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1.
BMC Public Health ; 19(1): 1090, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409319

RESUMO

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.


Assuntos
Efeitos Psicossociais da Doença , Influenza Humana/economia , Influenza Humana/epidemiologia , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Estações do Ano , Adulto Jovem
2.
BMC Health Serv Res ; 19(1): 585, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426795

RESUMO

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.


Assuntos
Efeitos Psicossociais da Doença , Influenza Humana/economia , Infecções Respiratórias/economia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Imunização , Vacinas contra Influenza , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Morbidade , Prevalência , Encaminhamento e Consulta/estatística & dados numéricos , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/prevenção & controle , Estudos Retrospectivos , Vigilância de Evento Sentinela , Vacinação/economia , Vacinação/estatística & dados numéricos
3.
Artigo em Inglês | MEDLINE | ID: mdl-31277347

RESUMO

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.


Assuntos
Serviço Hospitalar de Emergência/economia , Influenza Humana/diagnóstico , Influenza Humana/economia , Análise Custo-Benefício , Técnicas e Procedimentos Diagnósticos , Humanos
4.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(7): 713-718, 2019 Jul 06.
Artigo em Chinês | MEDLINE | ID: mdl-31288343

RESUMO

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.


Assuntos
Cuidado da Criança/estatística & dados numéricos , Efeitos Psicossociais da Doença , Influenza Humana/economia , Influenza Humana/epidemiologia , População Rural/estatística & dados numéricos , Instituições Acadêmicas/estatística & dados numéricos , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , China/epidemiologia , Feminino , Humanos , Masculino , Anos de Vida Ajustados por Qualidade de Vida
5.
Med. clín (Ed. impr.) ; 153(1): 16-27, jul. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183353

RESUMO

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


Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Vacinas contra Influenza , Influenza Humana/economia , Influenza Humana/epidemiologia , Atenção Primária à Saúde , Espanha/epidemiologia , Avaliação em Saúde , Avaliação do Impacto na Saúde/economia
7.
PLoS One ; 14(4): e0213499, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31034485

RESUMO

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.


Assuntos
Análise Custo-Benefício , Vacinas contra Influenza/economia , Influenza Humana/prevenção & controle , Vacinação/economia , Adolescente , Adulto , Feminino , Hospitalização/economia , Humanos , Vacinas contra Influenza/uso terapêutico , Influenza Humana/economia , Influenza Humana/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Readmissão do Paciente , Cobertura Vacinal/economia , Adulto Jovem
8.
BMC Infect Dis ; 19(1): 308, 2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30947693

RESUMO

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 .


Assuntos
Influenza Humana/epidemiologia , Antibacterianos/uso terapêutico , Antipiréticos/uso terapêutico , Pré-Escolar , Efeitos Psicossociais da Doença , Feminino , Humanos , Lactente , Vírus da Influenza A Subtipo H1N1/genética , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Vírus da Influenza A Subtipo H3N2/genética , Vírus da Influenza A Subtipo H3N2/isolamento & purificação , Vacinas contra Influenza/imunologia , Influenza Humana/economia , Influenza Humana/patologia , Influenza Humana/virologia , Masculino , Efeito Placebo , RNA Viral/genética , RNA Viral/metabolismo , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/epidemiologia , Índice de Gravidade de Doença
9.
BMC Public Health ; 19(1): 280, 2019 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-30849942

RESUMO

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.


Assuntos
Eficiência , Influenza Humana/economia , Política Organizacional , Instituições Acadêmicas/organização & administração , Adolescente , Criança , Análise Custo-Benefício , Custos e Análise de Custo , Feminino , Custos de Cuidados de Saúde , Humanos , Japão , Políticas , Salários e Benefícios , Mulheres Trabalhadoras
10.
Artigo em Inglês | MEDLINE | ID: mdl-30832264

RESUMO

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.


Assuntos
Absenteísmo , Efeitos Psicossociais da Doença , Surtos de Doenças/economia , Influenza Humana/economia , Influenza Humana/epidemiologia , Estações do Ano , Adulto , Feminino , Pessoal de Saúde , Hospitais de Ensino , Humanos , Itália/epidemiologia , Masculino , Estudos Retrospectivos
11.
Clin Microbiol Infect ; 25(7): 898-903, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30502486

RESUMO

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.


