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1.
PLoS One ; 15(3): e0230359, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32203527

RESUMEN

INTRODUCTION: The clinical and economic impact of cervical cancer consistently become a serious burden for all countries, including Indonesia. The implementation of HPV vaccination policy for a big country such as Indonesia requires a strong commitment from several decision-makers. The aim of this study was to provide a comprehensive description on cost-effectiveness and the budget-impact of HPV vaccination policy in Indonesia. METHOD: A cohort Markov model was used to evaluate the cost and the clinical impact of HPV vaccination for 10 years old girls in Indonesia. The researchers consider two doses of all three available HPV vaccines adjusted with the HPV infection profilewith 95% vaccination coverage to estimate the national cervical cancer incidence and mortality. The Budget impact analysis explores three different scenarios covering (1) Two districts per year expansion, (2) oneprovince per year expansion and (3) achieving the National Immunization Program in 2024. RESULTS: Upon fully vaccinating almost 2.3 million 10-year-old girls, 34,723; 43,414; and 51,522 cervical cancer cases were prevented by Quadrivalent, Bivalent and Nonavalent vaccines, consecutively. Furthermore, the highest (591 cases) and lowest (399 cases) mortality were prevented by Nonavalent and Quadrivalent vaccines, respectively. Most of the vaccines were considerably cost-effective and only the Bivalent vaccine with the GAVI/UNICEF price which will be considered a cost-saving strategy.To provide national coverage of HPV vaccination in Indonesia, the government has to provide an annual budget of about US$49 million and US$22 million using the government contract price and GAVI/UNICEF price, respectively. CONCLUSION: HPV vaccination shows a cost-effective strategy and the budget required to provide this policy is considerably affordable for Indonesia.


Asunto(s)
Análisis Costo-Beneficio , Vacunación Masiva/economía , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/administración & dosificación , Neoplasias del Cuello Uterino/prevención & control , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Presupuestos/estadística & datos numéricos , Niño , Simulación por Computador , Ahorro de Costo/estadística & datos numéricos , Femenino , Humanos , Incidencia , Indonesia/epidemiología , Cadenas de Markov , Vacunación Masiva/organización & administración , Vacunación Masiva/estadística & datos numéricos , Persona de Mediana Edad , Modelos Económicos , Mortalidad , Infecciones por Papillomavirus/economía , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/virología , Vacunas contra Papillomavirus/economía , Políticas , Dinámica Poblacional , Años de Vida Ajustados por Calidad de Vida , Neoplasias del Cuello Uterino/economía , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/virología , Cobertura de Vacunación/economía , Cobertura de Vacunación/organización & administración , Cobertura de Vacunación/estadística & datos numéricos , Adulto Joven
2.
Pediatrics ; 145(2)2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31932361

RESUMEN

BACKGROUND: Mandatory vaccination has been effective in maintaining high vaccination coverage in countries such as the United States. However, there are no peer-reviewed analyses of the association between mandates and both coverage and subsequent incidence of vaccine-preventable disease in Europe. METHODS: Using data from the European Centre for Disease Prevention and Control and the World Health Organization, we evaluated the relationship between country-level mandatory vaccination policies and (1) measles and pertussis vaccine coverage and (2) the annual incidence of these diseases in 29 European countries. Multivariate negative binomial and linear regression models were used to quantify these associations. RESULTS: Mandatory vaccination was associated with a 3.71 (95% confidence interval [CI]: 1.68 to 5.74) percentage point higher prevalence of measles vaccination and a 2.14 (95% CI: 0.13 to 4.15) percentage point higher prevalence of pertussis vaccination when compared with countries that did not have mandatory vaccination. Mandatory vaccination was only associated with decreased measles incidence for countries without nonmedical exemptions (adjusted incidence rate ratio = 0.14; 95% CI: 0.05 to 0.36). We did not find a significant association between mandatory vaccination and pertussis incidence. CONCLUSIONS: Mandatory vaccination and the magnitude of fines were associated with higher vaccination coverage. Moreover, mandatory vaccination was associated with lower measles incidence for countries with mandatory vaccination without nonmedical exemptions. These findings can inform legislative policies aimed at increasing vaccination coverage.


