooms, respectively. The average concentrations of targeted pyrethroids residue also decreased significantly in the kitchens and bedrooms.

Dynamics of bed bug infestations in three low-income housing communities with various bed bug management programs.

BACKGROUND: Infestations of the common bed bug, Cimex lectularius L., have become common in low-income communities in the USA over the last 15 years. We evaluated community-based integrated pest management (IPM) programs for reducing bed bug infestations. Two housing authorities (Bayonne and Hackensack) implemented bed bug IPM programs. A third housing authority (Paterson) was used as the control site. Building-wide surveys were conducted in all communities, three times, to evaluate the effectiveness of the IPM programs. RESULTS: From 0 to 24 months, the infestation rate at Bayonne, Hackensack, and Paterson decreased by 49, 64, and 26%, respectively. The two sites that adopted IPM achieved faster bed bug elimination than the control site. The bed bug introduction rate over a 24-month period at Bayonne, Hackensack, and Paterson was 7, 3, and 11%, respectively. The introduction rate was positively associated with the initial infestation rate. Residents from buildings enrolled in IPM programs were more satisfied with the bed bug control services than residents from the control site. CONCLUSION: IPM programs were more effective in reducing bed bug infestations than traditional pest control services, but many factors contributed to the lower than desired level of reduction in infestation rate. © 2017 Society of Chemical Industry.