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1.
Value Health ; 23(2): 200-208, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32113625

RESUMEN

OBJECTIVES: To identify how monetary incentives affect influenza vaccination uptake rate using a randomized control experiment and to subsequently design an optimal incentive program in Singapore, a high-income country with a market-based healthcare system. METHODS: 4000 people aged ≥65 were randomly assigned to 4 treatment groups (1000 each) and were offered a monetary incentive (in shopping vouchers) if they chose to participate. The baseline group was invited to complete a questionnaire with incentives of 10 Singapore dollars (SGD; where 1 SGD ≈ 0.73 USD), whereas the other three groups were invited to complete the questionnaire and be vaccinated against influenza at their own cost of around 32 SGD, in return for incentives of 10, 20, or 30 SGD. RESULTS: Increasing the total incentive for vaccination and reporting from 10 to 20 SGD increased participation in vaccination from 4.5% to 7.5% (P < .001). Increasing the total incentive from 20 to 30 SGD increased the participation rate to 9.2%, but this was not statistically significantly different from a 20-SGD incentive. The group of nonworking elderly were more sensitive to changes in incentives than those who worked. In addition to working status, the effects of increasing incentives on influenza vaccination rates differed by ethnicity, socio-economic status, household size, and a measure of social resilience. There were no significant differential effects by age group, gender, or education, however. The cost of the program per completed vaccination under a 20-SGD incentive is 36.80 SGD, which was the lowest among the three intervention arms. For a hypothetical population-level financial incentive program to promote influenza vaccination among the elderly, accounting for transmission dynamics, an incentive between 10 and 20 SGD minimizes the cost per completed vaccination from both governmental and health system perspectives. CONCLUSIONS: Appropriate monetary incentives can boost influenza vaccination rates. Increasing monetary incentives for vaccination from 10 to 20 SGD can improve the influenza vaccination uptake rate, but further increasing the monetary incentive to 30 SGD results in no additional gains. A partial incentive may therefore be considered to improve vaccination coverage in this high-risk group.


Asunto(s)
Costos de los Medicamentos , Asignación de Recursos para la Atención de Salud/economía , Servicios de Salud para Ancianos/economía , Programas de Inmunización/economía , Vacunas contra la Influenza/administración & dosificación , Vacunas contra la Influenza/economía , Vacunación Masiva/economía , Aceptación de la Atención de Salud , Régimen de Recompensa , Factores de Edad , Anciano , Análisis Costo-Beneficio , Femenino , Gastos en Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Vacunas contra la Influenza/efectos adversos , Masculino , Vacunación Masiva/efectos adversos , Motivación , Evaluación de Programas y Proyectos de Salud , Singapur
2.
BMC Infect Dis ; 20(1): 240, 2020 Mar 20.
Artículo en Inglés | MEDLINE | ID: mdl-32197591

RESUMEN

BACKGROUND: The current national influenza vaccination schedule in Mexico does not recommend vaccination in the school-aged population (5-11 years). Currently, there are limited data from middle-income countries analysing the cost-effectiveness of influenza vaccination in this population. We explored the clinical effects and economic benefits of expanding the current national influenza vaccination schedule in Mexico to include the school-aged population. METHODS: A static 1-year model incorporating herd effect was used to assess the cost-effectiveness of expanding the current national influenza vaccination schedule of Mexico to include the school-aged population. We performed a cross-sectional epidemiological study using influenza records (2009-2018), death records (2010-2015), and discharge and hospitalisation records (2010-2016), from the databases of Mexico's Influenza Surveillance System (SISVEFLU), the National Mortality Epidemiological and Statistical System (SEED), and the Automated Hospital Discharge System (SAEH), respectively. Cost estimates for influenza cases were based on 7 scenarios using data analysed from SISVEFLU; assumptions for clinical management of cases were defined according to Mexico's national clinical guidelines. The primary health outcome for this study was the number of influenza cases avoided. A sensitivity analysis was performed using conservative and optimistic parameters (vaccination coverage: 30% / 70%, Vaccine effectiveness: 19% / 68%). RESULTS: It was estimated that expanding the influenza immunisation programme to cover school-aged population in Mexico over the 2018-2019 influenza season would result in 671,461 cases of influenza avoided (50% coverage and 50% effectiveness assumed). Associated with this were 262,800 fewer outpatient consultations; 154,100 fewer emergency room consultations; 97,600 fewer hospitalisations, and 15 fewer deaths. Analysis of cases avoided by age-group showed that 55.4% of them were in the school-aged population, and the decrease in outpatient consultations was largest in this population. There was an overall decrease in the economic burden for the Mexican health care system of 111.9 million US dollars; the immunization programme was determined to be cost-saving in the base, conservative and optimistic scenarios. CONCLUSIONS: Vaccinating school-aged population in Mexico would be cost-effective; expansion of the current national vaccination schedule to this age group is supported.