Asunto(s)
Programas Obligatorios/estadística & datos numéricos , Vacuna Antisarampión/administración & dosificación , Sarampión/epidemiología , Vacuna contra la Tos Ferina/administración & dosificación , Cobertura de Vacunación/estadística & datos numéricos , Tos Ferina/epidemiología , Intervalos de Confianza , Europa (Continente)/epidemiología , Humanos , Incidencia , Programas Obligatorios/economía , Sarampión/prevención & control , Cobertura de Vacunación/economía , Tos Ferina/prevención & control
3.
BMC Health Serv Res ; 19(1): 741, 2019 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-31640687

RESUMEN

BACKGROUND: In recent years, several large studies have assessed the costs of national infant immunization programs, and the results of these studies are used to support planning and budgeting in low- and middle-income countries. However, few studies have addressed the costs and cost-effectiveness of interventions to improve immunization coverage, despite this being a major focus of policy attention. Without this information, countries and international stakeholders have little objective evidence on the efficiency of competing interventions for improving coverage. METHODS: We conducted a systematic literature review on the costs and cost-effectiveness of interventions to improve immunization coverage in low- and middle-income countries, including both published and unpublished reports. We evaluated the quality of included studies and extracted data on costs and incremental coverage. Where possible, we calculated incremental cost-effectiveness ratios (ICERs) to describe the efficiency of each intervention in increasing coverage. RESULTS: A total of 14 out of 41 full text articles reviewed met criteria for inclusion in the final review. Interventions for increasing immunization coverage included demand generation, modified delivery approaches, cash transfer programs, health systems strengthening, and novel technology usage. We observed substantial heterogeneity in costing methods and incompleteness of cost and coverage reporting. Most studies reported increases in coverage following the interventions, with coverage increasing by an average of 23 percentage points post-intervention across studies. ICERs ranged from $0.66 to $161.95 per child vaccinated in 2017 USD. We did not conduct a meta-analysis given the small number of estimates and variety of interventions included. CONCLUSIONS: There is little quantitative evidence on the costs and cost-effectiveness of interventions for improving immunization coverage, despite this being a major objective for national immunization programs. Efforts to improve the level of costing evidence-such as by integrating cost analysis within implementation studies and trials of immunization scale up-could allow programs to better allocate resources for coverage improvement. Greater adoption of standardized cost reporting methods would also enable the synthesis and use of cost data.


Asunto(s)
Países en Desarrollo/economía , Programas de Inmunización/economía , Renta/estadística & datos numéricos , Cobertura de Vacunación/economía , Análisis Costo-Beneficio , Humanos , Programas de Inmunización/estadística & datos numéricos , Lactante , Mejoramiento de la Calidad , Cobertura de Vacunación/estadística & datos numéricos
4.
BMC Med ; 17(1): 175, 2019 09 18.
Artículo en Inglés | MEDLINE | ID: mdl-31530275

RESUMEN

BACKGROUND: The introduction of highly effective direct-acting antiviral (DAA) therapy for hepatitis C has led to calls to eliminate it as a public health threat through treatment-as-prevention. Recent studies suggest it is possible to develop a vaccine to prevent hepatitis C. Using a mathematical model, we examined the potential impact of a hepatitis C vaccine on the feasibility and cost of achieving the global WHO elimination target of an 80% reduction in incidence by 2030 in the era of DAA treatment. METHODS: The model was calibrated to 167 countries and included two population groups (people who inject drugs (PWID) and the general community), features of the care cascade, and the coverage of health systems to deliver services. Projections were made for 2018-2030. RESULTS: The optimal incidence reduction strategy was to implement test and treat programmes among PWID, and in settings with high levels of community transmission undertake screening and treatment of the general population. With a vaccine available, the optimal strategy was to include vaccination within test and treat programmes, in addition to vaccinating adolescents in settings with high levels of community transmission. Of the 167 countries modelled, between 0 and 48 could achieve an 80% reduction in incidence without a vaccine. This increased to 15-113 countries if a 75% efficacious vaccine with a 10-year duration of protection were available. If a vaccination course cost US$200, vaccine use reduced the cost of elimination for 66 countries (40%) by an aggregate of US$7.4 (US$6.6-8.2) billion. For a US$50 per course vaccine, this increased to a US$9.8 (US$8.7-10.8) billion cost reduction across 78 countries (47%). CONCLUSIONS: These findings strongly support the case for hepatitis C vaccine development as an urgent public health need, to ensure hepatitis C elimination is achievable and at substantially reduced costs for a majority of countries.


