The economic rationale for cell-based influenza vaccines in children and adults: A review of cost-effectiveness analyses.

Seasonal influenza significantly affects both health and economic costs in children and adults. This narrative review summarizes published cost-effectiveness analyses (CEAs) of cell-based influenza vaccines in children and adults <65 years of age, critically assesses the assumptions and approaches used in these analyses, and considers the role of cell-based influenza vaccines for children and adults. CEAs from multiple countries demonstrated the cost-effectiveness of cell-based quadrivalent influenza vaccines (QIVc) compared with egg-based trivalent/quadrivalent influenza vaccines (TIVe/QIVe). CEA findings were consistent across models relying on different relative vaccine effectiveness (rVE) estimate inputs, with the rVE of QIVc versus QIVe ranging from 8.1% to 36.2% in favor of QIVc. Across multiple scenarios and types of analyses, QIVc was consistently cost-effective compared with QIVe, including in children and adults across different regions of the world.

Demand for mental health support services among health professionals in Vietnam: Lesson from COVID-19 Pandemic.

BACKGROUND: This study aimed to measure the preferences for mental health support among health professionals, their willingness to support the mental health of colleagues and associated factors. METHOD: A descriptive cross-sectional study was performed from August to October 2022 within five hospitals located in Hanoi, Vietnam. A total of 244 health professionals participated in the study. Data on socio-economic status, health and COVID-19-related characteristics, Depression Anxiety Stress Scale (DASS-21); and preferences for mental health support services were collected by using a structured self-reported questionnaire. Multivariate logistic regression models were utilized to identify associated factors with the demand for mental support services. RESULTS: 13.9%, 17.1% and 8.6% reported having at least mild depression, anxiety and stress, respectively. There 13.9% did not seek any mental health support during the COVID-19 pandemic. The most common support included talking with friends (52.9%), family (50.8%), colleagues (47.6%) and using social networks/Internet (43.5%). There 31.1% had been aware of mental health services, but only 18.0% used this service at least once. Regarding preferences, 47.3% had a demand for mental support services, and the most preferred service was providing coping skills (25.9%), followed by skills to support others against mental problems (22.2%). Major sources of support included psychiatrists (34.4%), colleagues (29.1%) and family (27.9%). The main preferred channels for support included telephone/mobile phone (35.7%) and Internet (20.9%). Only 12.3% were willing to provide mental support for colleagues during the pandemic. Age, education, perceived mental health status, ever seeking any mental service, and DASS-21 depression score were associated with demand for mental support services. CONCLUSION: This study found a lack of awareness of mental health services for health professionals, as well as moderate levels of demand for this service in this population. Raising awareness and developing tailored mental health support services are important to enhancing the mental well-being of health professionals in Vietnam to prepare for the next pandemic.

Impacts of financial development and green trade on the shadow economy: An insight of eagle countries using Bayesian approaches.

The existence of a shadow economy is recognized as an impediment to sustainable development. By applying the Bayesian approaches, the current article investigates the linkage between financial development, green trade, and the scope of the shadow economy, aiming to contribute to a comprehensive understanding of how these factors address the challenge posed by the shadow economy in Emerging and Growth-Leading Economies (EAGLE) from 2003 to 2016. The results demonstrate that (i) The progress of the financial sector is expected to diminish the scale of the shadow economy. Specifically, the expansion of financial institutions and markets has a strong and negative influence on the shadow economy. (ii) Increased involvement in green trade is likely to result in a decreased shadow economy. Empirical findings provide evidence for effective policymaking in simultaneously promoting sustainable trade practices, strengthening financial systems, and curtailing informal economic activities for inclusive economic development.

Do Peer Navigators Improve Initiation and Retention in HIV/VH/STI Treatment Programs for People From Key Populations? A Systematic Review of Effectiveness, Values and Preferences, and Cost.