Asunto(s)
Análisis Costo-Beneficio/métodos , Vacunas contra la Influenza/economía , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Vacunación/economía , Niño , Preescolar , Estudios Transversales , Prestación de Atención de Salud , Femenino , Hospitalización/economía , Humanos , Programas de Inmunización/economía , Esquemas de Inmunización , Incidencia , Gripe Humana/mortalidad , Masculino , México/epidemiología , Alta del Paciente , Cobertura de Vacunación
3.
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
4.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(10): 993-999, 2019 Oct 06.
Artículo en Chino | MEDLINE | ID: mdl-31607044

RESUMEN

Objective: To evaluate the cost-effectiveness of seasonal influenza vaccination, compared to no vaccination, for the elderly aged ≥60 years old in China. Methods: A static life-time Markov model is conducted to simulate the Chinese elderly population aged ≥60 years old. Taking the health care system perspective, one-year analytic cycle length is used for each influenza season. The model was assumed to be repeated until the individual reaches 100 years old. Three interventions were evaluated, including no vaccination, annual trivalent influenza vaccination, and annual quadrivalent influenza vaccination. Using the threshold of 3 times GDP per capita per Quality-adjusted life year (QALY) (193 932/QALY), the incremental cost-effectiveness ratio (ICER) was calculated to compare the cost-effectiveness of every two interventions.Model inputs like data for costs and utilities were from studies on Chinese population if they were available. QALY was used to measure health utility. One-way sensitivity analysis and probabilistic sensitivity analysis were adopted to quantify the level of confidence of the model output. Results: The total influenza associated costs of no vaccination would be 603 CNY per person, while the total costs of annual trivalent vaccination would be 1 027 CNY. Using trivalent vaccine would result in 0.007 QALY gained per person compared to no vaccination, with an increased cost of 424 CNY per person. The ICER of trivalent vaccination over no vaccination for all the elderly population in China would be 64 026 CNY per QALY gained, which was less than the threshold of 3 times GDP per capita. The total costs of annual quadrivalent vaccination would be 1 988 CNY. Using quadrivalent vaccine would result in 0.008 additional QALY gained per person compared to no vaccination, with an increased cost of 1 385 CNY per person. The ICER of quadrivalent vaccination over no vaccination would be 174 081 CNY per QALY gained, which was less than the threshold of 3 times GDP per capita. Conclusion: Vaccinating elderly population would improve health utilities at higher health care costs for the elderly. Using the threshold of 3 times GDP per capita per QALY (193 932/QALY), both trivalent and quadrivalent vaccination would be cost-effective compared to no vaccination in elderly Chinese population.


Asunto(s)
Vacunas contra la Influenza/economía , Gripe Humana , Anciano , Anciano de 80 o más Años , China , Análisis Costo-Beneficio , Humanos , Persona de Mediana Edad , Años de Vida Ajustados por Calidad de Vida , Estaciones del Año
5.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(10): 1000-1006, 2019 Oct 06.
Artículo en Chino | MEDLINE | ID: mdl-31607045