Assuntos
Serviço Hospitalar de Emergência , Influenza Humana/diagnóstico , Testes Imediatos/economia , Adolescente , Criança , Pré-Escolar , Análise Custo-Benefício , Feminino , Hospitais Universitários , Humanos , Imunoensaio , Lactente , Recém-Nascido , Vírus da Influenza A , Vírus da Influenza B , Influenza Humana/economia , Masculino , Nasofaringe/virologia , Testes Imediatos/normas , Estudos Prospectivos , Sensibilidade e Especificidade
12.
Clin Pediatr (Phila) ; 58(2): 177-184, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30387696

RESUMO

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.


Assuntos
Infecções por Enterovirus/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Influenza Humana/economia , Infecções por Picornaviridae/economia , Infecções por Vírus Respiratório Sincicial/economia , Criança , Pré-Escolar , Infecções por Enterovirus/terapia , Feminino , Humanos , Lactente , Influenza Humana/terapia , Unidades de Terapia Intensiva Pediátrica/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Infecções por Picornaviridae/terapia , Infecções por Vírus Respiratório Sincicial/terapia
13.
Arch Pediatr ; 26(1): 6-11, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30558857

RESUMO

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.


Assuntos
Testes Diagnósticos de Rotina/estatística & dados numéricos , Fluorimunoensaio/estatística & dados numéricos , Influenza Humana/diagnóstico , Adolescente , Criança , Pré-Escolar , Análise Custo-Benefício , Estudos Transversais , Testes Diagnósticos de Rotina/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Fluorimunoensaio/economia , França , Hospitalização/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Lactente , Vírus da Influenza A/genética , Vírus da Influenza B/genética , Influenza Humana/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade
14.
Rev Esp Salud Publica ; 922018 Nov 02.
Artigo em Espanhol | MEDLINE | ID: mdl-30394367

RESUMO

OBJECTIVE: The Comprehensive Care Home Unit of the General Hospital of Villarrobledo is a unit formed by a geriatrician who sees people in nursing homes to improve their quality of care. The activity of the Unit has been analyzed, mainly with the objective of avoiding referral to the emergency room, avoiding hospital admissions, avoiding hospital readmissions and reducing the number of hospital admission days. METHODS: We retrospectively described the clinical activity of the Unit during the influenza outbreak of 2017 and 2018. We selected sociodemographical variables, functional assessment scales (Katz index, Barthel index and the Functional Ambulation Classification), and the Global Deterioration Scale. We registered mortality, type of treatment, oncological patients and patients with supplementary tests. The population was divided into four subgroups: hospital admission avoided, hospital re-admission avoided, referral to the emergency department avoided and reduction of admission days. The demographic characteristics were described, including the mode or mean of the variables. An economic report was made, and an analysis of cost per process according to the subgroups, means of Related Groups for the Diagnosis and degree of dependency measured by the Barthel index. RESULTS: We selected 112 patients, they had a mean age of 82.2 years, Katz G (34.8%), IB 28.8 (DE 34.9), FAC 0 (63.4%) and GDS 7 (22.3%). The most frequent disease seen was respiratory infection (63.2%), 71.4% received active treatment, 10.7% complementary tests were performed, 17.9% oncological and 17% mortality. Cost analysis: hospital readmission avoided (€ 4,128 per patient) and patients with total disability (BI 0-20, € 3,623 per patient) presented more economic saving. The economic savings were more than € 230,000. CONCLUSIONS: The contribution of the Unit during periods of influenza outbreak is cost saving because of reduced numbers of admissions, numbers of readmissions, days of admission and emergency room visits.


Assuntos
Surtos de Doenças/economia , Hospitalização/economia , Influenza Humana/economia , Influenza Humana/terapia , Casas de Saúde , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Geriatria/economia , Recursos em Saúde , Humanos , Masculino , Admissão do Paciente , Readmissão do Paciente , Estudos Retrospectivos , Espanha
15.
Rev Esp Salud Publica ; 922018 10 17.
Artigo em Espanhol | MEDLINE | ID: mdl-30327454