BACKGROUND: Key populations are disproportionately affected by HIV, viral hepatitis (VH), and sexually transmitted infections (STIs) and face barriers to care. Peer navigation programs are widely used, but evidence supporting their use has not been synthesized. SETTING: Peer navigation programs for sex workers, men who have sex with men, people who inject drugs, prisoners, and trans and gender diverse people globally. METHODS: To inform World Health Organization guidelines, we conducted a systematic review of effectiveness, values and preferences, and cost studies published between January 2010 and May 2021. We searched CINAHL, PsycINFO, PubMed, and EMBASE; screened abstracts; and extracted data in duplicate. The effectiveness review included randomized controlled trials and comparative observational studies evaluating time to diagnosis or linkage to care, treatment initiation, treatment retention/completion, viral load, cure, or mortality. We assessed risk of bias and summarized findings in GRADE evidence profiles. Values and preferences and cost data were summarized descriptively. RESULTS: Four studies evaluated the effectiveness of peer navigators for key populations. All were focused on HIV; none were designed for VH or STIs. These studies showed mixed effects on linkage to care, treatment retention/completion, and viral load; no studies measured treatment initiation, cure, or mortality. Two values and preferences studies with community-based organization staff and health workers suggested peer navigators for key populations were acceptable and valued, although continued challenges remained. No cost studies were identified. CONCLUSIONS: Although limited, available studies provide moderate certainty evidence for benefits of HIV/VH/STI peer navigation programs for key populations. Further evaluations are needed.

Length of Postoperative Hospital Stay and Related Factors After Lobectomy for Lung Cancer: A Pre-enhanced Recovery After Surgery (ERAS) Single Center Assessment.

BACKGROUND: Lobectomy for lung cancer often presents a lot of potentially severe complications after surgery for patients. Enhanced Recovery After Surgery (ERAS) is a program to improve unexpected events. When implementing ERAS, there needs to be evidence of relevant factors that prolong hospital stays to encourage the participation of medical staff and leaders. This study is to determine the length of hospital stay (LOS) and its related factors after surgery in patients undergoing lobectomy for non-small cell lung cancer. METHODS:  A descriptive retrospective study was conducted on 99 patients undergoing lobectomy for non-small cell lung cancer at University Medical Center Ho Chi Minh City. Data were extracted from a computerized database of patients who were hospitalized for lobectomy in the treatment of non-small cell lung cancer from January 2018 to December 2021. The primary outcome was the postoperative LOS. RESULTS: Median postoperative LOS was 5.2 days (interquartile range 4.8 to 6.8 days). The complication rate was 19.2%, of which Clavien-Dindo II accounted for the highest at 9.1%. The 30-day readmission rate was 13.1%. The median of LOS in the current cigarette smoker's group was 1.9 days higher than the never-cigarette smoker's group and 1.5 days higher than the former cigarette smokers (p<0.001). Tumor-nodes-metastasis (TNM) stage III showed the highest LOS compared to other stages (p=0.029). Open surgery and thoracoscopic conversion to open showed postoperative LOS about two days longer than thoracoscopic surgery (p<0.001). ​Performing muscle relaxation and early extubation, multimodal analgesia reduced postoperative LOS by 1.6 days (p<0.001), and preoperative physical therapy and early physical therapy at recovery reduced postoperative LOS by 1.3 days (p<0.001). There was a strong positive correlation between the duration of endotracheal retention, duration of thoracic drainage, amount of blood loss, and postoperative LOS (R>0.5, p<0.001). The duration of the Post-Anesthesia Care Unit and fasting time after surgery showed an average positive correlation with postoperative LOS (0.3

Cost-utility analysis of molnupiravir for high-risk, community-based adults with COVID-19: an economic evaluation of the PANORAMIC trial.

