Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 751
Filtrar
1.
Am J Epidemiol ; 190(11): 2235-2241, 2021 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-34347036

RESUMO

In 1931, Edgar Sydenstricker, the former statistician of the US Public Health Service, challenged the common belief that the 1918 influenza outbreak had affected "the rich and the poor alike." Using data from 112,317 participants in a 1918 US national survey, he observed that, on the contrary, both morbidity and mortality from the flu had been higher among the poor than among the rich. To explain these differences, Sydenstricker stratified the analyses by 2 measures of affluence collected in the survey: "economic status" (from "very poor" to "well-to-do") and household crowding (i.e., number of people per household room). Economic status was associated with influenza attack rates within categories of crowding, but not the opposite, suggesting that characteristics of poverty other than "household congestion" were the culprit of the poor's higher influenza burden. Attack rate ratios for influenza in infants and older adults were greater for the poor or very poor. Sydenstricker reanalyzed an already 12-year-old data set in the context of the Great Depression to build the evidence base relating poverty to ill health. For this purpose he used a stratification approach to assess confounding, mediation, and interaction before the concepts were formally named.


Assuntos
Influenza Pandêmica, 1918-1919/mortalidade , Influenza Humana/mortalidade , Fatores Socioeconômicos , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Aglomeração , Humanos , Influenza Pandêmica, 1918-1919/economia , Influenza Humana/economia , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
3.
Expert Rev Pharmacoecon Outcomes Res ; 21(5): 911-922, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33930994

RESUMO

Introduction: Influenza can be a significant public health problem. Nevertheless, it is preventable through vaccination. Concerning the pediatric population, the recommendation of influenza vaccination is under-represented in many European countries. The aim of this systematic review is to evaluate the cost-effectiveness of universal childhood vaccination against influenza in Europe.Areas covered: We conducted a systematic review of original article assessing the cost-effectiveness of influenza vaccination by searching PubMed, Embase and Scopus databases for studies in English, starting from January 1st, 2010 up to October 21st, 2020.Expert opinion: Our literature review showed that all studies identified highlight that pediatric vaccinations using a live vaccine, especially in the quadrivalent formulation, are cost-effective compared to current vaccinations (elderly and at-risk groups) with TIV or no vaccination. A significant contribution to this positive economic profile is due to the indirect protection. Already many clinical data report the relevant direct and indirect impact of vaccination against influenza for younger subjects. The recent studies collected in this review showed also that the pediatric vaccination is also cost-effective. Therefore, decision-makers should now consider this new favorable evidence.


Assuntos
Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Vacinação/economia , Fatores Etários , Criança , Análise Custo-Benefício , Europa (Continente) , Humanos , Vacinas contra Influenza/economia , Influenza Humana/economia , Saúde Pública
4.
PLoS Med ; 18(3): e1003550, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33647033

RESUMO

BACKGROUND: Influenza illness burden is substantial, particularly among young children, older adults, and those with underlying conditions. Initiatives are underway to develop better global estimates for influenza-associated hospitalizations and deaths. Knowledge gaps remain regarding the role of influenza viruses in severe respiratory disease and hospitalizations among adults, particularly in lower-income settings. METHODS AND FINDINGS: We aggregated published data from a systematic review and unpublished data from surveillance platforms to generate global meta-analytic estimates for the proportion of acute respiratory hospitalizations associated with influenza viruses among adults. We searched 9 online databases (Medline, Embase, CINAHL, Cochrane Library, Scopus, Global Health, LILACS, WHOLIS, and CNKI; 1 January 1996-31 December 2016) to identify observational studies of influenza-associated hospitalizations in adults, and assessed eligible papers for bias using a simplified Newcastle-Ottawa scale for observational data. We applied meta-analytic proportions to global estimates of lower respiratory infections (LRIs) and hospitalizations from the Global Burden of Disease study in adults ≥20 years and by age groups (20-64 years and ≥65 years) to obtain the number of influenza-associated LRI episodes and hospitalizations for 2016. Data from 63 sources showed that influenza was associated with 14.1% (95% CI 12.1%-16.5%) of acute respiratory hospitalizations among all adults, with no significant differences by age group. The 63 data sources represent published observational studies (n = 28) and unpublished surveillance data (n = 35), from all World Health Organization regions (Africa, n = 8; Americas, n = 11; Eastern Mediterranean, n = 7; Europe, n = 8; Southeast Asia, n = 11; Western Pacific, n = 18). Data quality for published data sources was predominantly moderate or high (75%, n = 56/75). We estimate 32,126,000 (95% CI 20,484,000-46,129,000) influenza-associated LRI episodes and 5,678,000 (95% CI 3,205,000-9,432,000) LRI hospitalizations occur each year among adults. While adults <65 years contribute most influenza-associated LRI hospitalizations and episodes (3,464,000 [95% CI 1,885,000-5,978,000] LRI hospitalizations and 31,087,000 [95% CI 19,987,000-44,444,000] LRI episodes), hospitalization rates were highest in those ≥65 years (437/100,000 person-years [95% CI 265-612/100,000 person-years]). For this analysis, published articles were limited in their inclusion of stratified testing data by year and age group. Lack of information regarding influenza vaccination of the study population was also a limitation across both types of data sources. CONCLUSIONS: In this meta-analysis, we estimated that influenza viruses are associated with over 5 million hospitalizations worldwide per year. Inclusion of both published and unpublished findings allowed for increased power to generate stratified estimates, and improved representation from lower-income countries. Together, the available data demonstrate the importance of influenza viruses as a cause of severe disease and hospitalizations in younger and older adults worldwide.


