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1.
J Manag Care Spec Pharm ; 26(1): 42-47, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31880234

RESUMEN

BACKGROUND: Influenza (also known as "flu") is estimated to cause between 12,000 and 79,000 deaths annually. Vaccinations are beneficial in preventing influenza cases and reducing the likelihood of severe outcomes. Unfortunately, vaccination coverage is low among uninsured populations. Removing the cost barrier can help increase vaccination coverage in this group, averting flu cases and related morbidity and costs. OBJECTIVE: To model the potential effect of providing no-cost flu vaccinations to uninsured individuals on influenza-related morbidity, mortality, and costs. METHODS: In collaboration with the Department of Health and Human Services and local agencies, Walgreens pharmacies provided free flu vaccinations through a nationwide voucher distribution program. We calculated the redemption rate, potentially averted cases, and estimated cost savings for the 2015-2016 and 2016-2017 flu seasons. Using incidence and vaccine effectiveness estimates from the Centers for Disease Control and Prevention, we calculated the rate of influenza in the general population and the estimated cases averted based on the number of redeemed vouchers. We applied patient age along with parameters from published studies to estimate averted ambulatory care visits, hospitalizations, mortality, productively losses, and overall related costs. RESULTS: During the 2015-2016 flu season, the pharmacy chain distributed 600,000 vouchers with a redemption rate of 52.3%, resulting in 314,033 flu vaccinations. Improvements were subsequently made to the distribution process to increase utilization rates. There were 400,000 vouchers distributed during the 2016-2017 season with a higher redemption rate of 87.2%, resulting in 348,924 flu vaccinations. The estimated number of potentially averted cases was higher during the 2016-2017 season (13,347) than the 2015-2016 season (11,537) due to a higher redemption rate and increased flu activity. Taken together, we estimated that 8,621 ambulatory care visits, 314 hospitalizations, and 15 deaths were averted due to the flu voucher program. Averted health care costs totaled $937,494 in ambulatory care visits and $3,510,055 in hospitalizations. Averted productivity losses ranged from $4,473,509 to $14,613,502. CONCLUSIONS: This study demonstrates the effectiveness of a pharmacy-led partnership with local community-based organizations to promote flu vaccinations among uninsured individuals. Our model found that a no-cost flu voucher program has the potential to reduce influenza-related morbidity, mortality, and costs. DISCLOSURES: This study was funded by Walgreen Co. All authors are employees of Walgreen Co. and affiliated with Walgreens Center for Health and Wellbeing Research. Findings from this study were presented as a podium presentation at the Academy of Managed Care Pharmacy Nexus 2018; October 22-25, 2018; Orlando, FL.


Asunto(s)
Servicios Comunitarios de Farmacia/economía , Costos de los Medicamentos , Accesibilidad a los Servicios de Salud/economía , Vacunas contra la Influenza/administración & dosificación , Vacunas contra la Influenza/economía , Gripe Humana/economía , Gripe Humana/prevención & control , Vacunación Masiva/economía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Servicios Comunitarios de Farmacia/organización & administración , Ahorro de Costo , Análisis Costo-Beneficio , Femenino , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Vacunas contra la Influenza/efectos adversos , Gripe Humana/mortalidad , Masculino , Vacunación Masiva/efectos adversos , Vacunación Masiva/mortalidad , Pacientes no Asegurados , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos/epidemiología , Adulto Joven
3.
Nat Commun ; 10(1): 5310, 2019 11 22.
Artículo en Inglés | MEDLINE | ID: mdl-31757953

RESUMEN

The role of Africa in the dynamics of the global spread of a zoonotic and economically-important virus, such as the highly pathogenic avian influenza (HPAI) H5Nx of the Gs/GD lineage, remains unexplored. Here we characterise the spatiotemporal patterns of virus diffusion during three HPAI H5Nx intercontinental epidemic waves and demonstrate that Africa mainly acted as an ecological sink of the HPAI H5Nx viruses. A joint analysis of host dynamics and continuous spatial diffusion indicates that poultry trade as well as wild bird migrations have contributed to the virus spreading into Africa, with West Africa acting as a crucial hotspot for virus introduction and dissemination into the continent. We demonstrate varying paths of avian influenza incursions into Africa as well as virus spread within Africa over time, which reveal that virus expansion is a complex phenomenon, shaped by an intricate interplay between avian host ecology, virus characteristics and environmental variables.


