Optimization of Elderly Influenza and Pneumococcal Immunization Programs in Beijing, China Using Health Economic Evaluations: A Modeling Study.

(1) Background: Currently, residents ≥ 60 and ≥65 years old in Beijing, China, are eligible for free influenza and pneumococcal polysaccharide vaccines (PPSV23), respectively. The present study aimed to assess the cost-effectiveness of current and alternative strategies of dual influenza and PPSV23 vaccination among the elderly in Beijing. (2) Methods: We developed a Markov state-transition model to compare the costs and the quality-adjusted life years (QALYs) associated with four influenza and PPSV23 vaccination strategies among the elderly in Beijing. The strategies were as follows: (1) no vaccination; (2) only flu vaccine for people ≥ 60 years old; (3) flu vaccine for people ≥ 60 years old and PPSV23 for people ≥ 65 years old; and (4) dual influenza vaccines and PPSV23 for people ≥ 60 years old. Incremental costs and QALYs were quantified to determine the optimal option. If dominant strategies emerged, the Chinese gross domestic product per capita in 2021 (80,976 CNY) was used as the willingness-to-pay (WTP) threshold to covert QALYs into the monetary equivalent. (3) Results: The current program saved costs and increased QALYs compared to no vaccination or flu vaccine-only strategies. However, extending free PPSV23 to people ≥ 60 years old saved 0.35 CNY additionally while increasing QALYs marginally compared with the current policy. Results were robust in all sensitivity analyses. (4) Conclusion: Beijing's current dual influenza and pneumococcal vaccination program was cost-effective among the elderly compared with the preceding policies of no vaccination and flu-only immunization programs. However, the program can further save money while enhancing the population health by extending PPSV23 to all people ≥ 60 years old.

Title: the impact of a pilot integrated care model on the quality and costs of inpatient care among chinese elderly: a difference-in-difference analysis of repeated cross-sectional data.

BACKGROUND: Recently, integrated care has received tremendous popularity in China, a leading example of which is the Luohu model. In the present analysis, we aimed to examine the impacts of the Luohu model on the quality and costs of inpatient care. METHODS: We conducted a retrospective analysis using administrative claims databases of Shenzhen City (the city that the Luohu district sits) from Jan 2015-Apr 2017, which encompassed the time before and after the implementation of the pilot model. The outcomes were 30-day readmission, inpatient costs, and length of stay (LOS). Multivariable difference-in-difference analyses were conducted. RESULTS: In the first year following the integration, the Luohu model did not have impacts on any of the outcomes. Although its effect on readmission (ratio of odds ratio: 1.082; 95% CI: 0.865 to 1.353) was still not identified in the first four months of the second post-integration year, it decreased inpatient costs by CN¥ 1224.1 (95% CI: 372.7 to 2075.5) and LOS by 0.938 days (95% CI: 0.0416 to 1.835) per hospitalization episode during the same period. CONCLUSIONS: The Luohu model may reduce costs and LOS in the long term. It is potentially a viable approach to improve the value of inpatient care in China.

Cost-effectiveness of dual influenza and pneumococcal vaccination among the elderly in Shenzhen, China.

OBJECTIVE: To assess the cost-effectiveness of dual influenza and pneumococcal vaccination for the elderly in Shenzhen, China. METHODS: A Markov state-transition model with a weekly cycle was developed to compare the outcomes of dual influenza and pneumococcal vaccination for the prevention of influenza and pneumococcal infections compared with no vaccination among 70-74 years old people in Shenzhen over 5 years. The model allowed seasonal variation of influenza activity. We calculated the incremental cost-effectiveness ratio (ICER) with costs and quality-adjusted life years (QALYs) discounted at 5% annually from the societal perspective. The impact of parameter uncertainty on the results was examined using one-way and probabilistic sensitivity analyses (PSA). RESULTS: In the base case, dual vaccination prevented 5042 influenza infections, 26 IPD cases, 3 disabilities, 34 deaths, and cost US$7.1 per person while resulting in a net gain of 0.0026 QALYs compared with no vaccination. Using once the Chinese gross domestic product per capita in 2019 (US$10,289) as the willingness-to-pay threshold, dual vaccination was cost-effective with an ICER of US$2699 per QALY gained. One-way sensitivity analyses showed that the ICER was relatively sensitive to changes in influenza attack rates and influenza vaccine effectiveness. Based on the results of PSA with 1000 Monte Carlo simulations, receiving both vaccines was cost-effective in 100% of the repetitions. CONCLUSION: The current study provides evidence that dual influenza and pneumococcal vaccination is a cost-effective disease prevention strategy for the elderly in Shenzhen, China.

Dual influenza and pneumococcal vaccination was associated with lower short-term risks of all-cause and acute respiratory hospitalizations among the elderly in Shenzhen, China: a retrospective cohort study.

The present study evaluated the real-world effectiveness of influenza and pneumococcal dual-vaccination among Chinese elderly, the evidence on which was absent. Outpatient and inpatient claims databases from Jan 1, 2015 to Apr 1, 2017 of persons at least 60 years old in Shenzhen, China were merged with electronic records of influenza vaccines and 23-valent pneumococcal polysaccharide vaccines (PPSV23) from Oct 1, 2016 - May 31, 2017. Individuals who were vaccinated with influenza between Nov 1 and Dec 31, 2016 and received PPSV23 30 days within the date of influenza vaccination were defined as the vaccinated group. A control group consisted of individuals that received neither of the vaccines was constructed by matching on year of birth, sex, and district. The two outcomes were all-cause and acute respiratory hospitalizations. Difference-in-difference (DiD) logistic regressions that were proceeded with an entropy balancing (EB) process were used to analyse the effectiveness of dual-vaccination. A total of 48,116 eligible individuals were identified in the vaccinated group, which were matched by 93,692 individuals in the control group. The EB-DiD analyses estimated that dual-vaccination was associated with lower short-term risks of all-cause (odds ratio: 0.59, CI: 0.55-0.63) and acute respiratory (odds ratio: 0.49, CI: 0.41-0.59) hospitalizations.

Self-perceived oral health status and influencing factors of the elderly residents of a peri-urban area of La Paz, Bolivia.

AIM: To assess the self-perceived oral health status of the elderly in Bolivia and explore the relationship between the socio-demographic and subjective factors that influence such perception. DESIGN: A cross sectional study. SETTING: Pampahasi, peri-urban area of La Paz, Bolivia. PARTICIPANTS: A 22.5% (300) sample was selected randomly from the total population (1,336) of 60 years and above. Of the participants, 293 agreed to participate in the survey. METHODS: Information was collected by interviews at home. RESULTS: The mean age was 70 years (SD = 7.7), with more females (57%) than males. Sixty per cent of subjects categorised their oral health as poor. Logistic regression analysis showed that poor self-perceived oral health was associated significantly with not going to school, no/ fair satisfaction with economic status, poor chewing ability, perception of need for dental treatment, and poor self-perceived general health status. CONCLUSIONS: Socio-economic factors seem to contribute to poor oral health among the elderly in Bolivia. Considering that these factors are associated with bad oral health behaviour and few visits to dental clinics, there is a need to design dental education programmes and enhance accessibility to dental clinics for elderly people living in the peri-urban areas of La Paz, Bolivia.