BACKGROUND: The cost-effectiveness of molnupiravir, an oral antiviral for early treatment of SARS-CoV-2, has not been established in vaccinated populations. AIM: To evaluate the cost-effectiveness of molnupiravir relative to usual care alone among mainly vaccinated community-based people at higher risk of severe outcomes from COVID-19 over 6 months. DESIGN AND SETTING: An economic evaluation of the PANORAMIC trial in the UK. METHOD: A cost-utility analysis that adopted a UK NHS and personal social services perspective and a 6-month time horizon was performed using PANORAMIC trial data. Cost-effectiveness was expressed in terms of incremental cost per quality-adjusted life year (QALY) gained. Sensitivity and subgroup analyses assessed the impacts of uncertainty and heterogeneity. Threshold analysis explored the price for molnupiravir consistent with likely reimbursement. RESULTS: In the base-case analysis, molnupiravir had higher mean costs of £449 (95% confidence interval [CI] = 445 to 453) and higher mean QALYs of 0.0055 (95% CI = 0.0044 to 0.0067) than usual care (mean incremental cost per QALY of £81 190). Sensitivity and subgroup analyses showed similar results, except for those aged ≥75 years, with a 55% probability of being cost-effective at a £30 000 per QALY threshold. Molnupiravir would have to be priced around £147 per course to be cost-effective at a £15 000 per QALY threshold. CONCLUSION: At the current cost of £513 per course, molnupiravir is unlikely to be cost-effective relative to usual care over a 6-month time horizon among mainly vaccinated patients with COVID-19 at increased risk of adverse outcomes, except those aged ≥75 years.

Assessment of residual cancer burden and survival in neoadjuvant chemotherapy of inoperable stage III breast cancer: A ten-year follow-up analysis in Vietnam.

BACKGROUND: Prognostic scores such as Residual Cancer Burden (RCB), Clinical Pathological Score (CPS), and Neo-Bioscore have been introduced to categorize breast cancer patients into different prognostic risk groups after neoadjuvant chemotherapy (NAC). PURPOSE: To evaluate the prognostic value of the residual cancer burden index in a large group of Vietnamese breast cancer patients treated with neoadjuvant chemotherapy in real-world settings. METHODS: 126 patients diagnosed with stage III breast cancer received neoadjuvant chemotherapy according to the AP regimes. After operation of BC, pathologic complete response (pCR) and Residual cancer burden (RCB) were evaluated. All breast cancer patients' survival were analyzed by using Kaplan-Meier and Log-Rank models. RESULTS: The average overall survival (OS) time was 75 months, with 90 (71.4%) recurrence and 82 (65%) mortality. The Kaplan Meier curve between OS and DFS with subgroups RCB indicate that the groups with higher RCB had a lower probability of survival, with statistical significance. Adjusted Cox regression model for age, menstruation, side of breast, clinical respose and overall stage illustrate that patients in RCB group 3 had a 2.7 times higher risk of mortality (95% CI: 1.28-5.67) compared to RCB group 0, p = 0.01. Patients with higher RCB levels had a higher risk of mortality. CONCLUSION: Stage IIIC, RCB score and RCB group are the independent prognostic factors for predicting survival time of breast cancer patients receiving neoadjuvant treatment.

Evaluation of the validity and reliability of a self-assessment questionnaire for cosmetic outcomes after thyroidectomy: a cross-sectional validation study.

PURPOSE: The Self-Assessment Questionnaire for Cosmetic Outcomes (SAQCO) was developed by us to evaluate the cosmetic outcome of patients after thyroidectomy. This study aimed to examine the reliability and validity of SAQCO. METHODS: We analyzed the cosmetic outcomes of 368 patients who underwent thyroidectomy and completed the SAQCO 1 year after surgery. The one-dimensionality, reliability, and validity of SAQCO were assessed using factor analysis models, Cronbach's alpha, and test-retest statistics. The differences in cosmesis indices between patient characteristics and surgical parameters were analyzed through comparative and regression analyses. RESULTS: The unidimensional convergence of SAQCO was examined. A Cronbach's alpha of 0.91, strong item-total correlation values (from 0.77 to 0.89), and a test-retest correlation value of 0.86 indicated the internal consistency and reliability of the SAQCO. The cosmesis index was significantly highest in the transoral (92.3 points) and transaxillary groups (90.9 points), followed by the postauricular (84.8 points) and transcervical groups (76.4 points). CONCLUSION: This study examined the reliability and validity of the SAQCO and showed that it is a suitable questionnaire for assessing cosmetic satisfaction of patients after thyroidectomy. The transoral and transaxillary approaches yield significantly superior cosmetic results compared to the conventional transcervical and postauricular approaches.

Real world evidence for public health decision-making on vaccination policies: perspectives from an expert roundtable.

