A systematic literature review of economic evaluations of pneumococcal conjugate vaccines in east and southeast Asia (2006-2019).

INTRODUCTION: Pneumococcal infections can lead to serious invasive diseases such as meningitis, septicemia and pneumonia, as well as milder but more common illnesses such as sinusitis and otitis media. The World Health Organization (WHO) recommends the inclusion of pneumococcal conjugate vaccines (PCVs) in infant National Immunization Program (NIP) programs worldwide. Decision-makers in Asian countries planning to introduce PCVs in their respective NIP will need a comprehensive evidence of effectiveness of PCVs at the population level and economic evidence including cost-effectiveness. AREAS COVERED: A systematic literature review (from 1/1/2016 to 10/11/2019) of PCVs in East and Southeast Asia to understand (1) the contributing factors to cost-effectiveness results of PCVs and (2) whether gaps in evidence exist suggesting why the region may have yet to implement full NIPs. EXPERT OPINION: In East and Southeast Asia, vaccination with PCVs was found to significantly reduce the mortality and morbidity of pneumococcal diseases and was cost-effective compared to no vaccination. Study assumptions, specifically vaccine local acquisition, the inclusion or exclusion of indirect effects (serotype replacement and herd effect), cross-protection, and protection against nontypeable haemophilus influenzae and serotype 3, were the main drivers of cost-effectiveness.

The Cost-Effectiveness of 13-Valent Pneumococcal Conjugate Vaccine in Seven Chinese Cities.

Objective: This study estimates the cost-effectiveness of vaccination with the 13-valent pneumococcal conjugate vaccine (PCV13) among infants in Beijing, Shanghai, Shenzhen, Chengdu, Karamay, Qingdao, and Suzhou. Methods: A previously published cost-effectiveness model comparing vaccination with PCV13 to no vaccination was localized to the included Chinese cities. A systematic literature review was undertaken to identify age-specific incidence rates for pneumococcal bacteremia, pneumococcal meningitis, pneumonia, and otitis media (AOM). Age-specific direct medical costs of treating the included pneumococcal diseases were taken from the Chinese Health Insurance Association database. The base case analysis evaluated vaccine efficacy using direct effect and indirect effects (DE+ IDE). A subsequent scenario analysis evaluated the model outcomes if only DE was considered. A vaccination rate of 70% was used. The model reported outcomes over a one-year period after it was assumed the vaccine effects had reached a steady state (5-7 years after vaccine introduction) to include the direct and indirect effects of vaccination. Health outcomes were discounted at 5% during the steady-state period. Results: Vaccination with PCV13 was cost-effective in the base case analysis for all included cities with the incremental cost-effectiveness ratio (ICER) ranging from 1145 CNY(Shenzhen) to 15,422 CNY (Qingdao) per quality-adjusted life-year (QALY) gained. PCV13 was the dominant strategy in Shanghai with lower incremental costs and higher incremental QALYs. PCV13 remained cost-effective in the DE-only analysis with all ICERs falling below a cost-effectiveness threshold of three times GDP per capita in each city. Conclusions: Vaccination with PCV13 was a cost-effective strategy in the analyzed cities for both the DE-only and DE + IDE analyses. PCV13 became very cost-effective when a vaccination rate was reached where IDE is observed.

Association between frequency of spicy food consumption and hypertension: a cross-sectional study in Zhejiang Province, China.

BACKGROUND: Hypertension is a known risk factor for multiple chronic diseases. Existing literature on the association between frequency of spicy food consumption and hypertension shows mixed findings. METHODS: The analyses are based on the Tongxiang baseline dataset of the China Kadoorie Biobank prospective study, including data from electronic questionnaires, physical measurements and blood sample collection. A total of 53,916 participants aged 30-79 years were included in the final analysis. Multivariable logistic regression was used to estimate the association of spicy food consumption with hypertension, and multiple linear regression was performed to explore the association of spicy food consumption with systolic and diastolic blood pressure. RESULTS: Of the 53,916 participants, 23,921 had prevalent hypertension. 12.3% of participants reported consuming spicy food weekly. Among female participants, after adjusting for socio-demographic status, lifestyle factors, BMI, waist circumference, sleep duration and snoring, when compared with females who never consumed spicy food, the odds ratios (95% CI) for hypertension were 1.02 (0.96-1.08), 0.90 (0.79-1.01), and 0.88 (0.78-0.99), respectively, for females who consumed spicy food less than once weekly, 1-2 times weekly, and ≥ 3 times weekly (Ptrend = 0.04). The corresponding odds ratios for males were 1.02 (0.95-1.09), 1.07 (0.95-1.20), and 0.91 (0.81-1.01), respectively (Ptrend = 0.39). Among current alcohol drinkers, compared to participants who never consumed spicy food, the odds ratio (95% CI) for hypertension among participants consuming spicy food daily was 0.98 (0.80-1.20). The corresponding figure for non-current drinkers was 0.72 (0.62-0.84). The association was stronger among non-current alcohol drinkers than among current drinkers (Pheterogeneity = 0.02). CONCLUSIONS: Frequency of spicy food consumption is inversely associated with hypertension in females, but not in males.

Association of daytime napping in relation to risk of diabetes: evidence from a prospective study in Zhejiang, China.

BACKGROUND: Diabetes was a major risk factor for numerous chronic diseases. However, the associations between daytime napping and diabetes in the existing literature is still inconsistent. METHODS: The analysis included 53,916 participants aged 30-79 years of the China Kadoorie Biobank prospective study from Tongxiang. Incident diabetes were identified through linkage with incident diabetes surveillance systems, health insurance system, and death registries. Cox regressions were used to estimate the associations of daytime napping with diabetes. RESULTS: 5.11% of participants reported habitual daytime napping. During 488,233 person-years (median 9.4 years) of follow-up, 3333 incident diabetes, including 1249 males and 2084 females, were documented. After adjusting for socio-demographic status, behavioral lifestyle, BMI, waist circumference and snoring, as comparison with those without daytime napping, the hazard ratios for risk of diabetes were 1.39 (95% CI 1.21-1.59). The corresponding figures for males and females were 1.45 (95% CI 1.20-1.74) and 1.30 (95% CI 1.05-1.59), respectively. The corresponding figures for postmenopausal and premenopausal females were 1.41 (95% CI 1.08-1.80) and 1.13 (95% CI 0.78-1.59), respectively. CONCLUSIONS: Habitual daytime napping is positively associated with risk of diabetes in adults, except premenopausal females.