Asunto(s)
Gripe Aviar/transmisión , Gripe Humana/transmisión , Enfermedades de las Aves de Corral/transmisión , África , África Occidental , Animales , Humanos , Subtipo H5N1 del Virus de la Influenza A/genética , Subtipo H5N8 del Virus de la Influenza A/genética , Virus de la Influenza A/genética , Gripe Aviar/economía , Gripe Aviar/epidemiología , Gripe Aviar/virología , Gripe Humana/economía , Gripe Humana/epidemiología , Gripe Humana/virología , Filogenia , Aves de Corral , Enfermedades de las Aves de Corral/economía , Enfermedades de las Aves de Corral/epidemiología , Enfermedades de las Aves de Corral/virología
4.
Proc Natl Acad Sci U S A ; 116(41): 20786-20792, 2019 10 08.
Artículo en Inglés | MEDLINE | ID: mdl-31548402

RESUMEN

The efficacy of influenza vaccines, currently at 44%, is limited by the rapid antigenic evolution of the virus and a manufacturing process that can lead to vaccine mismatch. The National Institute of Allergy and Infectious Diseases (NIAID) recently identified the development of a universal influenza vaccine with an efficacy of at least 75% as a high scientific priority. The US Congress approved $130 million funding for the 2019 fiscal year to support the development of a universal vaccine, and another $1 billion over 5 y has been proposed in the Flu Vaccine Act. Using a model of influenza transmission, we evaluated the population-level impacts of universal influenza vaccines distributed according to empirical age-specific coverage at multiple scales in the United States. We estimate that replacing just 10% of typical seasonal vaccines with 75% efficacious universal vaccines would avert ∼5.3 million cases, 81,000 hospitalizations, and 6,300 influenza-related deaths per year. This would prevent over $1.1 billion in direct health care costs compared to a typical season, based on average data from the 2010-11 to 2018-19 seasons. A complete replacement of seasonal vaccines with universal vaccines is projected to prevent 17 million cases, 251,000 hospitalizations, 19,500 deaths, and $3.5 billion in direct health care costs. States with high per-hospitalization medical expenses along with a large proportion of elderly residents are expected to receive the maximum economic benefit. Replacing even a fraction of seasonal vaccines with universal vaccines justifies the substantial cost of vaccine development.


Asunto(s)
Análisis Costo-Beneficio , Costos de la Atención en Salud/estadística & datos numéricos , Hospitalización/economía , Vacunas contra la Influenza/economía , Gripe Humana/economía , Gripe Humana/prevención & control , Vacunación/economía , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Virus de la Influenza A/aislamiento & purificación , Vacunas contra la Influenza/uso terapéutico , Gripe Humana/epidemiología , Masculino , Persona de Mediana Edad , Estaciones del Año , Estados Unidos/epidemiología , Vacunación/métodos , Adulto Joven
5.
BMC Health Serv Res ; 19(1): 585, 2019 Aug 19.
Artículo en Inglés | MEDLINE | ID: mdl-31426795

RESUMEN

BACKGROUND: Influenza-like illnesses (ILIs) and lower respiratory tract infections (LRTIs) cause substantial morbidity and mortality worldwide. The study assessed the health and economic burden of ILI and LRTI according to age and comorbidities, since available evidence is limited and heterogeneous. METHOD: The prevalence of comorbidities, the seasonal incidence rates and the mean and per capita direct costs of ED accesses for ILI/LRTI, whether followed by hospitalization or not, recorded in adults aged ≥50 years over the last 6 years, in the referral hospitals located in the Genoese metropolitan area (Liguria, Italy) where the syndromic surveillance system is active, were evaluated through a retrospective observational study. Comorbidities were estimated through the Chronic Condition Data Warehouse that integrates multiple Medicare data sources. A comparison with the administrative healthcare International Classification of Diseases-9th revision-Clinical Modification (ICD-9-CM)-based data was also conducted. RESULTS: The prevalence of subjects with ≥1 comorbidity ranged from 23.49 to 59.92%. The most prevalent all-age comorbidities were cardiovascular diseases and cancer. The overall ILI/LRTI incidence rate was 6.73/1000 person-years, almost double the value derived from routine data, and increased with age. The highest rates were observed in patients with renal failure and bronchopneumopathies. The mean cost of ED accesses/hospitalization for ILI/LRTI was €3353 and was almost twice as high in the ≥85 years as in the youngest age-group. The highest mean costs were observed in patients with renal failure and cancer. The per capita costs increased from €4 to €71 with age, and were highest in patients with renal failure and bronchopneumopathy. CONCLUSION: The burden of ILIs/LRTIs in terms of ED accesses and hospitalizations in adults aged ≥50 years is heavy, and is related to increasing age and, especially, to specific comorbidities. These results could contribute to revising age- and risk-based anti-influenza and -pneumococcus immunization strategies.