RESUMEN

Objective: To evaluate the cost-effectiveness of potential government fully-funded influenza vaccination for diabetics in our country. Methods: From the societal perspective, a decision tree model was developed to compare outcomes (including impact on the influenza-related outpatient consultation, hospitalization and excess mortality, and quality-adjusted life years (QALY), as well as incremental cost-effectiveness ratio (ICER)) of a national fully-funded vaccination programme in the population with diabetes and status quo (i.e., vaccinated with out-of-pocket payment, with a uptake rate of zero), using the published data with regarding to influenza related ILI (influenza-like illness) consultation rate, hospitalization rate and excess mortality rate, health-related quality of life and economic burden, diabetes prevalence, population size, health seeking behaviour, vaccine uptake rate, vaccine efficacy/effectiveness, etc. A time horizon of 1 year was used in the present analysis, and all costs were expressed in CNY in 2016 using the consumer price index. All results are presented in M (P(25), P(75)). Results: In the scenario of 40% vaccination coverage in the population with diabetes, government fully-funded vaccination programme was estimated to cost 1.71 (1.67, 1.75) billions CNY, and expected to prevent 110 000 (81 000, 143 000) influenza-related ILI consultations, 36 000 (28 000, 44 000) influenza-related SARI hospitalizations and 12 000 (9 000, 16 000) influenza-related deaths due to respiratory and cardiovascular diseases. A total of 108 000 (82 000, 142 000) QALY were estimated to be gained. The ICER was 10 088 (7 365, 14 046) CNY per QALY gained. The probability of cost-effectiveness of the fully-funded vaccination programme was 99.1% at a threshold of 53 680 CNY per QALY gained (GDP per capita in 2016). Conclusion: Government fully-funded influenza vaccination in population with diabetes is cost-effective, and thus is recommended as the key strategy of diabetes prevention and control.


Asunto(s)
Diabetes Mellitus , Vacunas contra la Influenza/economía , Gripe Humana , Vacunación/economía , China , Análisis Costo-Beneficio , Gobierno , Humanos , Calidad de Vida , Años de Vida Ajustados por Calidad de Vida
6.
BMC Infect Dis ; 19(1): 805, 2019 Sep 14.
Artículo en Inglés | MEDLINE | ID: mdl-31521116

RESUMEN

BACKGROUND: Early Childhood Education Centre (ECEC) staff are strongly recommended to receive several immunizations including influenza and pertussis. However, evidence regarding the uptake is either old or lacking across all Australian States/Territories. This study aimed to explore the attitudes and barriers around ECEC staff vaccination and the immunisation policy/practices employed at their workplaces. METHODS: An online cross-sectional survey was undertaken of staff members (administrators and childcare center staff) in early 2017. We compared the individual's knowledge, attitude and practices as well as the centre's policy and practice variables between the vaccinated and unvaccinated respondents. A logistic model was used to identify the factors associated with uptake of the different vaccines. RESULTS: A total of 575 ECEC staff completed the survey. Sixty percent reported being aware of the recommendations about staff immunisation. While participants did acknowledge that they could spread diseases if unvaccinated (86%), 30% could not recall receiving a dTpa in the last 10 years. Private centres were less likely to provide free or onsite vaccination compared to other categories of centres. Less than half reported receiving any encouragement to get the influenza vaccine and only 33% reported that their centre provides onsite influenza vaccination. Regarding the introduction of mandatory policies, 69% stated that they would support a policy. CONCLUSION: Employers should consider supporting methods to maximize vaccination of their employees including providing free onsite vaccination. Participants were open to idea of mandatory vaccination; however, this needs to be explored further to determine how vaccine costs and access issues could be resolved.


Asunto(s)
Jardines Infantiles , Conductas Relacionadas con la Salud , Gripe Humana/prevención & control , Percepción , Maestros/psicología , Vacunación/psicología , Tos Ferina/prevención & control , Adulto , Australia , Niño , Preescolar , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Lactante , Vacunas contra la Influenza/economía , Vacunas contra la Influenza/uso terapéutico , Modelos Logísticos , Masculino , Persona de Mediana Edad , Vacuna contra la Tos Ferina/uso terapéutico , Encuestas y Cuestionarios , Vacunación/economía , Lugar de Trabajo
7.
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
8.
BMC Health Serv Res ; 19(1): 407, 2019 Jun 24.
Artículo en Inglés | MEDLINE | ID: mdl-31234842