INTRODUCTION: Influenza causes significant morbidity and mortality, but influenza vaccine uptake remains below most countries' targets. Vaccine policy recommendations vary, as do procedures for reviewing and appraising the evidence. AREAS COVERED: During a series of roundtable discussions, we reviewed procedures and methodologies used by health ministries in four European countries to inform vaccine recommendations. We review the type of evidence currently recommended by each health ministry and the range of approaches toward considering randomized controlled trials (RCTs) and real-world evidence (RWE) studies when setting influenza vaccine recommendations. EXPERT OPINION: Influenza vaccine recommendations should be based on data from both RCTs and RWE studies of efficacy, effectiveness, and safety. Such data should be considered alongside health-economic, cost-effectiveness, and budgetary factors. Although RCT data are more robust and less prone to bias, well-designed RWE studies permit timely evaluation of vaccine benefits, effectiveness comparisons over multiple seasons in large populations, and detection of rare adverse events, under real-world conditions. Given the variability of vaccine effectiveness due to influenza virus mutations and increasing diversification of influenza vaccines, we argue that consideration of both RWE and RCT evidence is the best approach to more nuanced and timely updates of influenza vaccine recommendations.

Modelling the population-level benefits and cost-effectiveness of cell-based quadrivalent influenza vaccine for children and adolescents aged 6 months to 17 years in the US.

BACKGROUND: Cell-based quadrivalent influenza vaccines (QIVc) can increase effectiveness against seasonal influenza by avoiding mismatch from egg adaption of vaccine viruses. This study evaluates the population-level cost-effectiveness and impacts on health outcomes of QIVc versus an egg-based vaccine (QIVe) in children aged 6 months to 17 years in the US. RESEARCH DESIGN AND METHODS: A dynamic age-structured susceptible-exposed-infected-recovered model was used to simulate influenza transmission in low and high incidence seasons for two scenarios: 1. QIVe for 6 months-17 year-olds, QIVc for 18-64 year-olds, and adjuvanted QIV (aQIV) for ≥ 65 year-olds, and 2. QIVc for 6 months-64 year-olds, and aQIV for ≥ 65 year-olds. Probabilistic sensitivity analysis was performed to account for uncertainty in parameter estimates. Cost-effectiveness was evaluated as incremental cost-effectiveness ratios (ICERs). RESULTS: Extension of QIVc to children resulted in 3-4% reductions in cases (1,656,271), hospitalizations (16,688), and deaths (2,126) at a population level in a high incidence season, and 65% reductions (cases: 2,856,384; hospitalizations: 31667; deaths: 4,163) in a low incidence season. Use of QIVc would be cost-saving, with ICERs of -$16,427/QALY and -$8,100/QALY from a payer perspective and -$22,669/QALY and -$15,015/QALY from a societal perspective, for low and high incidence seasons respectively. Cost savings were estimated at approximately $468 million and $1.366 billion for high and low incidence seasons, respectively. CONCLUSION: Use of QIVc instead of QIVe in children > 6 months of age in the US would reduce the disease burden and be cost-saving from both a payer and societal perspective.

Modified Coprecipitation Synthesis of Nickel-Rich NMC (Li1.0Ni0.6Mn0.2Co0.2O2) for Lithium-Ion Batteries: A Simple, Cost-Effective, Environmentally Friendly Method.

Lithium-ion batteries lay the foundation for satisfying the fast-growing demand of portable electronics and electric vehicles. However, due to the complexity of material syntheses, high fabrication temperature condition, and toxic gas emission, high volume manufacturing of lithium-ion batteries is still challenging. Here, we propose a modified coprecipitation method to synthesize Li1.0Ni0.6Mn0.2Co0.2O2 (NMC622-MCP) as a cathode material in a simple, cost-effective, and environmentally friendly approach. We demonstrate that the proposed method can be operated in a lower temperature environment, with respect to the requirement of conventional synthesis methods. Furthermore, only CO2 gas is emitted during synthesis. We also employed first-principles simulations to evaluate the crystallinity of the synthesized materials via X-ray diffractometer patterns. During charge/discharge processes, the obtained cathode materials induce outstanding electrochemical performance with a maximum specific capacity of up to 206.9 mAh g-1 at 0.05 C and a retention capacity of 83.22% after 100 cycles. Thus, the simple, cost-effective, environmentally friendly, and highly electrochemical performance of the newly acquired material envisages the modified coprecipitation method as a promising tool to manufacture cathode materials for lithium-ion batteries.