Asunto(s)
Erradicación de la Enfermedad , Hepacivirus/inmunología , Hepatitis C/prevención & control , Modelos Teóricos , Vacunación , Vacunas contra Hepatitis Viral/uso terapéutico , Antivirales/economía , Antivirales/uso terapéutico , Erradicación de la Enfermedad/economía , Erradicación de la Enfermedad/organización & administración , Erradicación de la Enfermedad/normas , Erradicación de la Enfermedad/estadística & datos numéricos , Hepatitis C/economía , Hepatitis C/epidemiología , Hepatitis C Crónica/economía , Hepatitis C Crónica/epidemiología , Hepatitis C Crónica/prevención & control , Humanos , Incidencia , Salud Pública/economía , Salud Pública/métodos , Abuso de Sustancias por Vía Intravenosa/economía , Abuso de Sustancias por Vía Intravenosa/epidemiología , Abuso de Sustancias por Vía Intravenosa/virología , Atención de Salud Universal , Vacunación/normas , Cobertura de Vacunación/economía , Cobertura de Vacunación/organización & administración , Vacunas contra Hepatitis Viral/economía
5.
PLoS One ; 14(9): e0222296, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31532806

RESUMEN

INTRODUCTION: The Accelerated Development of VAccine beNefit-risk Collaboration in Europe (ADVANCE) is a public private collaboration aiming to develop and test a system for rapid benefit-risk (B/R) monitoring of vaccines, using existing electronic healthcare record (eHR) databases in Europe. Part of the data in such sources is missing due to incomplete follow-up hampering the accurate estimation of vaccination coverage. We compared different methods for coverage estimation from eHR databases; naïve period prevalence, complete case period prevalence, period prevalence adjusted for follow-up time, Kaplan-Meier (KM) analysis and (adjusted) inverse probability weighing (IPW). METHODS: We created simulation scenarios with different proportions of completeness of follow-up. Both completeness independent and dependent from vaccination date and status were considered. The root mean squared error (RMSE) and relative difference between the estimated and true coverage were used to assess the performance of the different methods for each of the scenarios. We included data examples on the vaccination coverage of human papilloma virus and pertussis component containing vaccines from the Spanish BIFAP database. RESULTS: Under completeness independent from vaccination date or status, several methods provided estimates with bias close to zero. However, when dependence between completeness of follow-up and vaccination date or status was present, all methods generated biased estimates. The IPW/CDF methods were generally the least biased. Preference for a specific method should be based on the type of censoring and type of dependence between completeness of follow-up and vaccination. Additional insights into these aspects, might be gained by applying several methods.


Asunto(s)
Registros Electrónicos de Salud/economía , Cobertura de Vacunación/economía , Vacunación/economía , Europa (Continente) , Humanos , Papillomaviridae/inmunología , Vacuna contra la Tos Ferina/economía , Medición de Riesgo/economía
6.
PLoS One ; 14(9): e0221479, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31490961

RESUMEN

BACKGROUND: Despite having influenza vaccination policies and programs, countries in the Americas underutilize seasonal influenza vaccine, in part because of insufficient evidence about severe influenza burden. We aimed to estimate the annual burden of influenza-associated respiratory hospitalizations in the Americas. METHODS: Thirty-five countries in the Americas with national influenza surveillance were invited to provide monthly laboratory data and hospital discharges for respiratory illness (International Classification of Diseases 10th edition J codes 0-99) during 2010-2015. In three age-strata (<5, 5-64, and ≥65 years), we estimated the influenza-associated hospitalizations rate by multiplying the monthly number of respiratory hospitalizations by the monthly proportion of influenza-positive samples and dividing by the census population. We used random effects meta-analyses to pool age-group specific rates and extrapolated to countries that did not contribute data, using pooled rates stratified by age group and country characteristics found to be associated with rates. RESULTS: Sixteen of 35 countries (46%) contributed primary data to the analyses, representing 79% of the America's population. The average pooled rate of influenza-associated respiratory hospitalization was 90/100,000 population (95% confidence interval 61-132) among children aged <5 years, 21/100,000 population (13-32) among persons aged 5-64 years, and 141/100,000 population (95-211) among persons aged ≥65 years. We estimated the average annual number of influenza-associated respiratory hospitalizations in the Americas to be 772,000 (95% credible interval 716,000-829,000). CONCLUSIONS: Influenza-associated respiratory hospitalizations impose a heavy burden on health systems in the Americas. Countries in the Americas should use this information to justify investments in seasonal influenza vaccination-especially among young children and the elderly.


Asunto(s)
Hospitalización/estadística & datos numéricos , Gripe Humana/complicaciones , Infecciones del Sistema Respiratorio/complicaciones , Infecciones del Sistema Respiratorio/terapia , Adolescente , Adulto , Anciano , Américas/epidemiología , Análisis de Varianza , Niño , Preescolar , Costos y Análisis de Costo , Femenino , Humanos , Gripe Humana/prevención & control , Masculino , Persona de Mediana Edad , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/virología , Estaciones del Año , Cobertura de Vacunación/economía , Cobertura de Vacunación/estadística & datos numéricos , Adulto Joven
7.
Epidemiol Infect ; 147: e247, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-31364582