Assuntos
Efeitos Psicossociais da Doença , Hospitalização/estatística & dados numéricos , Influenza Humana/virologia , Orthomyxoviridae/fisiologia , Infecções Respiratórias/virologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Influenza Humana/economia , Masculino , Pessoa de Meia-Idade , Infecções Respiratórias/economia , Adulto Jovem
5.
Recenti Prog Med ; 112(3): 173-181, 2021 03.
Artigo em Italiano | MEDLINE | ID: mdl-33687354

RESUMO

When a pandemic occurs, scientific research moves fast in order to achieve readily results, such as effective therapies to fight the SARS-CoV-2 and vaccines. But this high-speed science, engaged by the emergency and characterized by the explosion of online publications in preprint form not subject to scrutiny by peer reviewers, carries some risks. And it represents a challenge to maintain research integrity and to comply with those globally recognized standard principles of fairness. Competition and the pressure to publish immediately - a way of encouraging rapid data sharing - can favor the dissemination of incomplete if not erroneous results obtained from partial studies, which feed false news, such as the benefits of a drug, and illusory hopes. It is commonly through press releases that "speed science" disseminates information to an audience that wants to be informed and reassured. Financial and political interests often mix with the urgency to find solutions. Covid-19 has highlighted in particular the risk of a politicization of science at the expense of transparency.


Assuntos
COVID-19 , Pandemias , Editoração/normas , Pesquisa/normas , SARS-CoV-2 , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/economia , Monofosfato de Adenosina/provisão & distribuição , Monofosfato de Adenosina/uso terapêutico , Alanina/análogos & derivados , Alanina/economia , Alanina/provisão & distribuição , Alanina/uso terapêutico , Antivirais/economia , Antivirais/provisão & distribuição , Antivirais/uso terapêutico , Vacinas contra COVID-19/efeitos adversos , Surtos de Doenças , Aprovação de Drogas , União Europeia , Humanos , Influenza Humana/tratamento farmacológico , Influenza Humana/economia , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Disseminação de Informação , Consentimento Livre e Esclarecido , Oseltamivir/economia , Oseltamivir/provisão & distribuição , Oseltamivir/uso terapêutico , Revisão da Pesquisa por Pares , Publicações Periódicas como Assunto , Política , Risco , Fatores de Tempo , Estados Unidos
6.
Am J Prev Med ; 60(4): 537-541, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33612337