Assessment of the Chemical Profile and Potential Medical Effects of a Flavonoid-Rich Extract of Eclipta prostrata L. Collected in the Central Highlands of Vietnam.

Eclipta prostrata L. (EPL), a medicinal plant, is widely utilized in the central highlands of Vietnam. This study aims to assess the chemical profile and potential medical effects of an EPL extract rich in flavonoids. A total of 36 secondary metabolites were identified from the EPL extract through GC-MS and UHPLC-UV analysis. Among them, 15 volatile compounds and several phenolic and flavonoid chemicals, including salicylic acid, epicatechin gallate, isovitexin, and apigetrin, were reported in EPL extract for the first time. This herbal extract demonstrated moderate inhibition against α-amylase and α-glucosidase, and high anti-oxidant and anti-acetylcholinesterase activities (IC50 = 76.8 ± 0.8 µg/mL). These promising attributes can be likely attributed to the high levels of major compounds, including wedelolactone (1), chlorogenic acid (3), epicatechin gallate (6), salicylic acid (8), isovitexin (9), apigetrin (11), and myricetin (12). These findings align with the traditional use of EPL for enhancing memory and cognitive function, as well as its potential benefits in diabetes management. The results of the molecular docking study reveal that the major identified compounds (1, 6, 9, and 11) showed a more effective acetylcholinesterase inhibitory effect than berberine chloride, with good binding energy (DS values, -12.3 to -14.3 kcal/mol) and acceptable values of RMSD (1.02-1.67 Å). Additionally, almost all the identified major compounds exhibited good ADMET properties within the required limits.

Accumulation degree and risk assessment of metals in street dust from a developing city in Central Taiwan.

Due to the numerous industrial parks and high traffic density in Miaoli, Taiwan, large amounts of metals may be released into the atmosphere, accumulating in street dust. Therefore, this study aimed to collect street dust in Miaoli to quantify the metals and assess the accumulation degree, sources, and potential risks. The enrichment factor (EF), geological accumulation index (Igeo), ecological risk, and non-carcinogenic and lifetime carcinogenic risk were estimated to assess the accumulation degree and the potential environmental and health risks. Pearson correlation analysis, principal component analysis, and positive matrix factor model were used to clarify the relationship between levels of metals and identify possible sources. The levels of metals in street dust in order were Fe > Zn > Mn > Cu > Cr > Ni > Pb > Sr > Co > Sb. According to Igeo, the level of Ni indicated moderately polluted. The levels of Zn, Cu, and Pb showed moderate to strong pollution, strong pollution, and very strong pollution, respectively. Results of average ecological risk analysis pointed out that Pb and Cu represent a very high risk, while other metals posed low-to moderate-level ecological risks. Excluding the Steel Enterprise area, based on the EF value and source identification, it might be concluded that Co, Sr, Fe, Mn, and Sb were mainly from natural sources, while Cu, Pb, and Zn come from anthropogenic pollution sources. Based on the results of the risk assessments, most metals pose no serious adverse health risk to humans. But, in comparison to Miaoli townships, the health risks of residents living in the Steel Enterprise area were higher. However, given that children and adolescents exposure to Co, Cr, Pb, and Ni together constitute a relatively higher carcinogenic risk (CR > 10-6), more attention needs to be paid to the populations most susceptible.

Platform adaptive trial of novel antivirals for early treatment of COVID-19 In the community (PANORAMIC): protocol for a randomised, controlled, open-label, adaptive platform trial of community novel antiviral treatment of COVID-19 in people at increased risk of more severe disease.