Asunto(s)
Costo de Enfermedad , Gripe Humana/economía , Infecciones del Sistema Respiratorio/economía , Anciano , Anciano de 80 o más Años , Comorbilidad , Femenino , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Inmunización , Vacunas contra la Influenza , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Italia/epidemiología , Masculino , Persona de Mediana Edad , Morbilidad , Prevalencia , Derivación y Consulta/estadística & datos numéricos , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/prevención & control , Estudios Retrospectivos , Vigilancia de Guardia , Vacunación/economía , Vacunación/estadística & datos numéricos
6.
BMC Public Health ; 19(1): 1090, 2019 Aug 13.
Artículo en Inglés | MEDLINE | ID: mdl-31409319

RESUMEN

BACKGROUND: Seasonal influenza contributes substantially to the burden of communicable diseases in Europe, especially among paediatric populations and the elderly. The aim of the present study was to estimate the incidence of seasonal influenza in Germany, the probabilities of related complications and the economic burden of influenza per case and on a population level for different age groups. METHODS: Claims data from 2012 to 2014 from > 8 million insured of a large German sick-ness fund were analysed. A matched case control study was used on a sub-sample of 100,000 influenza cases to calculate complication rates for ear infections/acute otitis media (AOM) and community-acquired pneumonia (CAP) as well as resource use and costs for seven age groups. RESULTS: Incidence of seasonal influenza varies between the years and is highest among infants and children 2 to 5 years of age. AOM is more likely in the younger age groups with up to 14% more patients in the influenza group than in the control group. CAP is more frequently observed in the younger age groups and in influenza patients 60 years and older. The manifestation of one influenza complication (AOM or CAP) significantly in-creases the occurrence of a second complication (AOM or CAP). The economic burden per case is highest in infants (€251.91) and persons over 60 years of age (€131.59). CONCLUSION: The burden of influenza is highest among infants and young children, which is also reflected in the economic burden. Influenza related costs per case are nearly double for infants compared to persons over 60 years of age.


Asunto(s)
Costo de Enfermedad , Gripe Humana/economía , Gripe Humana/epidemiología , Adolescente , Adulto , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Alemania/epidemiología , Humanos , Incidencia , Lactante , Recién Nacido , Revisión de Utilización de Seguros , Masculino , Persona de Mediana Edad , Estaciones del Año , Adulto Joven
7.
Artículo en Inglés | MEDLINE | ID: mdl-31277347

RESUMEN

BACKGROUND: Seasonal influenza causes significant morbidity worldwide and has a substantial economic impact on the healthcare system. OBJECTIVE: To assess the cost-benefit relation of implementing a real-time influenza test in emergency rooms (ER) of German hospitals. METHODS: A deterministic decision-analytic model was developed simulating the incremental costs of using the Solana® Influenza A+B test, compared to those of using conventional clinical judgement alone to confirm or exclude influenza in adult ILI (influenza-like illness) patients, in German ER, prior to hospitalization. Direct costs were evaluated from the hospital perspective, considering resource use directly related to influenza testing and treatment, as well as indirect costs incurred by nosocomial influenza transmission. RESULTS: Through base-case analysis and assuming an influenza prevalence of 42.6%, real-time testing with Solana® reduced average costs of hospitalized ILI patients by €132.61, per tested patient. Moreover, the Solana® saved €6.9 per tested patient in favor of the hospital. In probabilistic sensitivity analysis, under all reasonable assumptions, implementing the Solana® saved on average €144.13 as compared to applying the clinical-judgement-only strategy, thus, it was found to be constantly less expensive. CONCLUSIONS: Using highly sensitive and specific real-time influenza tests in ILI patients at German ER might significantly reduce hospital expenditures.


