Manufacturing costs of HPV vaccines for developing countries.

BACKGROUND: Nearly all of the 500,000 new cases of cervical cancer and 270,000 deaths occur in middle or lower income countries. Yet the two most prevalent HPV vaccines are unaffordable to most. Even prices to Gavi, the Vaccine Alliance, are unaffordable to graduating countries, once they lose Gavi subsidies. Merck and Glaxosmithkline (GSK) claim their prices to Gavi equal their manufacturing costs; but these costs remain undisclosed. We undertook this investigation to estimate those costs. METHODS: Searches in published and commercial literature for information about the manufacturing of these vaccines. Interviews with experts in vaccine manufacturing. FINDINGS: This detailed sensitivity analysis, based on the best available evidence, finds that after a first set of batches for affluent markets, manufacturing costs of Gardasil for developing countries range between $0.48 and $0.59 a dose, a fraction of its alleged costs of $4.50. Because volume of Cervarix is low, its per unit costs are much higher, though at comparable volumes, its costs would be similar. INTERPRETATION: Given the recovery of fixed and annual costs from sales in affluent markets, Merck's break-even price to Gavi could be $0.50-$0.60, not $4.50. These savings could support Gavi programs to strengthen delivery and increase coverage. Outside Gavi, prices to lower- and middle-income countries, with profit, could also be lowered and made available to millions more adolescents at risk. These estimates and their policy implications deserve further discussion.

Estimated research and development costs of rotavirus vaccines.

Diseases like rotavirus afflict both upper- and lower-income countries, but most serious illnesses and deaths occur among the latter. It is a vital public health issue that vaccines for these types of global diseases can recover research and development (R&D) costs from high-priced markets quickly so that manufacturers can offer affordable prices to lower-income nations. Cost recovery depends on how high R&D costs are, and this study attempts to replace high, unverified estimates with lower, more verifiable estimates for two new vaccines, RotaTeq (Merck) and Rotarix (GlaxoSmithKline or GSK), based on detailed searches of public information and follow-up interviews with senior informants. We also offer a new perspective on "cost of capital" as a claim for recovery from public bodies. Our estimates suggest that companies can recover all fixed costs quickly from affluent markets and thus can offer these vaccines to lower-income countries at prices they can afford. Better vaccines are a shared project between companies and public health agencies; greater transparency and consistency in reporting of R&D costs is needed so that fair prices can be established.

Improving patient safety: an economic perspective on the role of nurses.

AIMS: This paper synthesises patient safety research and insights from economic theory to generate guidance for nurse managers. The paper describes the key roles nurses and nurse managers can play in improving patient safety, and explains how insights from health economics can help inform and enhance this role, helping nurse managers to set priorities for improvement and for future research. BACKGROUND: Awareness of the need to improve patient safety is high, but insufficient attention has been paid to the cost-effectiveness of safety improvements, leading to difficulty in setting priorities. This paper suggests specific methods that nurses can and should use to prioritize and evaluate safety improvements. EVALUATION: This is a review article, synthesising the results of research on patient safety. KEY ISSUES: Because of their close connection to patients, nurses (and nurse managers in particular) have key roles to play in improving patient safety. Improving patient safety will also benefit nurses and other practitioners directly, because caregivers suffer lasting distress from being involved in incidents that harm patients. Reducing harmful incidents should also reduce attrition and alleviate chronic staffing shortages. Insights from health economics can help nurse managers to set priorities for improvement and to more effectively evaluate the changes made. CONCLUSIONS: Evidence on the costs and effects of most safety improvements is still lacking. Nurses can and should take a leadership role in implementing changes and evaluating their costs and effects. IMPLICATIONS FOR NURSING MANAGEMENT: To lead improvements in patient safety, nurse managers need to learn to use the Plan-Do-Study-Act Improvement Cycle, and need to develop an awareness of and ability to measure the costs and effects of changes. These changes would allow nurse managers to better make the business case for patient safety.

Preliminary outcomes and cost-benefit analysis of a community hospital emergency department screening and referral program for patients aged 75 or more.

PURPOSE: The purpose of this article is to report preliminary outcome and cost-benefit results for a patient safety quality improvement program intended to improve outcomes for patients aged 75 or more visiting the Emergency Department (ED). The program uses the Identification of Seniors at Risk (SAR) scale to screen, and refers patients at high risk for appropriate intervention. DESIGN/METHODOLOGY/APPROACH: The Plan-Do-Study-Act improvement cycle was used as a framework. Simple outcomes have been assessed by comparing patient sub-groups based on risk status and interventions received. Cost and benefits were assessed based on estimated program outcomes and average costs. Sensitivity analysis was performed to test alternate assumptions. FINDINGS: The screening tool appears to be accurate, and screening and referral appears to have a positive impact, reducing length of stay, returns to the ED, and subsequent admissions to hospital. However, most results are not statistically significant at the 95 percent level. The value of avoided care exceeds program costs under most assumptions. ORIGINALITY/VALUE: Screening and referring all eligible patients has still not been achieved; these are areas for future investigation and improvement. Screening and referral appear to be effective in improving outcomes but because program costs were low, net benefits may have been achieved; however given global budgeting for hospital care improvements in the use of resources (rather than budgetary savings) would be expected. The methods for improvement (the Plan-Do-Study-Act framework; process evaluation; multidisciplinary working group meetings; outcome assessment) are practical and useful for improving quality and safety in a small community hospital with limited resources.