INTRODUCTION: There is an urgent need to determine the safety, effectiveness and cost-effectiveness of novel antiviral treatments for COVID-19 in vaccinated patients in the community at increased risk of morbidity and mortality from COVID-19. METHODS AND ANALYSIS: PANORAMIC is a UK-wide, open-label, prospective, adaptive, multiarm platform, randomised clinical trial that evaluates antiviral treatments for COVID-19 in the community. A master protocol governs the addition of new antiviral treatments as they become available, and the introduction and cessation of existing interventions via interim analyses. The first two interventions to be evaluated are molnupiravir (Lagevrio) and nirmatrelvir/ritonavir (Paxlovid). ELIGIBILITY CRITERIA: community-dwelling within 5 days of onset of symptomatic COVID-19 (confirmed by PCR or lateral flow test), and either (1) aged 50 years and over, or (2) aged 18-49 years with qualifying comorbidities. Registration occurs via the trial website and by telephone. Recruitment occurs remotely through the central trial team, or in person through clinical sites. Participants are randomised to receive either usual care or a trial drug plus usual care. Outcomes are collected via a participant-completed daily electronic symptom diary for 28 days post randomisation. Participants and/or their Trial Partner are contacted by the research team after days 7, 14 and 28 if the diary is not completed, or if the participant is unable to access the diary. The primary efficacy endpoint is all-cause, non-elective hospitalisation and/or death within 28 days of randomisation. Multiple prespecified interim analyses allow interventions to be stopped for futility or superiority based on prespecified decision criteria. A prospective economic evaluation is embedded within the trial. ETHICS AND DISSEMINATION: Ethical approval granted by South Central-Berkshire REC number: 21/SC/0393; IRAS project ID: 1004274. Results will be presented to policymakers and at conferences, and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ISRCTN30448031; EudraCT number: 2021-005748-31.

Contributions of cost-effectiveness analyses (CEA) to influenza vaccination policy for older adults in Europe.

This review describes the importance of economic evaluations and real-world evidence (RWE) for the assessment of enhanced influenza vaccines for older adults in Europe. Individuals ≥65 years of age are at increased risk of severe influenza outcomes and many countries in Europe recommend enhanced vaccines for this population to mitigate immunosenescence. Some National Immunization Technical Advisory Groups (NITAGs) may preferentially recommend a specific enhanced vaccine, necessitating comparative economic evaluation and estimation of relative vaccine effectiveness between enhanced vaccine options in the absence of direct head-to-head efficacy data. Distinct approaches to economic modeling and cost-effectiveness analysis (CEA) guide national vaccination policies in Europe, including how underlying data, such as RWE, are used in these models. RWE is an important evidence source for input into CEA models based on disease factors (e.g., antigenic shift and seasonal variation) and practical factors (e.g., limitations of performing multiple randomized clinical trials to capture seasonal variation; the need to obtain relevant patient-oriented, real-world endpoints, such as hospitalizations). CEA is considered crucial to vaccine assessment among certain countries in Europe, but further harmonization of economic evaluations, including the use of RWE, across NITAGs in Europe may be of benefit, alongside standardized approaches for vaccine appraisal. In the future, more countries may use RWE as an input in CEA models to support NITAG recommendations for enhanced influenza vaccines in older populations, especially considering the value of RWE for the assessment of influenza epidemiology and vaccine effectiveness as stated by the World Health Organization, and the availability of a broad RWE base for certain enhanced vaccines.

X-band MMICs for a Low-Cost Radar Transmit/Receive Module in 250 nm GaN HEMT Technology.

This paper describes Monolithic Microwave Integrated Circuits (MMICs) for an X-band radar transceiver front-end implemented in 0.25 µm GaN High Electron Mobility Transistor (HEMT) technology. Two versions of single pole double throw (SPDT) T/R switches are introduced to realize a fully GaN-based transmit/receive module (TRM), each of which achieves an insertion loss of 1.21 dB and 0.66 dB at 9 GHz, IP1dB higher than 46.3 dBm and 44.7 dBm, respectively. Therefore, it can substitute a lossy circulator and limiter used for a conventional GaAs receiver. A driving amplifier (DA), a high-power amplifier (HPA), and a robust low-noise amplifier (LNA) are also designed and verified for a low-cost X-band transmit-receive module (TRM). For the transmitting path, the implemented DA achieves a saturated output power (Psat) of 38.0 dBm and output 1-dB compression (OP1dB) of 25.84 dBm. The HPA reaches a Psat of 43.0 dBm and power-added efficiency (PAE) of 35.6%. For the receiving path, the fabricated LNA measures a small-signal gain of 34.9 dB and a noise figure of 2.56 dB, and it can endure higher than 38 dBm input power in the measurement. The presented GaN MMICs can be useful in implementing a cost-effective TRM for Active Electronically Scanned Array (AESA) radar systems at X-band.