Asunto(s)
Servicio de Urgencia en Hospital/economía , Gripe Humana/diagnóstico , Gripe Humana/economía , Análisis Costo-Beneficio , Técnicas y Procedimientos Diagnósticos , Humanos
8.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(7): 713-718, 2019 Jul 06.
Artículo en Chino | MEDLINE | ID: mdl-31288343

RESUMEN

Objective: The objective of this study was to analyze the disease burden of influenza in schools and child care settings in rural areas of Hangzhou. Methods: Hospital visit influenza cases aged 3-17 years in hospitals that reported based on influenza surveillance system from 2016 to 2018 in Chun'an county, Hangzhou city were selected as study subjects and a total of 294 confirmed cases of influenza were selected using system sampling method. Questionnaires were designed to investigate the basic information and data on inpatients and outpatients among, health care and life quality, etc.. Direct and indirect economic burden and disability adjusted life year (DALY) were analyzed and compared among different age groups. Results: The mean age of investigated subjects was (8.88±3.92) years. A total of 143 (48.64%) investigated cases were male. In total of 283 (96.26%) cases were outpatients. The total economic burden was 124 743.95 CNY. The mean economic burden was 424.30 CNY per person. The mean direct and indirect economic burden was 361.33 and 62.97 CNY per person respectively. The difference of the mean direct, indirect and total economic burden per person between different age group was statistically significant (P<0.001). The 3-5 years age group showed the highest economic burden with the median value of direct, indirect and total economic burden per person being 276.24, 50.98 and 321.26 CNY, respectively, while the 12-17 years age group showed the lowest values with 175.30, 26.54, 201.79 CNY, respectively. The DALY of 294 influenza cases was 1.18, and the median of burden strength was 3.21 DALY/thousand. The difference of the burden of strength between different age group influenza case was statistically significant (P<0.001), of which the 12-17 years age group showed the highest value with 4.25 DALYs/thousand while the 3-5 years age group showed the lowest value with 2.60 DALY/thousand. Conclusion: The disease burden of influenza was heavy in schools and kindergartens in rural areas of Hangzhou city, with the cases aged from 3 to 5 years showing higher economic burden and cases aged from 12 to 17 years showing greater burden strength.


Asunto(s)
Cuidado del Niño/estadística & datos numéricos , Costo de Enfermedad , Gripe Humana/economía , Gripe Humana/epidemiología , Población Rural/estadística & datos numéricos , Instituciones Académicas/estadística & datos numéricos , Adolescente , Distribución por Edad , Niño , Preescolar , China/epidemiología , Femenino , Humanos , Masculino , Años de Vida Ajustados por Calidad de Vida
9.
Med. clín (Ed. impr.) ; 153(1): 16-27, jul. 2019. graf, tab
Artículo en Español | IBECS | ID: ibc-183353

RESUMEN

Con el objetivo de analizar la carga clínica, el impacto económico de la gripe y la eficiencia de los programas de vacunación antigripal en España, se ha llevado a cabo una revisión de la literatura. La incidencia media de gripe en España se sitúa en 2.069 casos por 100.000 habitantes, con un impacto relevante en mortalidad y la disminución de la calidad de vida relacionada con la salud. En cuanto a los costes asociados, la gripe genera todos los años una importante carga en atención primaria, hospitalaria, tratamientos y absentismo laboral, que podrían suponer hasta 1.000 millones de euros anuales. La vacunación es una medida eficiente para su prevención y puede generar ahorros para el sistema de salud. En conclusión, la gripe es un problema de salud relevante que anualmente genera una carga económica y clínica importante, pero cuya caracterización y medición deben ser mejoradas


A literature review has been carried out to analyse the clinical burden, the economic impact of influenza and the efficiency of influenza vaccination programmes in Spain. The average incidence rate of influenza in Spain is 2,069 cases per 100,000 inhabitants, with a significant impact on mortality and a reduction of health-related quality of life. In terms of its associated costs, influenza causes a significant burden on primary care, hospitals, treatments and absences from work every year, which could total one billion euros per year. Vaccination is an efficient measure for its prevention and can generate savings for the healthcare system. In conclusion, influenza is a significant health problem which generates a major economic and clinical burden annually; the profiling and measurement of which must be improved


Asunto(s)
Humanos , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Vacunas contra la Influenza , Gripe Humana/economía , Gripe Humana/epidemiología , Atención Primaria de Salud , España/epidemiología , Evaluación en Salud , Evaluación del Impacto en la Salud/economía
11.
Influenza Other Respir Viruses ; 13(5): 484-495, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31187609

