Prophylaxis against respiratory syncytial virus (RSV), varicella, and pneumococcal infections: Economic-based decision-making.

OBJECTIVE: To compare costs and health benefits of three prophylactic interventions recommended by the American Academy of Pediatrics (AAP) and to help quantify the impact of illness and enhance the physicians' ability to make informed decisions. STUDY DESIGN: Medline search was conducted of English-language cost-effectiveness studies of varicella and pneumococcal conjugate vaccination recommended for all healthy infants and of respiratory syncytial virus (RSV) prophylaxis with palivizumab (Synagis) for infants at high risk for severe RSV infection. Data were collected on cost-effectiveness, burden of illness, and efficacy and analyzed from the societal and payer perspective. Results were discounted by 5% and costs inflated to year 2002 dollars. RESULTS: From the societal perspective, estimates of cost per life-years saved were money savings for varicella, 175,300 US dollars for pneumococcal conjugate vaccination, and 66,200 US dollars for palivizumab prophylaxis; from the payer perspective, estimates were 28,100, 338,400, and 66,400 US dollars, respectively. CONCLUSIONS: Cost-effectiveness estimates for varicella and pneumococcal conjugate vaccination demonstrate that evaluating economic benefits from the societal rather than the payer perspective makes universal prophylaxis very financially attractive. By comparison, this same differential does not exist for the cost-effectiveness estimates of palivizumab from the societal and payer perspectives because its use is in a well-defined high-risk target population. From a societal perspective, prophylaxis is a rational public policy decision, although in target populations, incidence of serious illness and the primary cost components driving the cost offsets vary across prophylactic measures studied.

Prevalence of migraine among Mexican Americans in San Diego, California: survey 1.

OBJECTIVE: To determine the population-based prevalence of migraine in a cross-sectional random sample of Mexican Americans aged at least 45 years in San Diego County, California. BACKGROUND: The prevalence of migraine has been assessed in various populations in the United States and Mexico, but no study of migraine prevalence in Mexican Americans has been reported in the literature to date. DESIGN/METHODS: Using an epidemiological cross-sectional research design, the population-based prevalence and associated descriptive epidemiology of self-reported migraine was estimated in Mexican Americans aged at least 45 years in San Diego County, California from a random sample of size 657. RESULTS: The lifetime migraine prevalence was 9.2% (95% confidence interval, 6.8 to 11.6) and current prevalence was 7.4% (95% confidence interval, 5.3 to 9.5). The prevalence of migraine was higher in women than in men, higher in low income groups than in high income groups, and decreased with increasing age. Prevalence among Mexican Americans born in Mexico was twice that of American-born Mexican Americans. CONCLUSIONS: These population-based data on migraine prevalence in Mexican Americans aged 45 and over contribute substantially to the understanding of this disease. A second study addressing migraine prevalence in Mexican Americans younger than 45 years in San Diego County will be reported.