RESUMEN

BACKGROUND: Studies have noted variations in the cost-effectiveness of school-located influenza vaccination (SLIV), but little is known about how SLIV's cost-effectiveness may vary by targeted age group (e.g., elementary or secondary school students), or vaccine consent process (paper-based or web-based). Further, SLIV's cost-effectiveness may be impacted by its spillover effect on practice-based vaccination; prior studies have not addressed this issue. METHODS: We performed a cost-effectiveness analysis on two SLIV programs in upstate New York in 2015-2016: (a) elementary school SLIV using a stepped wedge design with schools as clusters (24 suburban and 18 urban schools) and (b) secondary school SLIV using a cluster randomized trial (16 suburban and 4 urban schools). The cost-per-additionally-vaccinated child (i.e., incremental cost-effectiveness ratio (ICER)) was estimated by dividing the incremental SLIV intervention cost by the incremental effectiveness (i.e., the additional number of vaccinated students in intervention schools compared to control schools). We performed deterministic analyses, one-way sensitivity analyses, and probabilistic analyses. RESULTS: The overall effectiveness measure (proportion of children vaccinated) was 5.7 and 5.5 percentage points higher, respectively, in intervention elementary (52.8%) and secondary schools (48.2%) than grade-matched control schools. SLIV programs vaccinated a small proportion of children in intervention elementary (5.2%) and secondary schools (2.5%). In elementary and secondary schools, the ICER excluding vaccine purchase was $85.71 and $86.51 per-additionally-vaccinated-child, respectively. When additionally accounting for observed spillover impact on practice-based vaccination, the ICER decreased to $80.53 in elementary schools -- decreasing substantially in secondary schools. (to $53.40). These estimates were higher than the published practice-based vaccination cost (median = $25.50, mean = $45.48). Also, these estimates were higher than our 2009-2011 urban SLIV program mean costs ($65) due to additional costs for use of a new web-based consent system ($12.97 per-additionally-vaccinated-child) and higher project coordination costs in 2015-2016. One-way sensitivity analyses showed that ICER estimates were most sensitive to the SLIV effectiveness. CONCLUSIONS: SLIV raises vaccination rates and may increase practice-based vaccination in primary care practices. While these SLIV programs are effective, to be as cost-effective as practice-based vaccination our SLIV programs would need to vaccinate more students and/or lower the costs for consent systems and project coordination. TRIAL REGISTRATION: ClinicalTrials.gov NCT02227186 (August 25, 2014), updated NCT03137667 (May 2, 2017).


Asunto(s)
Programas de Inmunización/economía , Vacunas contra la Influenza/economía , Servicios de Salud Escolar/economía , Instituciones Académicas/estadística & datos numéricos , Adolescente , Niño , Análisis Costo-Beneficio , Humanos , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , New York , Evaluación de Programas y Proyectos de Salud
9.
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
11.
J Am Assoc Nurse Pract ; 31(7): 391-395, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30829969

RESUMEN

BACKGROUND AND PURPOSE: Infection from influenza virus causes tens of thousands of deaths annually in the United States, costing millions to manage hospital complications. Barriers exist for patients to choose the influenza vaccine, which is proven to effectively reduce incidence of infection and complications from influenza virus. A significant percent of uninsured patients are at high risk of these complications because of chronic illness. This article examines the literature for evidence of effective interventions to increase influenza uptake rate in the uninsured adult population. METHODS: Literature review of data sources including the Cumulative Index to Nursing and Allied Health Literature, PubMed, Scopus, and the Cochrane Database of Systematic Reviews. CONCLUSIONS: Effective interventions include free vaccines, mass communication efforts, implementing an influenza questionnaire, training health care workers, using a vaccine facilitator, implementing a standing orders policy and opt-out policy, scheduling year-round appointments, clinicians recommending the vaccine, clinician audit and feedback, tracking in an electronic medical record, and narrative communication techniques. IMPLICATIONS FOR PRACTICE: To reduce influenza-related costs, and improve health outcomes, it is imperative that nurse practitioners use evidence-based interventions in the practice setting to increase influenza uptake rates in the adult uninsured population.


