Pediatric COVID-19 in Argentina: a comprehensive analysis of disease and economic burden through official data and a systematic literature review.

Background: Limited data are available on the clinical impact and economic burden of COVID-19 in the pediatric population in Argentina. We aimed to estimate the disease and economic burden of COVID-19 on children and adolescents. Methods: We analyzed official national databases and conducted a supplemental systematic review of the published literature with meta-analysis in children aged 0-18. The period of interest was from March 2020 to August 2021, before the introduction of vaccination in this age group as a national strategic plan. In addition, we used a cost of illness analysis to estimate the direct medical costs associated with COVID-19. All costs are reported in US dollars 2023. Results: A total of 450,503 confirmed COVID-19 cases and 180 multisystem inflammatory syndrome (MIS-C) were reported in Argentina in the study period. Fourteen observational clinical studies were identified. The meta-analyses of severity level from hospital patients showed that according to different studies 15%-28% of cases were asymptomatic, 68%-88% were mild or moderate, and 3%-10% were severe or critical. About 28% of children had an underlying disease. In addition, the estimated economic burden associated with COVID-19 was 80 million dollars and 4 million dollars corresponded to MISC. Conclusion: Significant impact of COVID-19 on the healthcare system and substantial economic implications for the pediatric population in Argentina were identified. The findings should help policymakers to make informed decisions and allocate resources effectively.

Modelling the Potential Public Health Impact of Different COVID-19 Vaccination Strategies with an Adapted Vaccine in Singapore.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing COVID-19 has been a dynamically changing virus, requiring the development of adapted vaccines. This study estimated the potential public health impact alternative vaccination strategies for COVID-19 in Singapore. RESEARCH DESIGN AND METHODS: The outcomes of alternative vaccination strategies with a future adapted vaccine were estimated using a combined Markov decision tree model. The population was stratified by high- and standard-risk. Using age-specific inputs informed by local surveillance data and published sources, the model estimated health (case numbers, hospitalizations, and deaths) and economic (medical costs and productivity losses) outcomes in different age and risk subpopulations. RESULTS: Booster vaccination in only the elderly and high-risk subpopulation was estimated to avert 278,614 cases 21,558 hospitalizations, 239 deaths, Singapore dollars (SGD) 277 million in direct medical costs, and SGD 684 million in indirect medical costs. These benefits increased as vaccination was expanded to other subpopulations. Increasing the booster vaccination coverage to 75% of the standard-risk population averted more deaths (3%), hospitalizations (29%), infections (145%), direct costs (90%), and indirect costs (192%) compared to the base case. CONCLUSIONS: Broader vaccination strategies using an adapted booster vaccine could have substantial public health and economic impact in Singapore.

Modelling the potential public health impact of different vaccination strategies with an omicron-adapted bivalent vaccine in Thailand.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing COVID-19 has continuously evolved, requiring the development of adapted vaccines. This study estimated the impact of the introduction and increased coverage of an Omicron-adapted bivalent booster vaccine in Thailand. RESEARCH DESIGN AND METHODS: The outcomes of booster vaccination with an Omicron-adapted bivalent vaccine versus no booster vaccination were estimated using a combined cohort Markov decision tree model. The population was stratified into high- and standard-risk subpopulations. Using age-specific inputs informed by published sources, the model estimated health (case numbers, hospitalizations, and deaths) and economic (medical costs and productivity losses) outcomes in different age and risk subpopulations. RESULTS: Booster vaccination in only the elderly and high-risk subpopulation was estimated to avert 97,596 cases 36,578 hospitalizations, 903 deaths, THB 3,119 million in direct medical costs, and THB 10,589 million in indirect medical costs. These benefits increased as vaccination was expanded to other subpopulations. Increasing the booster vaccination coverage to 75% of the standard-risk population averted more deaths (95%), hospitalizations (512%), infections (782%), direct costs (550%), and indirect costs (687%) compared to the base case. CONCLUSIONS: Broader vaccination with an Omicron-adapted bivalent booster vaccine could have significant public health and economic benefits in Thailand.

Impact of vaccination and non-pharmacological interventions on COVID-19: a review of simulation modeling studies in Asia.