RESUMEN

Dogs harbor numerous zoonotic pathogens, many of which are controlled through vaccination programs. The delivery of these programs can be difficult where resources are limited. We developed a dynamic model to estimate vaccination coverage and cost-per-dog vaccinated. The model considers the main factors that affect vaccination programs: dog demographics, effectiveness of strategies, efficacy of interventions and cost. The model was evaluated on data from 18 vaccination programs representing eight countries. Sensitivity analysis was performed for dog confinement and vaccination strategies. The average difference between modelled vaccination coverage and field data was 3.8% (2.3%-5.3%). Central point vaccination was the most cost-effective vaccination strategy when >88% of the dog population was confined. More active methods of vaccination, such as door-to-door or capture-vaccinate-release, achieved higher vaccination coverage in free-roaming dog populations but were more costly. This open-access tool can aid in planning more efficient vaccination campaigns in countries with limited resources.


Asunto(s)
Vacunación Masiva/veterinaria , Vacunas Antirrábicas/administración & dosificación , Rabia/prevención & control , Cobertura de Vacunación/economía , Vacunación/estadística & datos numéricos , África Oriental , África del Norte , Animales , Asia , América Central , Análisis Costo-Beneficio , Perros , Humanos , Vacunación Masiva/economía , América del Norte , Rabia/epidemiología , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Vacunación/economía
8.
Qual Manag Health Care ; 28(3): 155-162, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31246778

RESUMEN

BACKGROUND AND OBJECTIVES: Pay-for-performance (P4P) is broadly defined as financial incentives to providers for attaining prespecified quality outcomes. Providers, payers, and public officials have worked over the years to develop innovative solutions to rapidly and consistently bring new diagnostic tests and therapies to our patients. P4P has been instituted in various forms over the last 30 years. Vaccines are one of society's greatest public health innovations and vaccination programs provide a unique opportunity for P4P programs. We attempted to investigate the effect of P4P compensation model implementation on the vaccination rate. METHODS: Utilizing a systematic review and meta-analysis approach, we searched PubMed, Embase, Scopus, and Web of Science from inception to December 2018. RESULTS: Nine articles were included with poor to moderate quality. Improvements in vaccination rates after implementation of P4P were statistically significant in 8 of 9 of studies. However, due to the heterogeneity of the methods used, we could not pool the data. CONCLUSION: The results of this systematic review indicate that the implementation of P4P programs can increase the vaccination rate. In recent times when it has become increasingly more popular not to vaccinate, implementing P4P becomes even more important if it is shown to be an effective tool in increasing vaccination rates.


Asunto(s)
Reembolso de Incentivo , Cobertura de Vacunación/economía , Humanos
9.
Hum Vaccin Immunother ; 15(11): 2754-2768, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30964372

RESUMEN

Rotavirus gastroenteritis imposes a heavy burden on low- and middle-income countries. The World Health Organization defines the Eastern Mediterranean region (WHO-EMRO) as a diverse area in terms of socioeconomic status and health indicators. Rotavirus vaccination has been introduced, at least partially, in 19 out of the 22 EM countries; however, vaccine coverage remains low, and data on rotavirus disease burden is scarce.Available data on rotavirus prevalence, seasonality, vaccination status, and genotype evolution was systematically compiled following a literature review that identified 165 relevant WHO-EMRO epidemiology studies published between 1990 and 2017.Although the infectious agents responsible for acute gastroenteritis vary over time, rotavirus remained the leading cause of acute gastroenteritis in children, as seen in 76.3% of reviewed publications. Younger children (<2 years old) were at higher risk and thus increased vaccination coverage and surveillance systems are required to reduce the rotavirus gastroenteritis burden in WHO-EMRO countries.


Asunto(s)
Gastroenteritis/economía , Infecciones por Rotavirus/economía , Infecciones por Rotavirus/epidemiología , Cobertura de Vacunación/estadística & datos numéricos , Preescolar , Costo de Enfermedad , Gastroenteritis/epidemiología , Gastroenteritis/virología , Geografía , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Región Mediterránea , Prevalencia , Rotavirus , Infecciones por Rotavirus/prevención & control , Vacunas contra Rotavirus/administración & dosificación , Vacunas contra Rotavirus/economía , Cobertura de Vacunación/economía , Organización Mundial de la Salud
10.
PLoS One ; 14(4): e0213499, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31034485