Asunto(s)
Programas de Inmunización/normas , Vacunas contra la Influenza/uso terapéutico , Pacientes no Asegurados/estadística & datos numéricos , Humanos , Programas de Inmunización/métodos , Programas de Inmunización/estadística & datos numéricos , Vacunas contra la Influenza/economía , Gripe Humana/tratamiento farmacológico , Gripe Humana/prevención & control , Enfermeras Practicantes/tendencias , Estados Unidos
12.
Hum Vaccin Immunother ; 15(9): 2217-2226, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30785363

RESUMEN

This study evaluated physician practices and perceived barriers for influenza, tetanus, diphtheria, pertussis (Tdap), and zoster vaccination of adults in the United States (US), with emphasis on patients with Medicare versus commercial insurance. A cross-sectional internet-based survey of board-certified general/family practitioners and internists (N = 1,000) recruited from a national US physician panel was conducted in May 2017. For influenza, rates of physician recommendation (84% of Medicare patients, 82% of commercially-insured patients), administration (80% Medicare, 78% commercial), and referral (11% Medicare, 11% commercial) were similar regardless of insurance type. Tdap recommendation was higher for commercial compared to Medicare patients (59% vs. 54%, p < 0.001); while zoster recommendation was higher for Medicare patients than commercial (59% vs. 55%, p < 0.001). For Tdap and zoster, higher administration rates were reported in commercial patients (64% Tdap, 36% zoster) than Medicare (56% Tdap, 32% zoster), and referral rates were higher for Medicare patients (19% Tdap, 49% zoster) than commercial (14% Tdap, 42% zoster). Over 40% of physicians would be much more likely to administer Tdap and zoster vaccines if they were covered under Medicare Part B, with more physicians indicating financial barriers as "major" or "moderate" for Medicare than commercial patients. These differences may be related to financial barriers associated with adult vaccinations that are covered under Medicare Part D and involve patient out-of-pocket costs. Efforts to reduce financial barriers associated with adult vaccinations covered under Medicare Part D and to improve patient and physician knowledge could positively impact physician recommendation, administration, and referral for adult vaccination in the US.


Asunto(s)
Seguro de Salud/estadística & datos numéricos , Medicare , Pacientes/estadística & datos numéricos , Pautas de la Práctica en Medicina , Derivación y Consulta/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Adulto , Anciano , Estudios Transversales , Toxoide Diftérico/administración & dosificación , Toxoide Diftérico/economía , Femenino , Vacuna contra el Herpes Zóster/administración & dosificación , Vacuna contra el Herpes Zóster/economía , Humanos , Vacunas contra la Influenza/administración & dosificación , Vacunas contra la Influenza/economía , Seguro de Salud/normas , Masculino , Persona de Mediana Edad , Médicos , Encuestas y Cuestionarios , Toxoide Tetánico/administración & dosificación , Toxoide Tetánico/economía , Estados Unidos , Vacunación/economía , Adulto Joven
14.
Hum Vaccin Immunother ; 15(5): 1035-1047, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30735465

RESUMEN

Seasonal influenza is a very common disease. Yearly vaccination of at-risk population groups is a well-recognized cost-effective/cost-saving preventive measure. It is, however, unclear which available alternative has the most favorable economic profile. Some available options are: trivalent (TIV) and quadrivalent (QIV) inactivated vaccines, adjuvanted TIV (aTIV). Because of immunosenescence, aTIV has been specifically developed for elderly. The present study aimed at assessing the available evidence of aTIV use in elderly from the economic perspective. A systematic literature review targeting aTIV economic evaluations in adults aged ≥65 years was performed using Medline via Ovid, Embase, DARE and NHS/EED. Of a total of 3,654 papers screened, 18 studies (13 full papers, 5 conference abstracts) were included. It emerged that compared with both non-vaccination or non-adjuvanted vaccines, aTIV was cost-effective or cost-saving. The vaccinations strategies incorporating aTIV based on age and/or risk profile are associated with the most favorable economic outcomes.