RESUMO

BACKGROUND: Given the economic burden of seasonal influenza for the healthcare system, we performed a systematic review aiming to update available evidence on the cost-effectiveness of vaccination of seasonal influenza in different age groups, including children. METHODS: A systematic review of the literature on economic evaluations of seasonal influenza vaccination programs in children and adults was carried out. The following databases were searched (January 2013 - April 2018): Medline and PREMEDLINE, EMBASE, EconLit and databases of the Centre for Reviews and Dissemination (DARE, HTA, NHS EED). RESULTS: A total of 11 economic evaluations were included. Methodological quality of included studies was acceptable. Scientific evidence shows that seasonal influenza vaccination programs in school-age children can be a cost-effective alternative from national health system perspective and can be cost-saving from societal perspective in European countries. However, available evidence does not allow us to conclude that influenza vaccination programs in healthy adults under 65 years of age were a cost-effective alternative in our context, due to the high uncertainty and the lack of studies carried out in Spanish context. CONCLUSIONS: Vaccination programs for the prevention of seasonal influenza in school-age children (3-16 years) can be a cost-effective strategy.


Assuntos
Análise Custo-Benefício , Vacinas contra Influenza/economia , Influenza Humana/prevenção & controle , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Europa (Continente) , Humanos , Influenza Humana/economia , Pessoa de Meia-Idade , Estações do Ano , Adulto Jovem
16.
Vaccine ; 36(46): 7054-7063, 2018 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-30340884

RESUMO

INTRODUCTION: During an influenza epidemic, where early vaccination is crucial, pharmacies may be a resource to increase vaccine distribution reach and capacity. METHODS: We utilized an agent-based model of the US and a clinical and economics outcomes model to simulate the impact of different influenza epidemics and the impact of utilizing pharmacies in addition to traditional (hospitals, clinic/physician offices, and urgent care centers) locations for vaccination for the year 2017. RESULTS: For an epidemic with a reproductive rate (R0) of 1.30, adding pharmacies with typical business hours averted 11.9 million symptomatic influenza cases, 23,577 to 94,307 deaths, $1.0 billion in direct (vaccine administration and healthcare) costs, $4.2-44.4 billion in productivity losses, and $5.2-45.3 billion in overall costs (varying with mortality rate). Increasing the epidemic severity (R0 of 1.63), averted 16.0 million symptomatic influenza cases, 35,407 to 141,625 deaths, $1.9 billion in direct costs, $6.0-65.5 billion in productivity losses, and $7.8-67.3 billion in overall costs (varying with mortality rate). Extending pharmacy hours averted up to 16.5 million symptomatic influenza cases, 145,278 deaths, $1.9 billion direct costs, $4.1 billion in productivity loss, and $69.5 billion in overall costs. Adding pharmacies resulted in a cost-benefit of $4.1 to $11.5 billion, varying epidemic severity, mortality rate, pharmacy hours, location vaccination rate, and delay in the availability of the vaccine. CONCLUSIONS: Administering vaccines through pharmacies in addition to traditional locations in the event of an epidemic can increase vaccination coverage, mitigating up to 23.7 million symptomatic influenza cases, providing cost-savings up to $2.8 billion to third-party payers and $99.8 billion to society. Pharmacies should be considered as points of dispensing epidemic vaccines in addition to traditional settings as soon as vaccines become available.


Assuntos
Transmissão de Doença Infecciosa/prevenção & controle , Epidemias , Vacinas contra Influenza/administração & dosagem , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Farmácias , Vacinação/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Análise Custo-Benefício , Feminino , Humanos , Lactente , Recém-Nascido , Vacinas contra Influenza/economia , Vacinas contra Influenza/imunologia , Influenza Humana/economia , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Resultado do Tratamento , Estados Unidos/epidemiologia , Vacinação/economia , Cobertura Vacinal , Adulto Jovem
17.
Pharmacoeconomics ; 36(12): 1475-1490, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30251078