RESUMO

INTRODUCTION: Although many Medicare Advantage plans have waived cost sharing for COVID-19 hospitalizations, these waivers are voluntary and may be temporary. To estimate the magnitude of potential patient cost sharing if waivers are not implemented or are allowed to expire, this study assesses the level and predictors of out-of-pocket spending for influenza hospitalizations in 2018 among elderly Medicare Advantage patients. METHODS: Using the Optum De-Identified Clinformatics DataMart, investigators identified Medicare Advantage patients aged ≥65 years hospitalized for influenza in 2018. For each hospitalization, out-of-pocket spending was calculated by summing deductibles, coinsurance, and copays. The mean out-of-pocket spending and the proportion of hospitalizations with out-of-pocket spending exceeding $2,500 were calculated. A 1-part generalized linear model with a log link and Poisson variance function was fitted to model out-of-pocket spending as a function of patient demographic characteristics, plan type, and hospitalization characteristics. Coefficients were converted to absolute changes in out-of-pocket spending by calculating average marginal effects. RESULTS: Among 14,278 influenza hospitalizations, the mean out-of-pocket spending was $987 (SD=$799). Out-of-pocket spending exceeded $2,500 for 3.0% of hospitalizations. The factors associated with higher out-of-pocket spending included intensive care use, greater length of stay, and enrollment in a preferred provider organization plan (average marginal effect=$634, 95% CI=$631, $636) compared with enrollment in an HMO plan. CONCLUSIONS: In this analysis of elderly Medicare Advantage patients, the mean out-of-pocket spending for influenza hospitalizations was almost $1,000. Federal policymakers should consider passing legislation mandating insurers to eliminate cost sharing for COVID-19 hospitalizations. Insurers with existing cost-sharing waivers should consider extending them indefinitely, and those without such waivers should consider implementing them immediately.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Política de Saúde/legislação & jurisprudência , Hospitalização/economia , Influenza Humana/economia , Medicare Part C/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , COVID-19/economia , COVID-19/terapia , Custo Compartilhado de Seguro/economia , Custo Compartilhado de Seguro/legislação & jurisprudência , Custo Compartilhado de Seguro/estatística & dados numéricos , Efeitos Psicossociais da Doença , Feminino , Política de Saúde/economia , Hospitalização/estatística & dados numéricos , Humanos , Influenza Humana/terapia , Masculino , Medicare Part C/economia , Medicare Part C/legislação & jurisprudência , Estados Unidos
7.
Sci Rep ; 11(1): 795, 2021 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-33437025

RESUMO

For several decades, the World Health Organization has collected, maintained, and distributed invaluable country-specific disease surveillance data that allow experts to develop new analytical tools for disease tracking and forecasting. To capture the extent of available data within these sources, we proposed a completeness metric based on the effective time series length. Using FluNet records for 29 Pan-American countries from 2005 to 2019, we explored whether completeness was associated with health expenditure indicators adjusting for surveillance system heterogeneity. We observed steady improvements in completeness by 4.2-6.3% annually, especially after the A(H1N1)-2009 pandemic, when 24 countries reached > 95% completeness. Doubling in decadal health expenditure per capita was associated with ~ 7% increase in overall completeness. The proposed metric could navigate experts in assessing open access data quality and quantity for conducting credible statistical analyses, estimating disease trends, and developing outbreak forecasting systems.


Assuntos
Influenza Humana/epidemiologia , Orthomyxoviridae/isolamento & purificação , Acesso à Informação , América/epidemiologia , Confiabilidade dos Dados , Coleta de Dados/economia , Coleta de Dados/métodos , Surtos de Doenças , Humanos , Influenza Humana/diagnóstico , Influenza Humana/economia , Influenza Humana/prevenção & controle , Organização Mundial da Saúde
8.
Value Health ; 24(1): 11-18, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33431142

RESUMO

OBJECTIVES: To estimate the general practitioner (GP) consultation rate attributable to influenza in The Netherlands. METHODS: Regression analysis was performed on the weekly numbers of influenza-like illness (ILI) GP consultations and laboratory reports for influenza virus types A and B and 8 other pathogens over the period 2003-2014 (11 influenza seasons; week 40-20 of the following year). RESULTS: In an average influenza season, 27% and 11% of ILI GP consultations were attributed to infection by influenza virus types A and B, respectively. Influenza is therefore responsible for approximately 107 000 GP consultations (651/100 000) each year in The Netherlands. GP consultation rates associated with influenza infection were highest in children under 5 years of age, at 667 of 100 000 for influenza A and 258 of 100 000 for influenza B. Influenza virus infection was found to be the predominant cause of ILI-related GP visits in all age groups except children under 5, in which respiratory syncytial virus (RSV) infection was found to be the main contributor. CONCLUSIONS: The burden of influenza in terms of GP consultations is considerable. Overall, influenza is the main contributor to ILI. Although ILI symptoms in children under 5 years of age are most often associated with RSV infection, the majority of visits related to influenza occur among children under 5 years of age.


Assuntos
Influenza Humana/epidemiologia , Atenção Primária à Saúde/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Análise Custo-Benefício , Humanos , Lactente , Vacinas contra Influenza/administração & dosagem , Vacinas contra Influenza/economia , Influenza Humana/economia , Influenza Humana/prevenção & controle , Pessoa de Meia-Idade , Modelos Estatísticos , Países Baixos/epidemiologia , Atenção Primária à Saúde/economia , Viroses/economia , Viroses/epidemiologia , Adulto Jovem
9.
Value Health ; 24(1): 19-31, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33431149