Introduction: Epidemiological modeling is widely used to offer insights into the COVID-19 pandemic situation in Asia. We reviewed published computational (mathematical/simulation) models conducted in Asia that assessed impacts of pharmacological and non-pharmacological interventions against COVID-19 and their implications for vaccination strategy. Methods: A search of the PubMed database for peer-reviewed, published, and accessible articles in English was performed up to November 2022 to capture studies in Asian populations based on computational modeling of outcomes in the COVID-19 pandemic. Extracted data included model type (mechanistic compartmental/agent-based, statistical, both), intervention type (pharmacological, non-pharmacological), and procedures for parameterizing age. Findings are summarized with descriptive statistics and discussed in terms of the evolving COVID-19 situation. Results: The literature search identified 378 results, of which 59 met criteria for data extraction. China, Japan, and South Korea accounted for approximately half of studies, with fewer from South and South-East Asia. Mechanistic models were most common, either compartmental (61.0%), agent-based (1.7%), or combination (18.6%) models. Statistical modeling was applied less frequently (11.9%). Pharmacological interventions were examined in 59.3% of studies, and most considered vaccination, except one study of an antiviral treatment. Non-pharmacological interventions were also considered in 84.7% of studies. Infection, hospitalization, and mortality were outcomes in 91.5%, 30.5%, and 30.5% of studies, respectively. Approximately a third of studies accounted for age, including 10 that also examined mortality. Four of these studies emphasized benefits in terms of mortality from prioritizing older adults for vaccination under conditions of a limited supply; however, one study noted potential benefits to infection rates from early vaccination of younger adults. Few studies (5.1%) considered the impact of vaccination among children. Conclusion: Early in the COVID-19 pandemic, non-pharmacological interventions helped to mitigate the health burden of COVID-19; however, modeling indicates that high population coverage of effective vaccines will complement and reduce reliance on such interventions. Thus, increasing and maintaining immunity levels in populations through regular booster shots, particularly among at-risk and vulnerable groups, including older adults, might help to protect public health. Future modeling efforts should consider new vaccines and alternative therapies alongside an evolving virus in populations with varied vaccination histories.

Burden of COVID-19 during the omicron predominance in Brazil: a nationwide retrospective database study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has imposed significant burden on Brazil's health system. This study aimed to examine clinical characteristics, overall vaccine uptake, and to assess healthcare resource utilization (HCRU) and costs associated with acute COVID-19 in Brazil during the Omicron predominant period. METHODS: A nationwide retrospective study was conducted using various Brazilian databases including, COVID-19 related databases, public health systems, and other surveillance/demographic datasets. Individuals with positive COVID-19 test results between January 1 2022 and April 30 2022, during Omicron BA.1/BA.2 wave, were identified. Patients' demographics, vaccine uptake, HCRU and corresponding costs were described by age groups. RESULTS: A total of 8,160,715 (3.80%) COVID-19 cases were identified in the study cohort, ranging from 2.43% in <5 years to 62.05% in 19-49 years. The uptake of partial (Dose 1) or full immunization (Dose 2) was less than 0.1% in children aged <5 years, whereas in individuals ≥ 19 years, it exceeded 89.78% for Dose 1 and 84.07% for Dose 2. Overall booster vaccine uptake was 38.06%, which was significantly higher among individuals aged ≥ 65 years, surpassing 74.79%. Regardless of vaccination status, 87.2% cases were symptomatic, and 1.48% were hospitalized due to acute COVID-19 (<5 years: 2.33%, 5-11 years: 0.99%, 12-18 years: 0.32%, 19-49 years: 0.40%; 50-64 years: 1.50%, 65-74 years: 5.43%, and ≥ 75 years: 17.89%). Among the hospitalized patients (n = 120,450), 32.57% were admitted to ICU, of whom 31,283 (79.75%) individuals required mechanical ventilation (MV) support. The average cost per day in normal ward and ICU without MV in public/general hospital settings was $104.36 and $302.81, respectively. While average cost per day in normal ward and ICU with MV was $75.91 and $301.22 respectively. CONCLUSIONS: This study quantified the burden of COVID-19 in Brazil, suggesting substantial healthcare resources required to manage the COVID-19 pandemic.

Modeling the potential public health impact of different vaccination strategies with an omicron-adapted bivalent vaccine in Malaysia.

