The Societal Value of Vaccines: Expert-Based Conceptual Framework and Methods Using COVID-19 Vaccines as A Case Study

Health technology assessments (HTAs) of vaccines typically focus on the direct health benefits to individuals and healthcare systems. COVID-19 highlighted the widespread societal impact of infectious diseases and the value of vaccines in averting adverse clinical consequences and in maintaining or resuming social and economic activities. Using COVID-19 as a case study, this research work aimed to set forth a conceptual framework capturing the broader value elements of vaccines and to identify appropriate methods to quantify value elements not routinely considered in HTAs. A two-step approach was adopted combining a targeted literature review and three rounds of expert elicitation based on a modified Delphi method, leading to a conceptual framework of 30 value elements related to broader health effects, societal and economic impact, public finances, and uncertainty value. When applying the framework to COVID-19 vaccines in post-pandemic settings, 13 value elements were consensually rated highly important by the experts for consideration in HTAs. The experts reviewed over 10 methods that could be leveraged to quantify broader value elements and provided technical forward-looking recommendations. Limitations of the framework and the identified methods were discussed. This study supplements on-going efforts aimed towards a broader recognition of the full societal value of vaccines.

The Association Between Diabetic Retinopathy and the Prevalence of Age-Related Macular Degeneration-The Kailuan Eye Study.

This study aimed to investigate the prevalence of age-related macular degeneration (AMD) in patients with diabetes mellitus (DM) and diabetic retinopathy (DR) and analyze whether DR is a risk factor for AMD. This population-based epidemiological study included 14,440 people from the Kailuan Eye Study in 2016, of whom 1,618 were patients with type 2 DM aged over 50 years, and 409 had DM with DR. We analyzed whether there were differences in the prevalence of AMD between DM with DR and DM without DR, and conducted a hierarchical statistical analysis according to different stages of DR. Using variable regression analysis, we explored whether DR constituted a risk factor for AMD. In the DM population, the prevalence of wet AMD in patients with DM with and without DR was 0. 3 and 0.2%, respectively, with no significant difference (P = 0.607). Meanwhile, the prevalence of dry AMD in patients with DM with and without DR was 20.8 and 16.0%, respectively, with a significant difference. In the subgroup analysis of dry AMD, the prevalence of early, middle, and late dry AMD in DM with DR was 14.4, 5.9, and 0.5%, respectively. In DM without DR, the prevalence of early, middle, and late dry AMD was 10.5, 4.8, and 0.7%, respectively (P = 0.031). In the subgroup analysis of DR staging, statistical analysis could not be performed because of the limited number of patients with PDR. In the variable regression analysis of risk factors for dry AMD, after adjusting for age, sex, body mass index, hypertension, and dyslipidemia, DR constituted the risk factor for dry AMD. In conclusion, DM did not constitute a risk factor for AMD, and the prevalence of wet AMD and dry AMD in patients with DM and DR was higher than that in patients with DM without DR (among which dry AMD was statistically significant). Multivariate regression analysis confirmed that DR is an independent risk factor for dry AMD. Reasonable control of DM and slowing down the occurrence and development of DR may effectively reduce the prevalence of AMD in patients with DM.

Public Health Impact of the Pfizer-BioNTech COVID-19 vaccine (BNT162b2) in the first year of rollout in the United States