Asunto(s)
Adyuvantes Inmunológicos/administración & dosificación , Análisis Costo-Beneficio , Vacunas contra la Influenza/economía , Gripe Humana/prevención & control , Polisorbatos/administración & dosificación , Escualeno/administración & dosificación , Vacunación/economía , Factores de Edad , Anciano , Anciano de 80 o más Años , Anticuerpos Antivirales/sangre , Humanos , Vacunas contra la Influenza/inmunología , Factores de Riesgo
15.
PLoS One ; 14(1): e0209643, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30682030

RESUMEN

OBJECTIVES: Despite a high vaccine uptake rate of over 80% in South Korea, the disease burden of influenza is still high among the elderly, which may be due to low effectiveness of vaccines. Therefore, the cost-effectiveness of use among the elderly was analyzed in order to compare the current trivalent influenza vaccine (TIV) with a quadrivalent influenza vaccine (QIV) or MF59-adjuvanted trivalent influenza vaccine (ATIV). METHODS: A static lifetime Markov model was used. It was assumed that the model would be repeated until individuals reached the age of 100. Cost-effectiveness was analyzed across three age groups (65-74 years, 75-84 years, and ≥85 years), and the at-risk group was studied. RESULTS: Compared to the TIV, the QIV was expected to reduce the number of influenza infections by 342,873, complications by 17,011, hospitalizations by 8,568, and deaths by 2,031. The QIV was highly cost-effective when compared to the TIV, with a base case incremental cost-effectiveness ratio (ICER) estimated at USD 17,699/QALY (1USD = 1,151KRW), and the ICER decreased with age and was USD 3,431/QALY in the group aged 85 and above. Sensitivity analysis revealed that the ICER was sensitive to the QIV price, the proportion of influenza B, and vaccine mismatching. On the other hand, the ATIV was expected to reduce the number of influenza cases and complications by 1,812,395 and 89,747, respectively, annually, yielding cost-saving among all ages. ATIV price and vaccine efficacy were the most influential parameters for the ICER of ATIV. CONCLUSIONS: The QIV and ATIV strategies were considered more cost-effective in comparison to the TIV for vaccination strategies implemented for the elderly. However, owing to a lack of data on the effectiveness of ATIV among the elderly, a large-scale effectiveness study is required.


Asunto(s)
Vacunas contra la Influenza/economía , Vacunas contra la Influenza/inmunología , Vacunación/métodos , Adyuvantes Inmunológicos/uso terapéutico , Adyuvantes Farmacéuticos/uso terapéutico , Anciano , Anciano de 80 o más Años , Análisis Costo-Beneficio/métodos , Femenino , Humanos , Gripe Humana/prevención & control , Masculino , Cadenas de Markov , República de Corea , Factores de Riesgo , Resultado del Tratamiento
17.
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
18.
Vaccine ; 37(1): 25-33, 2019 01 03.
Artículo en Inglés | MEDLINE | ID: mdl-30471956

RESUMEN

BACKGROUND: Due to competing health priorities, low- and middle-income countries (LMIC) may need to prioritize between different influenza vaccine risk groups. Risk group prioritization may differ in LMIC based upon programmatic feasibility, country-specific prevalence of risk conditions and influenza-associated morbidity and mortality. METHODS: In South Africa, we collected local disease burden data (both published and unpublished) and published vaccine efficacy data in risk groups and healthy adults. We used these data to aid policy makers with risk group prioritization for influenza vaccination. We used the following formula to assess potential vaccine averted disease in each risk group: rate of influenza-associated hospitalization (or death) per 100,000 population * influenza vaccine efficacy (VE). We further estimated the cost per hospital day averted and the cost per year of life saved by influenza vaccination. RESULTS: Pregnant women, HIV-infected adults, and adults and children with tuberculosis disease had among the highest estimates of hospitalizations averted per 100,000 vaccinated and adults aged 65 years and older had the highest estimated deaths averted per 100,000 vaccinated. However, when assessing both the cost per hospital day averted (range: USD148-1,344) and the cost per year of life saved (range: USD112-1,230); adults and children with TB disease, HIV-infected adults and pregnant women had the lowest cost per outcome averted. DISCUSSION: An assessment of the potential disease outcomes averted and associated costs may aid policymakers in risk group prioritization for influenza vaccination.