RESUMEN

BACKGROUND: Economic burden estimates are essential to guide policy-making for influenza vaccination, especially in resource-limited settings. METHODS: We estimated the cost, absenteeism, and years of life lost (YLL) of medically and non-medically attended influenza-associated mild and severe respiratory, circulatory and non-respiratory/non-circulatory illness in South Africa during 2013-2015 using a modified version of the World Health Organization (WHO) worksheet based tool for estimating the economic burden of seasonal influenza. Additionally, we restricted the analysis to influenza-associated severe acute respiratory illness (SARI) and influenza-like illness (ILI; subsets of all-respiratory illnesses) as suggested in the WHO manual. RESULTS: The estimated mean annual cost of influenza-associated illness was $270.5 million, of which $111.3 million (41%) were government-incurred costs, 40.7 million (15%) were out-of-pocket expenses, and $118.4 million (44%) were indirect costs. The cost of influenza-associated medically attended mild illness ($107.9 million) was 2.3 times higher than that of severe illness ($47.1 million). Influenza-associated respiratory illness costs ($251.4 million) accounted for 93% of the total cost. Estimated absenteeism and YLL were 13.2 million days and 304 867 years, respectively. Among patients with influenza-associated WHO-defined ILI or SARI, the costs ($95.3 million), absenteeism (4.5 million days), and YLL (65 697) were 35%, 34%, and 21% of the total economic and health burden of influenza. CONCLUSION: The economic burden of influenza-associated illness was substantial from both a government and a societal perspective. Models that limit estimates to those obtained from patients with WHO-defined ILI or SARI substantially underestimated the total economic and health burden of influenza-associated illness.


Asunto(s)
Absentismo , Costo de Enfermedad , Hospitalización/economía , Gripe Humana/economía , Esperanza de Vida , Hospitalización/estadística & datos numéricos , Humanos , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/complicaciones , Gripe Humana/epidemiología , Estaciones del Año , Vigilancia de Guardia , Sudáfrica/epidemiología , Vacunación/legislación & jurisprudencia
12.
BMJ Open ; 9(4): e027832, 2019 04 03.
Artículo en Inglés | MEDLINE | ID: mdl-30948617

RESUMEN

OBJECTIVES: To quantify population-level health and economic consequences of sick leave among workers with influenza symptoms. INTERVENTIONS: Compared with current sick leave practice (baseline), we evaluated the health and cost consequences of: (1) increasing the proportion of workers on sick leave from 65% (baseline) to 80% or 90%; (2) shortening the maximum duration from symptom onset to sick leave from 4 days (baseline) to 2 days, 1.5 days, 1 day and 0.5 days; and (3) combinations of 1 and 2. METHODS: A dynamic compartmental influenza model was developed using Norwegian population data and survey data on employee sick leave practices. The sick leave interventions were simulated under 12 different seasonal epidemic and 36 different pandemic influenza scenarios. These scenarios varied in terms of transmissibility, the proportion of symptomatic cases and illness severity (risk of primary care consultations, hospitalisations and deaths). Using probabilistic sensitivity analyses, a net health benefit approach was adopted to assess the cost-effectiveness of the interventions from a societal perspective. RESULTS: Compared with current sick leave practice, sick leave interventions were cost-effective for 31 (65%) of the pandemic scenarios, and 11 (92%) of the seasonal scenarios. Economic benefits from sick leave interventions were greatest for scenarios with low transmissibility, high symptomatic proportions and high illness severity. Overall, the health and economic benefits were greatest for the intervention involving 90% of sick workers taking sick leave within one-half day of symptoms. Depending on the influenza scenario, this intervention resulted in a 44.4%-99.7% reduction in the attack rate. Interventions involving sick leave onset beginning 2 days or later, after the onset of symptoms, resulted in economic losses. CONCLUSIONS: Prompt sick leave onset and a high proportion of sick leave among workers with influenza symptoms may be cost-effective, particularly during influenza epidemics and pandemics with low transmissibility or high morbidity.


Asunto(s)
Gripe Humana/economía , Pandemias , Ausencia por Enfermedad/economía , Absentismo , Adulto , Análisis Costo-Beneficio , Femenino , Humanos , Gripe Humana/epidemiología , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Salud Laboral/estadística & datos numéricos , Estaciones del Año , Ausencia por Enfermedad/estadística & datos numéricos , Adulto Joven
13.
BMC Infect Dis ; 19(1): 308, 2019 Apr 04.
Artículo en Inglés | MEDLINE | ID: mdl-30947693