BackgroundAs the body of evidence on COVID-19 and post-vaccination outcomes continues to expand, this analysis sought to evaluate the public health impact of the Pfizer-BioNTech COVID-19 Vaccine, BNT162b2, during the first year of its rollout in the US. MethodsA combined Markov decision tree model compared clinical and economic outcomes of the Pfizer-BioNTech COVID-19 Vaccine (BNT162b2) versus no vaccination in individuals aged [≥]12 years. Age-stratified epidemiological, clinical, economic, and humanistic parameters were derived from existing data and published literature. Scenario analysis explored the impact of using lower and upper bounds of parameters on the results. The health benefits were estimated as the number of COVID-19 symptomatic cases, hospitalizations and deaths averted, and Quality Adjusted Life Years (QALYs) saved. The economic benefits were estimated as the amount of healthcare and societal cost savings associated with the vaccine-preventable health outcomes. ResultsIt was estimated that, in 2021, the Pfizer-BioNTech COVID-19 Vaccine (BNT162b2) contributed to averting almost 9 million symptomatic cases, close to 700,000 hospitalizations, and over 110,000 deaths, resulting in an estimated $30.4 billion direct healthcare cost savings, $43.7 billion indirect cost savings related to productivity loss, as well as discounted gains of 1.1 million QALYs. Scenario analyses showed that these results were robust; the use of alternative plausible ranges of parameters did not change the interpretation of the findings. ConclusionsThe Pfizer-BioNTech COVID-19 Vaccine (BNT162b2) contributed to generate substantial public health impact and vaccine-preventable cost savings in the first year of its rollout in the US. The vaccine was estimated to prevent millions of COVID-19 symptomatic cases and thousands of hospitalizations and deaths, and these averted outcomes translated into cost-savings in the billions of US dollars and thousands of QALYs saved. As only direct impacts of vaccination were considered, these estimates may be conservative. KEY SUMMARY POINTSO_ST_ABSWhy carry out this study?C_ST_ABSO_LIAssessing the population-level health and economic impact of the Pfizer-BioNTech COVID-19 Vaccine (BNT162b2) is important for policy makers and payers who support decision-making and investment in vaccination. C_LIO_LIThese analyses may be relevant to the public, especially those who remain hesitant to COVID-19 vaccination. C_LI What was learned from the study?O_LIThis study showed that Pfizer-BioNTech COVID-19 Vaccine (BNT162b2) was an effective strategy that contributed to generating substantial public health impact and economic gains in the US in 2021 C_LIO_LIThe vaccine was estimated to prevent millions of COVID-19 symptomatic cases and thousands of hospitalizations and deaths, and these averted outcomes translated into cost-savings in the billions of US dollars and millions of QALYs saved C_LIO_LIThe study highlights the importance of continuing widespread uptake of the Pfizer-BioNTech COVID-19 Vaccine (BNT162b2) to prevent COVID-19 related disease and generate substantial benefits from a broad, patient-centric, societal perspective C_LI

MicroRNA in tumor angiogenesis and target therapy / 中华实验眼科杂志

Angiogenesis is a complex process and plays an important role in tumor growth and metastasis.Among the factors of angiogenesis, vascular endothelial growth factor (VEGF) is most widely studied factor in the regulation of tumor angiogenesis.MicroRNAs (miRNAs) are a class of small non-coding RNAs that play a vital role in tumor angiogenesis and metastasis through post-transcriptional regulation.They can function in diverse biological processes via regulating multiple pathways, such as VEGF, to promote or inhibit tumor angiogenesis.Uveal melanoma (UM) is the most common primary intraocular malignant tumor.It seriously threatens vision, eyeballs and even life of patient.Since angiogenesis plays an important role in UM tumor growth, invasion and metastasis, understanding the regulation of tumor angiogenesis has become important for tumor therapy.In this review, we summarized the regulatory role of miRNAs and their targets in tumor angiogenesis and discussed the potential therapeutic interventions of miRNAs for tumor angiogenesis, including nanoparticles and cell-derived membrane vesicles.

Association of serum components of GH axis with GHR exon 3 polymorphism in idiopathic short stature children / 天津医药

Objective To investigate the possible association of circulating components of GH-IGFs-IGFBPs system with the GHR-exon 3 genotype in idiopathic short stature (ISS) children. Methods Genomic DNA was extracted and isolat-ed from peripheral leukocytes in 108 ISS children. GHR-exon 3 polymorphism was analyzed with multiplex poly-merase chain reactions (PCR) assay. According to the results of genotype, ISS children were divided into GHRfl group and GHRd 3 group. The height and weight were recorded in two groups. The body mass index (BMI) and BMI standard deviation score (SDS) were measured. The serum levels of insulin-like growth factor (IGF)-1, IGF-binding protein (IGFBP)-3, IGF-1 SDS and IGFBP3 SDS were calculated. GH stimulation test was used to measure the serum GH peak value. Fifty-five ISS chil-dren were treated with recombine human GH [0.15 IU/(kg·d)] for three months to analyse the association of IGF-1 response of GH treatment and genotypes. Results There were 63 GHRfl and 45 GHRd3 in 108 ISS children. There were no signifi-cant differences in BMI, IGF-1, IGFBP3, GH peak, IGF-1 SDS and IGFBP3 SDS between two groups (P>0.05). Multiple stepwise regression analysis showed that age, IGFBP3, lg (BMI) and lg (GH peak) were influencing factors of lgIGF-1 (P<0.05). In 55 ISS children treated with rhGH, there were 34 cases of GHRd3. The differences of △IGF-1 and △IGF-1 SDS were higher in GHRd3 group than those of GHRfl group (n=21). Conclusion The GH sensitivity may be a risk factor in ISS children, which may not be related with GHR polymorphism.