BACKGROUND: Coronavirus disease 2019 (COVID-19) case numbers have increased following the emergence of the Omicron variant. This study estimated the impact of introducing and increasing the coverage of an Omicron-adapted bivalent booster vaccine in Malaysia. RESEARCH DESIGN AND METHODS: A combined cohort Markov decision tree model was used to compare booster vaccination with an Omicron-adapted bivalent COVID-19 vaccine versus no booster vaccination in Malaysia. The model utilized age-specific data from January 2021 to March 2022 derived from published sources. The outcomes of interest included case numbers, hospitalizations, deaths, medical costs, and productivity losses. The population was stratified into high-risk and standard-risk subpopulations, and the study evaluated the benefits of increased coverage in different age and risk groups. RESULTS: Vaccinating only high-risk individuals and those aged ≥ 65 years was estimated to avert 274,313 cases, 33229 hospitalizations, 2,434 deaths, Malaysian ringgit (MYR) 576 million in direct medical costs, and MYR 579 million in indirect costs. Expanding vaccination coverage in the standard-risk population to 75% was estimated to avert more deaths (31%), hospitalizations (155%), infections (206%), direct costs (206%), and indirect costs (281%). CONCLUSIONS: These findings support broader population Omicron-adapted bivalent booster vaccination in Malaysia with potential for significant health and economic gains.

Estenose valvular aórtica e o uso de TAVI: revisão narrativa das evidências publicadas e avaliação básica de custos / Aortic valve stenosis and the use of TAVI: narrative review of published evidences and basic costs assessment

Objetivo: Revisar as evidências clínicas da estenose valvular aórtica em suas dimensões médica e econômica, analisando as alternativas de tratamento cirúrgico em pacientes de alto risco cirúrgico com foco na tecnologia do implante transcateter de válvula aórtica (TAVI). Métodos: Foi elaborada uma revisão narrativa das publicações relacionadas à estenose vascular aórtica e às metodologias de tratamento cirúrgico, assim como a comparação entre a metodologia TAVI e as abordagens convencionais (substituição cirúrgica de válvula aórtica por esternotomia, valvuloplastia por balão intra-aórtico e tratamento farmacológico), abordando ainda dados sobre algumas diferentes marcas e gerações de dispositivos de TAVI oferecidas no mercado brasileiro, avaliando a eficácia, a segurança e o custo de tratamento. Resultados: Em pacientes portadores de estenose aórtica grave sintomática e inoperáveis pela abordagem convencional, o uso do TAVI mostrou ser uma alternativa mais segura, eficaz e econômica em comparação aos tratamentos convencionais. Estudos com robustez metodológica mostram que esse procedimento alcança taxas superiores a 80% de sobrevida em um ano e aproximadamente 30% em cinco anos, mesmo em pacientes de alto risco. No entanto, foram observadas diferenças significativas nos desfechos entre diferentes estudos, que podem ser atribuídas não apenas ao desenho e à amostragem, mas às diferenças entre as diversas opções de gerações e marcas de dispositivos para TAVI disponíveis no mercado. Essas opções diferem principalmente na estrutura, via de inserção e modo de expansão. As válvulas de terceira geração vêm apresentando os melhores resultados em termos de eficácia, segurança e facilidade no procedimento, que resultam em mais benefícios aos pacientes e equilibram os custos de tratamento em médio e longo prazos. Conclusões: Estudos com evidências robustas avaliando desfechos representativos para o tratamento da estenose aórtica grave e sintomática mostram que a tecnologia minimamente invasiva TAVI é eficaz, segura no tratamento de pacientes de alto risco ou inoperáveis, com melhorias significativas nos dispositivos de terceira geração.

Objective: To review the clinical evidences of aortic valve stenosis in its medical and economical settings, reviewing the surgical treatment alternatives in patients at high surgical risk focused on the transcatheter aortic valve implantation (TAVI) technology. Methods: A structured review of the publications related to the disease and to the surgical treatment methodologies was conducted, followed by a search for information about the TAVI methodology, with comparisons between this method and conventional approaches (surgical aortic valve replacement by means of sternotomy, valvuloplasty via intra-aortic balloon and pharmacological treatment) and comparisons between different brands and generations of TAVI devices, evaluating the treatment efficacy, safety and cost. Results: In patients with severe symptomatic aortic stenosis who cannot be operated using the conventional approach, the use of TAVI was shown to be a safer, more effective and more economical alternative compared to the conventional treatments. The studies of the best methodology show that this is a safe, effective and curative procedure, reaching rates above 80% in 1-year survival and of approximately 30% in 5-year survival, even in patients at high risk. However, significant differences in the outcomes among different studies were observed, which may be attributed to the design and sampling as well as to the differences among the several options of TAVI devices available on the market. These options differ in structure, insertion route, expansion mode and in the several generations of valves. Third-generation valves have been presenting the best results in terms of efficacy, safety and procedure easiness, which result in more benefits to patients and balance the medium-term and long-term treatment cost. Conclusions: The most robust studies evaluating the TAVI valves show that this minimally invasive technology is effective and safe for the treatment of severe symptomatic aortic stenosis in patients at high risk or who cannot be operated.