Evaluating the health and economic outcomes of a PCV15 vaccination program for adults aged 65 years-and-above in Switzerland.

OBJECTIVE: To assess the health and economic outcomes of a PCV13 or PCV15 age-based (65 years-and-above) vaccination program in Switzerland. INTERVENTIONS: The three vaccination strategies examined were:Target population: All adults aged 65 years-and-above. Perspective(s): Switzerland health care payer. TIME HORIZON: 35 years. Discount rate: 3.0%. Costing year: 2023 Swiss Francs (CHF). STUDY DESIGN: A static Markov state-transition model. DATA SOURCES: Published literature and publicly available databases or reports. OUTCOME MEASURES: Pneumococcal diseases (PD) i.e., invasive pneumococcal diseases (IPD) and non-bacteremic pneumococcal pneumonia (NBPP); total quality-adjusted life-years (QALYs), total costs and incremental cost-effectiveness ratios (CHF/QALY gained). RESULTS: Using an assumed coverage of 60%, the PCV15 strategy prevented a substantially higher number of cases/deaths than the PCV13 strategy when compared to the No vaccination strategy (1,078 IPD; 21,155 NBPP; 493 deaths). The overall total QALYs were 10,364,620 (PCV15), 10,364,070 (PCV13), and 10,362,490 (no vaccination). The associated overall total costs were CHF 741,949,814 (PCV15), CHF 756,051,954 (PCV13) and CHF 698,329,579 (no vaccination). Thus, the PCV13 strategy was strongly dominated by the PCV15 strategy. The ICER of the PCV15 strategy (vs. no vaccination) was CHF 20,479/QALY gained. In two scenario analyses where the vaccine effectiveness for serotype 3 were reduced (75% to 39.3% for IPD; 45% to 23.6% for NBPP) and NBPP incidence was increased (from 1,346 to 1,636/100,000), the resulting ICERs were CHF 29,432 and CHF 13,700/QALY gained, respectively. The deterministic and probabilistic sensitivity analyses demonstrated the robustness of the qualitative results-the estimated ICERs for the PCV15 strategy (vs. No vaccination) were all below CHF 30,000/QALYs gained. CONCLUSIONS: These results demonstrate that using PCV15 among adults aged 65 years-and-above can prevent a substantial number of PD cases and deaths while remaining cost-effective over a range of inputs and scenarios.

General Practitioners' Awareness and Perception of Current Pneumococcal Vaccination for Adult Patients with Known Risk Factors in Switzerland: Evidence from a Survey.

In Switzerland, the National Immunization Advisory Group (NITAG) has formulated recommendations for pneumococcal vaccination among adult risk patients. Little is known about general practitioners' (GPs') perception, knowledge, and implementation of these recommendations. Therefore, we investigated GPs' awareness and drivers of and barriers to pneumococcal vaccination using a cross-sectional web-based survey of GPs. Of the 300 study participants, 81.3% were aware of the recommendations for vaccinating at-risk adult patients, but only 42.7% were aware of all risk groups. The recommendations were perceived by 79.7% as slightly to very complex. Most GPs (66.7%) had good arguments to convince patients to get vaccinated, but only 41.7% reported recognizing patients at risk for pneumococcal disease, and only 46.7% checked their patients' vaccination status and proposed vaccination if needed. The main reasons for not vaccinating were patients' refusal (80.1%), lack of reimbursement by the health insurance (34.5%), patients' fear of side effects (25.1%), and lack of regulatory approval despite the NITAG recommendations (23.7%). Most (77.3%) agreed that the treating chronic disease specialist should recommend the vaccination and 94.7% believed that adult-risk patients would not be aware of their need for pneumococcal vaccinations. Optimal implementation of the recommendations will require addressing knowledge gaps and reported barriers.

Cost-effectiveness of the 15-valent pneumococcal conjugate vaccine for high-risk adults in Switzerland.

