RESUMO
As of March 2021, COVID-19 has claimed the lives of more than 2.7 million people worldwide. Vaccination has started in most countries around the world. In this study, we estimated the cost-effectiveness of strategies for COVID-19 vaccination for Turkey compared to a baseline in the absence of vaccination and imposed measures by using an enhanced SIRD (Susceptible, Infectious, Recovered, Death) model and various scenarios for the first year after vaccination. The results showed that vaccination is cost-effective from a health care perspective, with an incremental cost-effectiveness ratio (ICER) of 511 USD/QALY and 1045 USD/QALY if vaccine effectiveness on transmission is equal or reduced to only 50% of effectiveness on disease, respectively, at the 90% baseline effectiveness of the vaccine. From a societal perspective, cost savings were estimated for both scenarios. Other results further showed that the minimum required vaccine uptake to be cost-effective would be at least 30%. Sensitivity and scenario analyses, as well as the iso-ICER curves, showed that the results were quite robust and that major changes in cost-effectiveness outcomes cannot be expected. We can conclude that COVID-19 vaccination in Turkey is highly cost-effective or even cost-saving.
RESUMO
This study aimed to examine the burden of neonatal deaths in Denizli province, Turkey, over a 5-year period and to investigate the role of "routine" primary health care (PHC) services provided to mothers and infants by the Ministry of Health in reducing neonatal deaths, while controlling for major confounding factors. A retrospective cohort study was conducted based on the health records of the Provincial Health Directorate of Denizli, Turkey. Data were collected from the 5-year records of a total of 119 PHC units responsible for providing comprehensive PHC services to all residents of the province. A random-effect Poisson panel regression was employed to investigate the association between "monitoring services (for mothers and babies) provided by PHC unit personnel" and the neonatal mortality. According to the results of study the final model revealed that "monitoring", i.e., the joint factor for the average number of regular visits of the mother (during pregnancy and over puerperium) and that of the babies over the neonatal period was found to have a positive impact on decreasing the neonatal infant mortality rate. In the final model, controlling for the total number of live births in the health care service area, neonatal mortality was detected to be negatively associated with total populations per nurse, total populations per midwife, presence of prematurity and presence of low birth weight whereas having deliveries in the hospital setting decreased the risk of neonatal deaths significantly. The findings of the study are important, revealing that the neonatal mortality rates could be decreased significantly by increasing the number of regular health visits of mothers and newborn babies to PHC units, with no need for specialized health personnel or additional costs.