Real-World Evidence in Cost-Effectiveness Analysis of Enhanced Influenza Vaccines in Adults ≥ 65 Years of Age: Literature Review and Expert Opinion.

Influenza vaccination can benefit most populations, including adults ≥ 65 years of age, who are at greater risk of influenza-related complications. In many countries, enhanced vaccines, such as adjuvanted, high-dose, and recombinant trivalent/quadrivalent influenza vaccines (aTIV/aQIV, HD-TIV/HD-QIV, and QIVr, respectively), are recommended in older populations to provide higher immunogenicity and increased relative vaccine efficacy/effectiveness (rVE) than standard-dose vaccines. This review explores how efficacy and effectiveness data from randomized controlled trials and real-world evidence (RWE) are used in economic evaluations. Findings from published cost-effectiveness analyses (CEA) on enhanced influenza vaccines for older adults are summarized, and the assumptions and approaches used in these CEA are assessed alongside discussion of the importance of RWE in CEA. Results from many CEA showed that adjuvanted and high-dose enhanced vaccines were cost-effective compared with standard vaccines, and that differences in rVE estimates and acquisition price may drive differences in cost-effectiveness estimates between enhanced vaccines. Overall, RWE and CEA provide clinical and economic rationale for enhanced vaccine use in people ≥ 65 years of age, an at-risk population with substantial burden of disease. Countries that consider RWE when making vaccine recommendations have preferentially recommended aTIV/aQIV, as well as HD-TIV/HD-QIV and QIVr, to protect older individuals.

Cost-Effectiveness of the Use of Adjuvanted Quadrivalent Seasonal Influenza Vaccine in Older Adults in Ireland.

BACKGROUND: Enhanced vaccines (e.g., containing adjuvants) have shown increased immunogenicity and effectiveness in older adults, who often respond sub-optimally to conventional influenza vaccines. In this study, we evaluated the cost-effectiveness of an inactivated, seasonal, MF59-adjuvanted quadrivalent influenza vaccine (aQIV) for use in adults ≥ 65 years in Ireland. METHODS: A published dynamic influenza model incorporating social contact, population immunity, and epidemiological data was used to assess the cost-effectiveness of aQIV in adults ≥ 65 years of age compared with a non-adjuvanted QIV. Sensitivity analysis was performed for influenza incidence, relative vaccine effectiveness, excess mortality, and the impact on bed occupancy from co-circulating influenza and COVID-19. RESULTS: The use of aQIV resulted in discounted incremental cost-effectiveness ratios (ICERs) of EUR 2420/quality-adjusted life years (QALYs) and EUR 12,970/QALY from societal and payer perspectives, respectively, both of which are below the cost-effectiveness threshold of EUR 45,000/QALY. Sensitivity analysis showed that aQIV was effective in most scenarios, except when relative vaccine effectiveness compared to QIV was below 3%, and resulted in a modest reduction in excess bed occupancy. CONCLUSION: The use of aQIV for adults ≥ 65 years old in Ireland was shown to be highly cost-effective from both payer and societal perspectives.

Radiological risk assessment of outdoor222Rn and220Rn around rare earth element and uranium mines from northern Vietnam.

The outdoor222Rn and220Rn concentrations at 320 sampling points at 1 m above the ground in different sites surrounding rare earth element (REE) and uranium mines from northern Vietnam were measured using the RAD7. Results showed that222Rn concentrations were always higher than220Rn concentrations with large variation ranges from 25.7 to 573 Bq m-3and from 18.5 to 385 Bq m-3, respectively. The high correlation between220Rn and228Ra concentrations in surface soil of the studied sites were observed. The highest220Rn and222Rn concentrations are found at the sampling points of the REE NX-Lai Chau site. The220Rn and222Rn activities surrounding the REE mines were found to be higher than those surrounding the uranium mines. The average annual committed effective doses originated from the inhalation of220Rn and222Rn outdoor concentrations is about five times higher than the worldwide average value.