BACKGROUND: Vaccination against pneumococcal disease (PD) has shown a favorable cost-effectivenessprofile for many national immunization programs. While vaccination efforts have concentrated on children, many adults with underlying illnesses face elevated risks of PD and death. A 15-valent pneumococcal conjugate vaccine (V114) is currently available offering protection against 15 different serotypes and can be used in adults. RESEARCH DESIGN AND METHODS: We examined the cost-effectiveness of V114 vaccination in high-risk adults, aged 18+, in Switzerland. To this end, a Markov model was constructed estimating the lifetime direct medical costs and clinical effectiveness of V114 vaccination on invasive pneumococcal disease (IPD) and non-bacteremic pneumococcal pneumonia (NBPP). RESULTS: Considering 60% vaccine uptake and direct effects of vaccination, in total 760 IPD and 4,396 NBPP in- and outpatient cases could be prevented. Vaccinating high-risk adults with V114 led to CHF 37.4 million additional vaccination costs but saved CHF 14.4 million of medical treatment costs. V114 vaccination produced a gain of 2,095 QALYs and 6,320 LYs compared with no vaccination, leading to incremental cost-effectiveness ratios of CHF 17,866/QALY and CHF 15,616/QALY gained from a health care payer and societal perspective, respectively. CONCLUSIONS: This evidence justifies the implementation of V114 vaccination among high-risk adults in Switzerland.

Diurnal distribution of loud calls in sympatric wild indris (Indri indri) and ruffed lemurs (Varecia variegata): implications for call functions.

We carried out a short study on the diurnal call distribution of two sympatric lemurs in the Réserve Naturelle Intégrale Zahamena (eastern Madagascar). Whereas indris (Indri) song bouts were clearly concentrated in the early morning hours, the roar/shriek choruses of ruffed lemurs (Varecia) exhibited a much more even distribution throughout the day. These differences in distribution pattern support earlier claims that indri song bouts are more likely to serve territorial functions, whereas ruffed lemur loud calls may serve both spacing and/or alarm call functions.

Does female dominance facilitate feeding priority in black-and-white ruffed lemurs (Varecia variegata) in southeastern Madagascar?

Although many Malagasy lemurs are thought to be female dominant and to have female feeding priority, to date the relationship between these behaviors has been rigorously established only in Lemur catta, and other ways that females might achieve feeding priority have not been examined closely. Erhart and Overdorff [International Journal of Primatology 20:927-940, 1999] suggested that one way female primates achieve feeding priority is to initiate and lead groups to food, thereby gaining access to the food first and positively influencing their food intake compared to other group members. Here we describe female dominance patterns and potential measures of feeding priority in two groups of black-and-white ruffed lemurs (Varecia variegata) that were observed over a 15-month period in southeastern Madagascar. We predicted that the females would 1) be consistently dominant to males, 2) lead groups to food sources more often than males, and 3) have higher feeding rates compared to males when they arrived at food sources first. The results were dissimilar between the study groups. During the study, the oldest adult female in group 1 died. There was no evidence for female dominance in this group, and the remaining (likely natal) female did not lead the group more often, nor did she have a higher food intake than males. Group 1 dispersed shortly after the time frame reported here. In contrast, the resident female in group 2 was dominant to group males (based on agonistic interactions), led the group to food sources more often, and experienced a higher food intake when she arrived first at a food source. How these patterns vary over time and are influenced by the number of females in groups, group stability, food quality, and reproductive condition will be examined in future analyses.

Social system of the Alaotran gentle lemur (Hapalemur griseus alaotrensis): genetic characterization of group composition and mating system.

Group composition and mating system were investigated in wild Alaotran gentle lemurs (Hapalemur griseus alaotrensis) using genetic markers. These small-bodied herbivorous and cathemeral primates are endemic to the reed and papyrus beds around Lac Alaotra in Madagascar. They live in small groups in small, defended territories. Data were collected during the rainy seasons in 1996, 1997, and 1999, and include 99 individuals from 22 neighboring social groups and an additional 30 animals from other areas representing most of the geographic range. Animals were located by researchers canoeing in the marshes bordering the lake. After a group's size was determined by direct observation, all individuals were captured, marked, and released. During handling each individual was weighed and sexed, and hair samples for DNA extraction were collected. A 342 bp mtDNA control region sequence and 10 nuclear microsatellite loci provided multilocus genotypes that were used to assess pedigree relations and population structure. Alaotran gentle lemurs were found in groups of two to nine individuals (mean: 4.3), comprising one or two breeding females, their offspring, and one reproducing male. Solitary individuals of both sexes were encountered rarely. Breeding females were the permanent core of the social groups, whereas intergroup transfer of reproductive males was relatively frequent. Forty percent of all reproducing groups contained two breeding females, which were related to each other as closely as mother-daughter or full sisters. Parentage assessment revealed a variable mating system ranging from serial monogamy to polygyny within social groups. At least 8% of paternities involved extragroup males. Additional data on life history and reproduction are presented, and the social system of the Alaotran gentle lemur is discussed in the light of the new genetic findings.