RESUMEN

BACKGROUND: Although influenza vaccination has been shown to reduce the incidence of major adverse cardiac events (MACE) among those with existing cardiovascular disease (CVD), in the 2015-16 season, coverage for persons with heart disease was only 48% in the US. METHODS: We built a Monte Carlo (probabilistic) spreadsheet-based decision tree in 2018 to estimate the cost-effectiveness of increased influenza vaccination to prevent MACE readmissions. We based our model on current US influenza vaccination coverage of the estimated 493,750 US acute coronary syndrome (ACS) patients from the healthcare payer perspective. We excluded outpatient costs and time lost from work and included only hospitalization and vaccination costs. We also estimated the incremental cost/MACE case averted and incremental cost/QALY gained (ICER) if 75% hospitalized ACS patients were vaccinated by discharge and estimated the impact of increasing vaccination coverage incrementally by 5% up to 95% in a sensitivity analysis, among hospitalized adults aged ≥ 65 years and 18-64 years, and varying vaccine effectiveness from 30-40%. RESULT: At 75% vaccination coverage by discharge, vaccination was cost-saving from the healthcare payer perspective in adults ≥ 65 years and the ICER was $12,680/QALY (95% CI: 6,273-20,264) in adults 18-64 years and $2,400 (95% CI: -1,992-7,398) in all adults 18 + years. These resulted in ~ 500 (95% CI: 439-625) additional averted MACEs/year for all adult patients aged ≥18 years and added ~700 (95% CI: 578-825) QALYs. In the sensitivity analysis, vaccination becomes cost-saving in adults 18+years after about 80% vaccination rate. To achieve 75% vaccination rate in all adults aged ≥ 18 years will require an additional cost of $3 million. The effectiveness of the vaccine, cost of vaccination, and vaccination coverage rate had the most impact on the results. CONCLUSION: Increasing vaccination rate among hospitalized ACS patients has a favorable cost-effectiveness profile and becomes cost-saving when at least 80% are vaccinated.


Asunto(s)
Análisis Costo-Beneficio , Vacunas contra la Influenza/economía , Gripe Humana/prevención & control , Vacunación/economía , Adolescente , Adulto , Femenino , Hospitalización/economía , Humanos , Vacunas contra la Influenza/uso terapéutico , Gripe Humana/economía , Gripe Humana/epidemiología , Masculino , Persona de Mediana Edad , Modelos Económicos , Readmisión del Paciente , Cobertura de Vacunación/economía , Adulto Joven
12.
Hum Vaccin Immunother ; 15(10): 2378-2385, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30843757

RESUMEN

Although a proven and effective preventive health measure, childhood immunization programs remain vulnerable to budgetary pressures. Sustainable financing of immunization programs is an important issue that presents a challenge for middle-income countries (MIC) in particular, in part due to technological advances meaning more vaccines are available. This study aimed to analyse trends in immunization program investment across 15 MIC selected based on availability of data, income level classification, and regional representativeness. We assessed investment trends in relation to vaccine coverage, vaccine access, and broader health indicators. Immunization and expenditure data were obtained from the World Health Organisation (WHO) database and the WHO UNICEF Joint Reporting Form and WHO Vaccine Product, Price and Procurement from 2006-2016. We calculated a weighted average index of vaccine commitment (WAIVC) based on vaccine coverage, vaccine scope, and weighted by vaccine innovation measured by approximating vaccine expenditure. Correlation analyses were conducted between immunization expenditure per-capita and each WAIVC, infant mortality and life expectancy. Correlation analyses at a global and individual country level indicate an improvement in immunization access, vaccination commitment measured by WAIVC, and scope of available vaccines in countries with sustained increases in vaccination funding. Increases in national immunization expenditure were correlated with reduced infant mortality and increased life expectancy. Vaccine expenditure comprises a small proportion (less than 2%) of total healthcare spending and has not uniformly increased in accordance with the scope of available vaccines. The present analysis supports the premise that countries with consistent increases in vaccine expenditure have increased vaccine coverage and commitment measured by WAIVC and improved broader health outcomes, indicating the value of sustained investment in vaccination for improved population health. The benefits of vaccine expenditure in this holistic fashion are critical to inform policy decisions on national budget allocation for vaccine funding.


Asunto(s)
Programas de Inmunización , Renta , Cobertura de Vacunación/economía , Vacunación/economía , Vacunas/economía , Países en Desarrollo , Salud Global , Humanos , Programas de Inmunización/economía , Programas de Inmunización/tendencias , Vacunación/tendencias , Cobertura de Vacunación/tendencias , Organización Mundial de la Salud
13.
BMC Res Notes ; 12(1): 84, 2019 Feb 14.
Artículo en Inglés | MEDLINE | ID: mdl-30764874

RESUMEN

OBJECTIVE: To estimate the immunization coverage among children admitted for consultation or hospitalization in health structures of Lomé. RESULTS: A total of 797 respondent-child couples were included and 31.1% of them had their immunization cards. Complete immunization coverage was 69.3%, 95% confidence interval (65.9-72.5) and per antigen, it ranged from 83.1% for measles to 95.7% for BCG. Factors associated with incomplete immunization were the absence of immunization card (p < 0.001), respondents' sex (p < 0.001), level of education (p < 0.001), marital status (p < 0.001) and the level of the health structure in the organization of the Togolese health system (p < 0.001). Obstacles to immunization were mainly the lack of money to pay for immunization fees (38.4%) and forgetting the immunization appointment (28.1%).