RESUMO

INTRODUCTION: Trivalent influenza vaccines (TIVs) are currently reimbursed for subjects aged ≥ 65 years and children between 6 and 59 months of age under a national immunization program in South Korea. Quadrivalent influenza vaccines (QIVs) are expected to address the potential problem of influenza B-lineage mismatch for TIVs. OBJECTIVE: The objective of this analysis was to compare the cost effectiveness of QIV versus TIV in children aged 6-59 months and older adults ≥ 65 years of age in South Korea. METHODS: A 1-year static population model was employed to compare the costs and outcomes of a QIV vaccination program compared with TIV in children aged 6-59 months and older adults ≥ 65 years of age in South Korea. Influenza-related parameters (probabilities, health resource use, and costs) were derived from an analysis of the National Health Insurance System claims database between 2010 and 2013 under a broad and narrow set of International Classification of Diseases, Tenth Revision (ICD-10) codes used to identify influenza. Other inputs were extracted from published literature. Incremental cost-effectiveness ratios (2016 South Korean Won [KRW] per quality-adjusted life-year [QALY] gained) were estimated using a 'limited' societal perspective as per the Korean pharmacoeconomic guidelines. QALYs lost due to premature mortality were discounted at 5% annually. RESULTS: For both age groups combined, under the narrow definition of influenza, QIV is expected to prevent nearly 16,000 (2923 in children and 13,011 in older adults) medically attended influenza cases, nearly 8000 (672 in children, 7048 in older adults) cases of complications, and over 230 (0 in children, 238 in older adults) deaths annually compared with TIV. The impact of using QIV versus TIV in this setting translates into savings of KRW 24 billion (KRW 0.6 billion in children, KRW 23.4 billion in older adults) in annual medical costs, and over 2100 (18 in children, 2084 in older adults) QALYs. Under the broad definition, the corresponding results are over 190,000 (50,697 in children, 140,644 in older adults) influenza cases, over 37,000 (12,623 in children, 24,526 in older adults) complications, 270 deaths (0 in children, 270 in older adults), KRW 94.22 billion (KRW 16 billion in children, KRW 78.2 billion in older adults), and over 3500 QALYs saved (316 in children, 3260 in older adults). CONCLUSION: The use of QIV over TIV was estimated to not be cost effective in children 6-59 months of age, but cost saving in older adults, using the narrow definition of influenza; however, QIV use was cost saving in both age groups using the broad definition. QIV is expected to yield more benefits in older adults ≥ 65 years of age than in children aged 6-59 months due to higher influenza-related mortality and costs among the older adults. Further analyses considering the indirect effects of influenza vaccination in children are required.


Assuntos
Programas de Imunização/organização & administração , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Vacinação/métodos , Fatores Etários , Idoso , Pré-Escolar , Redução de Custos/estatística & dados numéricos , Análise Custo-Benefício , Farmacoeconomia , Humanos , Lactente , Vacinas contra Influenza/economia , Influenza Humana/economia , Influenza Humana/mortalidade , Anos de Vida Ajustados por Qualidade de Vida , República da Coreia , Vacinação/economia
18.
Aust N Z J Public Health ; 42(5): 444-446, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30088691

RESUMO

OBJECTIVE: To perform a comprehensive economic evaluation of border closure for an island nation in the face of severe pandemic scenarios. METHODS: The costing tool developed by the New Zealand (NZ) Treasury (CBAx) was used for the analyses. Pandemic scenarios were as per previous work;1 epidemiological data were from past New Zealand influenza pandemics. RESULTS: The net present value of successful border closure was NZ$7.86 billion for Scenario A (half the mortality rate of the 1918 influenza pandemic) and $144 billion for preventing a more severe pandemic (10 times the mortality of scenario A). Cost-utility analyses found border closure was relatively cost-effective, at $14,400 per QALY gained in Scenario A, and cost-saving for Scenario B (taking the societal perspective). CONCLUSIONS: This work quantifies the economic benefits and costs from border closure for New Zealand under specific assumptions in a generic but severe pandemic threat (e.g. influenza, synthetic bioweapon). Preparing for such a pandemic response seems wise for an island nation, although successful border closure may only be feasible if planned well ahead. Implications for public health: Policy makers responsible for generic pandemic planning should explore how border closure could be implemented, including practical and legal frameworks.


Assuntos
Análise Custo-Benefício , Influenza Humana/prevenção & controle , Pandemias/prevenção & controle , Humanos , Influenza Humana/economia , Nova Zelândia , Pandemias/economia
19.
Respir Med ; 141: 144-149, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30053960