Long-term effects of L-T4 treatment on physical and intellectual development for congenital hypothyroidism / 中华内分泌代谢杂志

To explore the long-term effects of L-T4 treatment on physical and intellectual development in neonatal congenital hypothyroidism(CH) patients during adolescence and adulthood.14 out of 15 patients,aged 15-31 years old,including 9 males and 6 females,were diagnosed by neonatal screening for congenital hypothyroidism.(1) By treatment for 10 years until adolescence,return visit ages were 12.6-18.1 years old,the height of patients were normal in 14 cases,weight normal in 8 cases,and overweight in 6 cases.Only the first patient of neonatal screening for congenital hypothyroidism height 154 cm,weight of 43.5 kg,which were below the standard.Bone age by X-ray showed 9 normal,1 case of rapid development,4 cases with left wrist bone age retardation.IQ combined Raven's test(CRT) showed 3 cases excellent,7 cases normal,3 cases borderline,and 2 cases low.(2)Treatment for more than 20 years to adulthood,9 cases of return visits (8 cases were screened out) by 23-31 years of age,with 5 males and 4 females,height and bone age were all normal,normal weight,only 2 cases BMI slightly overweight.As to IQ,good were in 7 cases,mild retardation in 2 cases.7 patients received above average education;they were all employed except one.The employed patients were all capable for their jobs.In summary,screening out of 8 patients,1 case were of mild mental retardation (12.5％);while 7 patients(87.5％),both in physical and intellectual levels were as those of the normal population.

Relationship of expressions of E-cadherin and ?-catenin proteins and gastric mucosa intestinal metaplasia and gastric carcinoma / 中国现代普通外科进展

Objective:To study the relationship of expressions of E-cadherin and ?-catenin proteins and gastric mucosa intestinal metaplasia and gastric carcinoma.Methods:The immunohistochemical Envision method was used to determine the expressions of E-cadherin and ?-catenin in 30 cases of simple intestinal metaplasia(SIM) ,38 cases of atypia intestinal metaplasia(AIM) and 55 cases of gastric carcinoma.Results:The reduced expression rates of E-cadherin and ?-catenin in gastric carcinoma were significantly higher than that in SIM(P0.05) .Conclusion :E-cadherin and ?-catenin proteins take part in the transformation from intestinal metaplasia to carcinoma in gastric mucosa,AIM is a kind of precancerosis of gastric carcinoma.

Logistic Regression Analysis on Risk Factors of Episiotomy Infection / 中华医院感染学杂志

OBJECTIVE To investigate the risk factors and prevention of episiotomy infection.METHODS Retrospective analysis on 105 episiotomy infection cases and 210 episiotomy cases without infection which were chosen randomly by 1∶2 Logistic regression and single factor analysis was taken.RESULTS Infection rate of episiotomy was 1.23%.Single factor analysis showed there were nine factors correlated with episiotomy infection.Taking prophylactic antibiotic couldn′t prevent infection,showing no correlation with episiotomy infection(P

Expression of c-erbB-2 and ki67 proteins in simple intestinal metaplasia,atypical intestinal metaplasia and gastric adenocarcinoma / 中国现代普通外科进展

Objective:To study the expressions of c-erbB-2 and ki67 proteins in simple intestinal metaplasia(SIM),atypical intestinal metaplasia(AIM) and gastric adenocarcinoma,and the relationships among them.Methods:The immunohistochemical EnVision method was used to determine the expressions of c-erbB-2 and ki67 in 27 cases of SIM,26 cases of AIM and 37 cases of gastric adenocarcinoma.Results:The positive rates of c-erbB-2 and ki67 in gastric adenocarcinoma were significantly higher than that in SIM(P0.05).Conclusion:The high expression of c-erbB-2 and ki67 in AIM and gastric adenocarcinoma suggested that AIM may play an important role in gastric adenocarcinoma.The AIM is one kind of precancerosis of gastric adenocarcinoma.

Relationship of expression of CDX2 and PTEN proteins and gastric metaplasia / 中国现代普通外科进展

Objective: To study the relationship of expression of CDX2 and PTEN proteins and gastric metaplasia. Methods: Immunohistochemistry Envision method was used to detect the expression of CDX2 and PTEN proteins in simple intestinal metaplasia (SIM), atypical intestinal metaplasia (AIM) and gastric adenocarcinoma. Results: The positive rates of CDX2 in SIM, AIM and gastric adenocarcinoma was 82.6%, 51.5% and 36.4% respectively. The expression of CDX2 in gastric adenocarcinoma was significantly lower than that in SIM(P0.05). The positive rates of PTEN in SIM, AIM and gastric adenocarcinoma were 86.9%,75.8%and 47.7% respectively and the difference between SIM and gastric adenocarcinoma was significant (P