Asunto(s)
Prioridades en Salud , Recursos en Salud , Vacunas contra la Influenza/economía , Gripe Humana/prevención & control , Vacunación/economía , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Niño , Preescolar , Costo de Enfermedad , Análisis Costo-Beneficio , Femenino , Infecciones por VIH/epidemiología , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Vacunas contra la Influenza/uso terapéutico , Gripe Humana/mortalidad , Masculino , Persona de Mediana Edad , Embarazo , Factores de Riesgo , Sudáfrica , Tuberculosis/epidemiología , Adulto Joven
19.
Vaccine ; 37(2): 226-234, 2019 01 07.
Artículo en Inglés | MEDLINE | ID: mdl-30527660

RESUMEN

BACKGROUND: Coverage levels for many recommended adult vaccinations are low. The cost-effectiveness research literature on adult vaccinations has not been synthesized in recent years, which may contribute to low awareness of the value of adult vaccinations and to their under-utilization. We assessed research literature since 1980 to summarize economic evidence for adult vaccinations included on the adult immunization schedule. METHODS: We searched PubMed, EMBASE, EconLit, and Cochrane Library from 1980 to 2016 and identified economic evaluation or cost-effectiveness analysis for vaccinations targeting persons aged ≥18 years in the U.S. or Canada. After excluding records based on title and abstract reviews, the remaining publications had a full-text review from two independent reviewers, who extracted economic values that compared vaccination to "no vaccination" scenarios. RESULTS: The systematic searches yielded 1688 publications. After removing duplicates, off-topic publications, and publications without a "no vaccination" comparison, 78 publications were included in the final analysis (influenza = 25, pneumococcal = 18, human papillomavirus = 9, herpes zoster = 7, tetanus-diphtheria-pertussis = 9, hepatitis B = 9, and multiple vaccines = 1). Among outcomes assessing age-based vaccinations, the percent indicating cost-savings was 56% for influenza, 31% for pneumococcal, and 23% for tetanus-diphtheria-pertussis vaccinations. Among age-based vaccination outcomes reporting $/QALY, the percent of outcomes indicating a cost per QALY of ≤$100,000 was 100% for influenza, 100% for pneumococcal, 69% for human papillomavirus, 71% for herpes zoster, and 50% for tetanus-diphtheria-pertussis vaccinations. CONCLUSIONS: The majority of published studies report favorable cost-effectiveness profiles for adult vaccinations, which supports efforts to improve the implementation of adult vaccination recommendations.


Asunto(s)
Análisis Costo-Beneficio , Vacuna contra Difteria, Tétanos y Tos Ferina/economía , Vacunas contra la Influenza/economía , Vacunas Neumococicas/economía , Vacunación/economía , Adulto , Factores de Edad , Canadá , Difteria/prevención & control , Vacuna contra Difteria, Tétanos y Tos Ferina/uso terapéutico , Hepatitis B/prevención & control , Humanos , Esquemas de Inmunización , Vacunas contra la Influenza/uso terapéutico , Gripe Humana/prevención & control , Vacunas Neumococicas/uso terapéutico , Neumonía Neumocócica/prevención & control , Tétanos/prevención & control , Estados Unidos
20.
Ned Tijdschr Geneeskd ; 1622018 09 06.
Artículo en Holandés | MEDLINE | ID: mdl-30306759

RESUMEN

Based on current research, there are no valid reasons to assume that influenza vaccination of people aged 60 and over without any other medical indications, in the context of the national programme of influenza prevention, leads to significant, relevant and cost-effective health benefits. In view of the pressure on health care budgets and the decreasing social willingness to vaccinate, it is of great and urgent importance that the actual effect of influenza vaccination is quantified in a double-blind placebo-controlled randomized trial (RCT) with relevant outcome measures, which does not suffer from the methodological shortcomings of the few previous studies. In order to demonstrate a 10% reduction in hospitalisation for respiratory infections, this RCT should include approximately 100,000 subjects and follow these participants for three years. We consider such a trial feasible in the Dutch situation.


Asunto(s)
Vacunas contra la Influenza , Gripe Humana/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto/ética , Vacunación , Anciano , Análisis Costo-Beneficio , Método Doble Ciego , Hospitalización/estadística & datos numéricos , Humanos , Vacunas contra la Influenza/economía , Persona de Mediana Edad , Países Bajos , Evaluación de Resultado en la Atención de Salud , Ensayos Clínicos Controlados Aleatorios como Asunto/normas , Vacunación/economía
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