RESUMEN

BACKGROUND: Despite World Health Organization recommendations, in many countries young children are not targeted for influenza vaccination. To help inform influenza vaccination policy, we examined the occurrence and burden of influenza in healthy children aged 6 to 35 months using data from a recent phase III placebo-controlled influenza vaccine trial conducted in countries in the Northern and Southern Hemispheres. METHODS: This was an analysis of data from participants included in the placebo arm of a phase III clinical trial in healthy children aged 6 to 35 months (EudraCT no. 2013-001231-51). Included children had never been vaccinated for influenza and were observed for one influenza season. Outcome measures included the occurrence of influenza-like illness (ILI), laboratory-confirmed influenza, virus types/subtypes, severe symptoms and complications of confirmed influenza, and healthcare use associated with confirmed influenza. RESULTS: Data from 2210 participants were analysed. ILI was reported for 811 participants (36.7%). Of these, 255 participants (31.4%) had 263 virologically confirmed episodes of influenza. The overall influenza attack rate was 11.5%. The most common influenza virus detected was A(H3N2) (40.7%), followed by B/Yamagata (23.6%), A(H1N1) (18.6%), and B/Victoria (8.0%). Grade 3 fever was reported in 24.3% of confirmed episodes, acute lower respiratory infection in 8.7%, acute otitis media in 6.1%, and pneumonia in 1.9%. In most influenza episodes (93.2%), antipyretics, analgesics, or non-steroidal anti-inflammatory drugs were taken. Antibiotics were prescribed for 41.4% of influenza episodes. More than half of the influenza episodes (57.0%) resulted in outpatient visits. Influenza resulted in overnight hospitalisation in 1.1% of episodes. CONCLUSIONS: Influenza is associated with a significant burden of disease in healthy children. This analysis also revealed that antibiotics continue to be frequently used for young children with influenza. TRIAL REGISTRATION: EudraCT no. 2013-001231-51 .


Asunto(s)
Gripe Humana/epidemiología , Evaluación de Resultado en la Atención de Salud , Antibacterianos/uso terapéutico , Antipiréticos/uso terapéutico , Preescolar , Costo de Enfermedad , Femenino , Humanos , Lactante , Subtipo H1N1 del Virus de la Influenza A/genética , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Subtipo H3N2 del Virus de la Influenza A/genética , Subtipo H3N2 del Virus de la Influenza A/aislamiento & purificación , Vacunas contra la Influenza/inmunología , Gripe Humana/economía , Gripe Humana/patología , Gripe Humana/virología , Masculino , Efecto Placebo , ARN Viral/genética , ARN Viral/metabolismo , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/epidemiología , Índice de Severidad de la Enfermedad
14.
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
15.
Artículo en Inglés | MEDLINE | ID: mdl-30832264

RESUMEN

This study aims to estimate the economic costs of sickness absenteeism of health care workers in a large Italian teaching hospital during the seasonal flu periods. A retrospective observational study was performed. The excess data of hospital's sickness absenteeism during three seasonal influenza periods (2010/2011; 2011/2012; 2012/2013) came from a previous study. The cost of sickness absenteeism was calculated for six job categories: medical doctor, technical executive (i.e., pharmacists); nurses and allied health professionals (i.e., radiographer), other executives (i.e., engineer), non-medical support staff, and administrative staff, and for four age ranges: <39, 40⁻49, 50⁻59, and >59 years. An average of 5401 employees working each year were under study. There were over 11,100 working days/year lost associated with an influenza period in Italy, the costs associated were approximately 1.7 million euros, and the average work loss was valued at € 327/person. The major shares of cost appeared related to nurses and allied health professionals (45% of total costs). The highest costs for working days lost were reported in the 40⁻49 age range, accounting for 37% of total costs. Due to the substantial economic burden of sickness absenteeism, there are clear benefits to be gained from the effective prevention of the influenza.


Asunto(s)
Absentismo , Costo de Enfermedad , Brotes de Enfermedades/economía , Gripe Humana/economía , Gripe Humana/epidemiología , Estaciones del Año , Adulto , Femenino , Personal de Salud , Hospitales de Enseñanza , Humanos , Italia/epidemiología , Masculino , Estudios Retrospectivos
16.
BMC Public Health ; 19(1): 280, 2019 Mar 08.
Artículo en Inglés | MEDLINE | ID: mdl-30849942

RESUMEN

BACKGROUND: Like other countries, Japan experiences a seasonal influenza epidemic every year. In order to return to school after a influenza-related absence, most Japanese students are required to submit a recovery certificate (chiyu-shoumeisyo in Japanese). The objective of this study was to estimate the economic consequences of this practice. METHODS: A cost analysis was conducted to estimate the additional costs incurred by the issuance of recovery certificates from a restricted societal perspective. The estimated number of influenza patients under 15 years old from the 2013/14 season to the 2017/18 season, the proportion of working mothers were used to calculate the estimated total number of recovery certificates issued per year. The cost of return visits to physicians and the cost for issuing certificates were included in the direct costs. Productivity loss was estimated using the mean monthly salary of women and was included in indirect costs. RESULTS: The recovery certificate policy imposed an additional cost of 0.94 million USD per one million population. One-way deterministic sensitivity analysis demonstrated that the additional cost of the recovery certificate policy amounted to between 0.55 and 2.27 million USD per one million population. Probabilistic sensitivity analysis showed similar results. CONCLUSIONS: The recovery certificate policy has a substantial negative economic impact on the Japanese healthcare system and society from a restricted societal perspective.