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Cobertura de Vacunación/estadística & datos numéricos , Preescolar , Estudios Transversales , Femenino , Accesibilidad a los Servicios de Salud/economía , Humanos , Lactante , Masculino , Factores Socioeconómicos , Togo , Cobertura de Vacunación/economía
14.
Ann Otol Rhinol Laryngol ; 128(4): 309-315, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30595025

RESUMEN

OBJECTIVES:: To investigate vaccine compliance and clinical outcomes after implementation of an initiative to provide the human papillomavirus (HPV) vaccine to all patients with recurrent respiratory papillomatosis (RRP). METHODS:: A retrospective review was performed of all adult patients treated for RRP from 2012 to 2017. Rates of HPV vaccination were evaluated before and after December 2015, when a program was established to increase compliance by educating patients and providing financial assistance toward vaccine administration. Paired sample analyses were conducted to compare intersurgical intervals (ISIs) and number of procedures per year pre- and post-vaccination. RESULTS:: Fourteen patients with RRP completed the HPV vaccine series, with 11 patients undergoing vaccination after the initiative began. The pre-initiative vaccination rate of all patients with RRP was 9.7%; post-initiative rates improved to 43.8% ( P = .004; odds ratio, 7.26). Of vaccinated patients, there were significant differences between mean pre-vaccine ISI (3.5 months) and post-vaccine ISI (12.8 months; P = .0021), as well as between number of surgical procedures performed per year before and after vaccination (2.7 vs 0.81; P = .014). After vaccination, 5 patients demonstrated no evidence of papilloma regrowth for >12 months. CONCLUSIONS:: Initiatives focused on patient education and financial support can successfully boost HPV vaccination rates in an RRP patient cohort. Our research mirrors prior findings that HPV vaccination is correlated with an increase in time between procedures and a decrease in number of procedures needed per year-factors that can dramatically reduce the disease burden on patients coping with RRP.


Asunto(s)
Vacuna Tetravalente Recombinante contra el Virus del Papiloma Humano Tipos 6, 11 , 16, 18/uso terapéutico , Infecciones por Papillomavirus , Cooperación del Paciente/estadística & datos numéricos , Educación del Paciente como Asunto , Infecciones del Sistema Respiratorio , Cobertura de Vacunación , Adulto , Vacunas contra el Cáncer/uso terapéutico , Femenino , Apoyo Financiero , Humanos , Masculino , Papillomaviridae/efectos de los fármacos , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/economía , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/uso terapéutico , Educación del Paciente como Asunto/métodos , Educación del Paciente como Asunto/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/economía , Infecciones del Sistema Respiratorio/prevención & control , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Estados Unidos , Cobertura de Vacunación/economía , Cobertura de Vacunación/métodos , Cobertura de Vacunación/estadística & datos numéricos
15.
Hum Vaccin Immunother ; 15(6): 1302-1309, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30261152

RESUMEN

Background: Cholera is a considerable health burden in developing country settings including Bangladesh. The oral cholera vaccine (OCV) is a preventative tool to control the disease. The objective of this study was to describe whether the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), could provide the OCV to rural communities using existing government infrastructure. Methods: The study was conducted in rural sub-district Keraniganj, 20 km from the capital city Dhaka. All listed participants one year and above in age (excluding pregnant women) were offered two doses of OCV at a 14 day interval. Existing government facilities were used to deliver and also maintain the cold chain required for the vaccine. All events related to vaccination were recorded at the 17 vaccination sites to evaluate the coverage and feasibility of OCV program. Results: A total of 29,029 individuals received the 1st dose (90% of target) and 26,611 individuals received the 2nd dose (83% of target and 92% of 1st dose individuals) of OCV. The highest vaccination coverage was in younger children (1-9 years) and the lowest was amongst 18-29-year age group. Somewhat better coverage was seen amongst the female participants than males (92% vs. 88% for the 1st dose and 93% vs. 90% for the 2nd dose). The cost of vaccine cost was calculated as US$1.00 per dose plus freight, insurance, and transportation and the total vaccine delivery cost was US$70,957. Conclusion: This was a project undertaken using existing public health program resources to collect empirical evidence on the use of a mass OCV campaign in the rural setting. Mass vaccination with the OCV is feasible in the rural setting using existing governmental vaccine delivery systems in Bangladesh.