RESUMO

OBJECTIVES: Influenza and Influenza-like syndromes (I-LSs) are very common events in general practice, and their relevance is frequently underestimated. Aim of the study was to assess the economic impact of influenza and Influenza-like syndromes (I-LSs) in the Italian general population by using real-world data from a retrospective database. METHODS: A cross-sectional survey via Computer Assisted Telephone Interview (CATI) was carried out by using a specific questionnaire which is able to assess the rate of infectious episodes, together with subject's behavior in case of influenza or I-LSs, and prescribed therapy. Collected data were statistically analyzed to calculate the economic impact of influenza and I-LSs episodes according to both the National Health System Perspective (NHS-P) and the Italian Families Perspective (S-P). The components of cost were: influenza vaccination, used drugs, General Practitioner (GP) visits, Emergency Room (ER) visits, hospitalizations, and productivity loss. RESULTS: According to the NHS-P, the annual cost for managing influenza or I-LSs amounted to € 60.24, corresponding to € 38.71 per episode. About 72% of the cost was due to GP/ER visits and hospitalization; 22% to drugs, and 6% to vaccination. In the IF-P, the annual cost increased to € 249.70 (€ 140.33 per episode) and almost 90% of the cost was related to workdays lost, while only 11% and 1.3% were due to drugs and vaccination, respectively. Annual cost was highly related to the mean duration of influenza or I-LSs episodes in both perspectives (€ 111─388 in IF-P and € 56─68 in NHS-P). Furthermore, the number of workdays lost due to these episodes showed a significant impact on the overall cost (€ 195─304) only in the NHS-P. CONCLUSIONS: Influenza and I-LSs have a not negligible economic impact, both for the NHS and for the society. Resource consumption is considerable in the NHS-P, while the productivity loss due to people absenteeism causes the most relevant impact in the IF-P.


Assuntos
Influenza Humana/tratamento farmacológico , Influenza Humana/economia , Absenteísmo , Antivirais/agonistas , Efeitos Psicossociais da Doença , Estudos Transversais , Feminino , Hospitalização/economia , Humanos , Itália , Masculino , Estudos Retrospectivos , Inquéritos e Questionários , Vacinação/economia
20.
PLoS One ; 13(6): e0198685, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29879206

RESUMO

BACKGROUND: Influenza vaccination is a commonly used intervention to prevent influenza infection in healthcare workers (HCWs) and onward transmission to other staff and patients. We undertook a systematic review to synthesize the latest evidence of the direct epidemiological and economic effectiveness of seasonal influenza vaccination among HCW. METHODS: We conducted a systematic search of MEDLINE/PubMed, Scopus, and Cochrane Central Register of Controlled Trials from 1980 through January 2018. All studies comparing vaccinated and non-vaccinated (i.e. placebo or non-intervention) groups of HCWs were included. Research articles that focused on only patient-related outcomes or monovalent A(H1N1)pdm09 vaccines were excluded. Two reviewers independently selected articles and extracted data. Pooled-analyses were conducted on morbidity outcomes including laboratory-confirmed influenza, influenza-like illnesses (ILI), and absenteeism. Economic studies were summarized for the characteristics of methods and findings. RESULTS: Thirteen articles met eligibility criteria: three articles were randomized controlled studies and ten were cohort studies. Pooled results showed a significant effect on laboratory-confirmed influenza incidence but not ILI. While the overall incidence of absenteeism was not changed by vaccine, ILI absenteeism was significantly reduced. The duration of absenteeism was also shortened by vaccination. All published economic evaluations consistently found that the immunization of HCW was cost saving based on crude estimates of avoided absenteeism by vaccination. No studies, however, comprehensively evaluated both health outcomes and costs of vaccination programs to examine cost-effectiveness. DISCUSSION: Our findings reinforced the influenza vaccine effects in reducing infection incidence and length of absenteeism. A better understanding of the incidence of absenteeism and comprehensive economic program evaluations are required to ensure the best possible management of ill HCWs and the investment in HCW immunization in increasingly constrained financial environments. These steps are fundamental to establish sustainability and cost-effectiveness of vaccination programs and underpin HCW immunization policy.


Assuntos
Pessoal de Saúde/estatística & dados numéricos , Vacinas contra Influenza/uso terapêutico , Influenza Humana/prevenção & controle , Vacinação/estatística & dados numéricos , Absenteísmo , Análise Custo-Benefício , Pessoal de Saúde/economia , Humanos , Incidência , Transmissão de Doença Infecciosa do Paciente para o Profissional/economia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/estatística & dados numéricos , Transmissão de Doença Infecciosa do Profissional para o Paciente/economia , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/estatística & dados numéricos , Influenza Humana/economia , Influenza Humana/epidemiologia , Influenza Humana/transmissão , Estações do Ano , Vacinação/economia
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