Asunto(s)
Eficiencia , Gripe Humana/economía , Política Organizacional , Instituciones Académicas/organización & administración , Adolescente , Niño , Análisis Costo-Beneficio , Costos y Análisis de Costo , Femenino , Costos de la Atención en Salud , Humanos , Japón , Políticas , Salarios y Beneficios , Mujeres Trabajadoras
17.
Arch Pediatr ; 26(1): 6-11, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30558857

RESUMEN

OBJECTIVE: The objective of this study was to evaluate the impact of a rapid diagnostic test for influenza (the Sofia® Influenza A+B FIA rapid diagnostic test [RDT]) in a pediatric emergency department (PED). METHODS: A retrospective, observational, cross-sectional study was conducted in the PED of the Lille University Hospital between 2013 and 2015. All patients under 18 years of age for whom influenza RDT was administered were included. Clinical data, management, and related hospitalizations were compared between positive and negative RDT groups. The length of stay in the PED (main outcome) and the number of additional tests (biological and radiographic tests) between the two groups were compared. RESULTS: A total of 238 tests were reported: 119 positive, 110 negative, nine invalid. The mean length of stay in the PED was significantly lower in the positive RDT group: 4.0h vs. 7.4h (P<10-6). Patients with positive RDT had significantly fewer biological tests (20% vs. 56%; P<10-7) and radiographs (23% vs. 52%; P<10-5). The prevalence of hospitalizations in a short-stay unit was significantly lower in patients with positive RDT (0.8% vs. 9.1%; P=0.009). CONCLUSIONS: This study showed a significant medical impact of the use of Sofia® Influenza RDT A+B FIA in a PED regarding the length of stay and the number of additional explorations.


Asunto(s)
Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Fluoroinmunoensayo/estadística & datos numéricos , Gripe Humana/diagnóstico , Adolescente , Niño , Preescolar , Análisis Costo-Beneficio , Estudios Transversales , Pruebas Diagnósticas de Rutina/economía , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Fluoroinmunoensayo/economía , Francia , Hospitalización/estadística & datos numéricos , Hospitales Pediátricos/estadística & datos numéricos , Hospitales Universitarios/estadística & datos numéricos , Humanos , Lactante , Virus de la Influenza A/genética , Virus de la Influenza B/genética , Gripe Humana/economía , Tiempo de Internación/estadística & datos numéricos , Masculino , Estudios Retrospectivos , Sensibilidad y Especificidad
18.
Clin Microbiol Infect ; 25(7): 898-903, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30502486

RESUMEN

OBJECTIVES: This prospective study performed in the paediatric emergency department of the University Hospital of Saint-Etienne aimed to measure the impact of the 24/7 bedside use of the Veritor™ System (Becton Dickinson) on the reduction of supplementary investigations, hospital stay and antimicrobial use. METHODS: Influenza virus A and B antigens were detected with a rapid influenza digital immunoassay (DIA) on nasopharyngeal aspirates (NPAs) sampled from the children consulting at the paediatric emergency department between January and March 2016 for influenza-like illness. The same NPA was tested by immunofluorescence and/or molecular routine assays. Before performing the DIA, the clinician filled in a questionnaire listing the tests that he/she would have prescribed in the absence of the rapid testing. The prescription of complementary investigations, antimicrobial treatments and hospital stay were also compared to those of the 3 previous years. RESULTS: A total of 514 children with flu-like symptoms were included. The use of the DIA at bedside decreased the prescription of blood puncture by 47.9% (21.2% to 6.6%), of chest X-rays by 69.0% (33.3% to 10.3%), of lumbar puncture by 77.8% (7.0% to 1.6%), of urine culture by 79.2% (23.3% to 4.9%), of antibiotic treatments by 70.1% (16.9% to 5.1%), and of hospital stay by 25.0% (27.2% to 20.4%), resulting in a reduction of medical costs estimated to more than €69 000 in a season. CONCLUSIONS: In addition to delivering a rapid aetiological diagnosis, this strategy saves medical costs and favours an antimicrobial stewardship strategy. However, further prospective studies are needed to confirm our findings.