Asunto(s)
Vacunas contra el Cólera/economía , Cólera/prevención & control , Vacunación Masiva/economía , Vacunación Masiva/organización & administración , Cobertura de Vacunación/organización & administración , Administración Oral , Adolescente , Adulto , Bangladesh , Niño , Preescolar , Vacunas contra el Cólera/administración & dosificación , Costos y Análisis de Costo , Estudios de Factibilidad , Femenino , Humanos , Esquemas de Inmunización , Lactante , Masculino , Vacunación Masiva/estadística & datos numéricos , Persona de Mediana Edad , Mujeres Embarazadas , Refrigeración , Población Rural , Cobertura de Vacunación/economía , Cobertura de Vacunación/estadística & datos numéricos , Adulto Joven
16.
Eur J Public Health ; 29(1): 23-27, 2019 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-30252035

RESUMEN

Background: The French National Cancer Control Plan (NCCP) launched in 2014 set the objective to improve human papillomavirus (HPV) vaccination coverage (VC). The NCCP included a measure to integrate a VC indicator in the pay for performance (P4P) scheme for general practitioners (GPs), which was not implemented. The objective of the study was to analyse the reasons for non-implementation of this measure, using the health policy analysis framework. Methods: The policy from proposal to non-implementation of the HPV VC indicator into the P4P scheme was analysed through the actors involved, the content of the measure, the contextual factors and the processes of policy-making. Results: The actors were the Ministry of Health (MOH) and National Cancer Institute as policy-makers, the public health insurance as an indirect target, and GPs as direct targets. The content of the policy was not evidence-informed and was not included into the NCCP preparation report. The context included vaccine hesitancy and ethical concerns from GPs in opposition with MOH. The process involved a diversity of stakeholders with a complex governance and no strict monitoring of the measure. Conclusions: Complex vaccination policy governance associated with a non-evidence-informed policy content and an unfavourable context may have been the reasons for the policy failure.


Asunto(s)
Política de Salud/economía , Cumplimiento de la Medicación/estadística & datos numéricos , Infecciones por Papillomavirus/prevención & control , Reembolso de Incentivo/economía , Reembolso de Incentivo/estadística & datos numéricos , Cobertura de Vacunación/economía , Cobertura de Vacunación/estadística & datos numéricos , Adulto , Femenino , Médicos Generales , Humanos , Masculino , Persona de Mediana Edad
17.
Hum Vaccin Immunother ; 15(1): 228-234, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30199310

RESUMEN

Hepatitis B vaccination rates in China have recently increased. This study aimed to investigate infant vaccination coverage for birth cohorts from 1997 to 2011 in rural regions and to assess catch-up vaccination potential. We used questionnaire-based interviews from a cross-section of 6,529 individuals from seven provinces. Logistic regression analyses were used to model two measures of infant vaccination status, namely, birth dose within 24 hours and three doses within the first year of life. During interviews, individuals' vaccination status and vaccination plan were recorded. Unvaccinated individuals without plans for future vaccination were presented with a hypothetical offer of free vaccination and indirect cost compensation. Institutional birth rates were higher than vaccination rates, but both increased over time. Vaccination coverage rates were not significantly associated with sex. Infant vaccination coverage was positively associated with a mother's educational level, household income level, knowledge of transmission routes, and perceived duration of protection obtained through vaccination. Vaccination status at the time of the survey showed the occurrence of catch-up vaccinations, but a notable percentage of individuals remained unvaccinated and had no plans for future vaccination. Of these individuals, approximately 50% were prepared to accept vaccination if offered free of charge.


Asunto(s)
Vacunas contra Hepatitis B/administración & dosificación , Hepatitis B/prevención & control , Cobertura de Vacunación/estadística & datos numéricos , China , Estudios de Cohortes , Femenino , Humanos , Lactante , Modelos Logísticos , Masculino , Madres/educación , Madres/psicología , Población Rural , Factores Socioeconómicos , Encuestas y Cuestionarios , Cobertura de Vacunación/economía
18.
Hum Vaccin Immunother ; 15(2): 487-495, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30204043