Asunto(s)
Servicio de Urgencia en Hospital , Gripe Humana/diagnóstico , Pruebas en el Punto de Atención/economía , Adolescente , Niño , Preescolar , Análisis Costo-Beneficio , Femenino , Hospitales Universitarios , Humanos , Inmunoensayo , Lactante , Recién Nacido , Virus de la Influenza A , Virus de la Influenza B , Gripe Humana/economía , Masculino , Nasofaringe/virología , Pruebas en el Punto de Atención/normas , Estudios Prospectivos , Sensibilidad y Especificidad
19.
Clin Pediatr (Phila) ; 58(2): 177-184, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30387696

RESUMEN

We reviewed the resource utilization of patients with human rhinovirus/enterovirus (HRV/ENT), influenza A/B (FLU), or respiratory syncytial virus (RSV). A total of 2013 patients with nasopharyngeal swabs positive for HRV/ENT, RSV, or FLU were included. Records were reviewed for respiratory support, vascular access procedures, emergency department care only versus admission versus pediatric intensive care unit (PICU) care, antibiotics, length of stay, and billing data. Of the 2013 subjects, 1251 tested positive for HRV/ENT, 558 for RSV, and 204 for FLU. Fewer HRV/ENT patients were discharged from the emergency department ( P < .001); and they were more likely to be admitted to the pediatric intensive care unit ( P < .001). HRV/ENT and RSV patients were more likely to require invasive procedures ( P = .01). Median hospital costs for HRV/ENT patients were more than twice that of FLU patients ( P < .001). HRV/ENT infection in pediatric patients poses a significant resource and cost burden, even when compared with other organisms.


Asunto(s)
Infecciones por Enterovirus/economía , Costos de la Atención en Salud/estadística & datos numéricos , Recursos en Salud/estadística & datos numéricos , Gripe Humana/economía , Infecciones por Picornaviridae/economía , Infecciones por Virus Sincitial Respiratorio/economía , Niño , Preescolar , Infecciones por Enterovirus/terapia , Femenino , Humanos , Lactante , Gripe Humana/terapia , Unidades de Cuidado Intensivo Pediátrico/economía , Tiempo de Internación/estadística & datos numéricos , Masculino , Infecciones por Picornaviridae/terapia , Infecciones por Virus Sincitial Respiratorio/terapia
20.
Korean J Intern Med ; 34(5): 1136-1144, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-29232939

RESUMEN

BACKGROUND/AIMS: Unlike Western countries, the 2009 pandemic influenza infection among pregnant women was reported as mild in a previous interim study in South Korea. However, several mortalities were reported thereafter, suggesting that nationwide data were lacking. METHODS: This case-control study covers the entire 2009 pandemic inf luenza period, from May 2009 to February 2010. The clinical and economic data of pregnant (case) and age-matched non-pregnant (control) women with influenza A (H1N1) pdm09 virus (H1N1pdm09) infection were retrospectively collected from nine hospitals in South Korea. RESULTS: A total of 130 pregnant women with H1N1pdm09 infection were identified. The mean age of the pregnant women was 31.1 years (range, 19 to 41) and mean gestational age was 18.4 weeks (range, 3 to 40). Both case and control groups were similar in terms of age (p = 0.43) and comorbidities (p = 0.18). The overall rate of complications was comparable between the two groups (p = 0.648). However, mortality was reported only among the cases, so mean economic per capita burden is estimated to be higher for pregnant women compared to the control (4,821,992 Korean won [KRW] vs. 351,233 KRW, p = 0.31). Obstetric complications were observed in 12 cases, including preterm labor (n = 7), low birth-weight (n = 3), miscarriage (n = 1), stillbirth (n = 1), and cleft lip (n = 1). CONCLUSION: Although statistically insignificant, the detrimental impact of influenza A H1N1pdm09 on pregnancy can be serious in some complicated cases in South Korea. Thus, the strong recommendation of influenza vaccination should be maintained for pregnant women as a high priority.


Asunto(s)
Subtipo H1N1 del Virus de la Influenza A/patogenicidad , Gripe Humana/epidemiología , Pandemias , Complicaciones del Embarazo/epidemiología , Adulto , Costo de Enfermedad , Femenino , Costos de la Atención en Salud , Estado de Salud , Humanos , Gripe Humana/economía , Gripe Humana/mortalidad , Gripe Humana/virología , Pandemias/economía , Embarazo , Complicaciones del Embarazo/economía , Complicaciones del Embarazo/mortalidad , Complicaciones del Embarazo/virología , Resultado del Embarazo , República de Corea/epidemiología , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Adulto Joven
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