RESUMEN

Influenza vaccination is an important public health intervention for older adults, yet vaccination rates remain suboptimal. We conducted an online survey of Canadians ≥ 65 years to explore satisfaction with publicly-funded standard-dose influenza vaccines, and perceptions of the need for a more effective product. They were provided with information about currently approved influenza vaccines, and were asked about their preferences should all formulations be available for free, and should the recently approved high-dose (HD) vaccine for seniors be available at a cost. From March to April 2017, 5014 seniors completed the survey; mean age was 71.3 ± 5.17 years, 50% were female, and 42.6% had one or more chronic conditions. 3403 (67.9%) had been vaccinated against influenza in the 2016/17 season. Of all respondents, 3460 (69%) were satisfied with the standard-dose influenza vaccines, yet 3067 (61.1%) thought that a more effective vaccine was/may be needed. If HD was only available at a cost, 1426 (28.4%) respondents would consider it, of whom 62.9% would pay $20 or less. If all vaccines were free next season, 1914 (38.2%) would opt for HD (including 12.2% of those who previously rejected influenza vaccines), 856 (17.1%) would choose adjuvanted vaccine, and 558 (11.1%) standard-dose vaccine. 843 (16.8%) of respondents were against vaccines, 451 (9.0%) had no preference and 392 (7.8%) were uncertain. Making this product available through publicly funded programs may be a strategy to increase immunization rates in this population.


Asunto(s)
Costos de los Medicamentos , Conocimientos, Actitudes y Práctica en Salud , Vacunas contra la Influenza/economía , Gripe Humana/prevención & control , Salud Pública/economía , Anciano , Femenino , Humanos , Vacunas contra la Influenza/clasificación , Masculino , Sistemas en Línea , Salud Pública/estadística & datos numéricos , Encuestas y Cuestionarios , Cobertura de Vacunación/economía
19.
Am J Prev Med ; 56(2): e55-e63, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30522895

RESUMEN

CONTEXT: Children in care of the child welfare system tend to underutilize preventive health services compared with other children. The purpose of this systematic review was to assess current knowledge regarding immunization coverage levels for children in the child welfare system and to determine barriers and supports to them utilizing immunization services. EVIDENCE ACQUISITION: Articles published in Medline, Embase, Cochrane Library, CINAHL, SocINDEX, and ERIC from January 1, 2000 to October 13, 2017 were searched. Thesis and conference databases and relevant websites were also examined. Studies were included if written in English, from high-income countries, and addressed immunizations for children in the child welfare system. Independent dual screening, extraction, and quality appraisal were conducted between October 2016 and December 2017, followed by narrative synthesis. EVIDENCE SYNTHESIS: Of 2,906 records identified, 33 met inclusion criteria: 21 studied coverage, two studied barriers/supports, and ten studied both. Nineteen studies were moderate or high quality and thus included in the narrative synthesis; 15 studied coverage, one studied barriers/supports, and three studied both. Most studies found lower coverage among children in child welfare. The few studies that explicitly studied barriers/supports to immunization identified that a collaborative and coordinated approach between health and social services was key to service delivery to this population. CONCLUSIONS: This review highlights that children in care of the child welfare system are at risk of poor immunization coverage. There is a need for high-quality studies on this issue, with a focus on assessing supports/barriers to immunization in this population.


Asunto(s)
Bienestar del Niño/estadística & datos numéricos , Países Desarrollados/estadística & datos numéricos , Cobertura de Vacunación/estadística & datos numéricos , Niño , Bienestar del Niño/economía , Países Desarrollados/economía , Humanos , Cobertura de Vacunación/economía , Cobertura de Vacunación/organización & administración
20.
Vaccine ; 36(49): 7542-7548, 2018 11 26.
Artículo en Inglés | MEDLINE | ID: mdl-30377065

RESUMEN

BACKGROUND: Myanmar's national immunization program was launched in 1978. Routine immunization is mainly provided at sub-center level with midwives assigned as main vaccinators. The vaccinators at the sub-centers have to obtain vaccines from their designated township health department's cold room for immunization services. This study aimed to calculate the operational costs of routine immunization at sub-centers in Myanmar. METHODS: A cross-sectional study was conducted among 160 sub-centers throughout the country. Face-to-face interviews were conducted with the main vaccinator at each sub-center using a pre-tested questionnaire. The study analyzed the operational costs per facility and the associations between sub-center characteristics and operational costs. RESULTS: In Myanmar, the average operational costs of routine immunization per sub-center ranged from 434,700-990,125 MMK for rural areas and 235,875-674,250 MMK for urban areas. The operational costs increased by 8,749.50 MMK (95% CI: 6,805.79-10,693.21; p < 0.001) per mile and 5,752.50 MMK (95% CI: 914.22-10,590.79; p < 0.05) per working day. CONCLUSION: This study indicated that the operational costs at sub-centers were high and varied significantly among the different geographical areas. The operational costs could be reduced by additional support for the resources, for example, installing cold chain facilities at sub-centers and opening new sub-centers throughout the country.


Asunto(s)
Programas de Inmunización/economía , Cobertura de Vacunación/economía , Estudios Transversales , Geografía/economía , Costos de la Atención en Salud , Instituciones de Salud , Mianmar , Refrigeración , Encuestas y Cuestionarios , Vacunas/administración & dosificación , Vacunas/economía
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