RESUMO

OBJECTIVE: This study evaluates the cost-effectiveness of extending the Dutch influenza vaccination program for elderly and medical high-risk groups to include pediatric influenza vaccination, taking indirect protection into account. METHODS: An age-structured dynamic transmission model was used that was calibrated to influenza-associated GP visits over 4 seasons (2010-2011 to 2013-2014). The clinical and economic impact of different pediatric vaccination strategies were compared over 20 years, varying the targeted age range, the vaccine type for children or elderly and high-risk groups. Outcome measures include averted symptomatic infections and deaths, societal costs and quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Costs and QALYs were discounted at 4% and 1.5% annually. RESULTS: At an assumed coverage of 50%, adding pediatric vaccination for 2- to 17-year-olds with quadrivalent live-attenuated vaccine to the current vaccination program for elderly and medical high-groups with quadrivalent inactivated vaccine was estimated to avert, on average, 401 820 symptomatic cases and 72 deaths per year. Approximately half of averted symptomatic cases and 99% of averted deaths were prevented in other age groups than 2- to 17-year-olds due to herd immunity. The cumulative discounted 20-year economic impact was 35 068 QALYs gained and €1687 million saved, that is, the intervention was cost-saving. This vaccination strategy had the highest probability of being the most cost-effective strategy considered, dominating pediatric strategies targeting 2- to 6-year-olds or 2- to 12-year-olds or strategies with trivalent inactivated vaccine. CONCLUSION: Modeling indicates that introducing pediatric influenza vaccination in The Netherlands is cost-saving, reducing the influenza-related disease burden substantially.


Assuntos
Vacinas contra Influenza/administração & dosagem , Vacinas contra Influenza/economia , Influenza Humana/prevenção & controle , Adolescente , Fatores Etários , Criança , Pré-Escolar , Análise Custo-Benefício , Humanos , Programas de Imunização/economia , Influenza Humana/economia , Influenza Humana/epidemiologia , Modelos Econômicos , Países Baixos/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida , Estações do Ano
10.
Value Health ; 24(1): 3-10, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33431150

RESUMO

OBJECTIVES: As of 2019, quadrivalent influenza vaccine (QIV) has replaced trivalent influenza vaccine (TIV) in the national immunization program in The Netherlands. Target groups are individuals of 60+ years of age and those with chronic diseases. The objective was to estimate the incremental break-even price of QIV over TIV at a threshold of €20 000 per quality-adjusted life-year (QALY). METHODS: An age-structured compartmental dynamic model was adapted for The Netherlands to assess health outcomes and associated costs of vaccinating all individuals at higher risk for influenza with QIV instead of TIV over the seasons 2010 to 2018. Influenza incidence rates were derived from a global database. Other parameters (probabilities, QALYs and costs) were extracted from the literature and applied according to Dutch guidelines. A threshold of €20 000 per QALY was applied to estimate the incremental break-even prices of QIV versus TIV. Sensitivity analyses were performed to test the robustness of the model outcomes. RESULTS: Retrospectively, vaccination with QIV instead of TIV could have prevented on average 9500 symptomatic influenza cases, 2130 outpatient visits, 84 hospitalizations, and 38 deaths per year over the seasons 2010 to 2018. This translates into 385 QALYs and 398 life-years potentially gained. On average, totals of €431 527 direct and €2 388 810 indirect costs could have been saved each year. CONCLUSION: Using QIV over TIV during the influenza seasons 2010 to 2018 would have been cost-effective at an incremental price of maximally €3.81 (95% confidence interval, €3.26-4.31). Sensitivity analysis showed consistent findings on the incremental break-even price in the same range.


Assuntos
Vacinas contra Influenza/economia , Vacinas contra Influenza/imunologia , Influenza Humana/prevenção & controle , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Gastos em Saúde , Humanos , Vacinas contra Influenza/administração & dosagem , Influenza Humana/economia , Influenza Humana/epidemiologia , Modelos Econômicos , Países Baixos/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida , Estudos Retrospectivos
11.
Value Health ; 24(1): 32-40, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33431151

RESUMO

OBJECTIVES: In Germany, routine influenza vaccination with quadrivalent influenza vaccines (QIV) is recommended and reimbursed for individuals ≥60 years of age and individuals with underlying chronic conditions. The present study examines the cost-effectiveness of a possible extension of the recommendation to include strategies of childhood vaccination against seasonal influenza using QIV. METHODS: A dynamic transmission model was used to examine the epidemiological impact of different childhood vaccination strategies. The outputs were used in a health economic decision tree to calculate the costs per quality-adjusted life year (QALY) gained from a societal and a third-party payer (TPP) perspective. Strain-specific epidemiology, vaccine uptake, and vaccine efficacy data from the 10 non-pandemic seasons from 2003/2004 to 2013/2014 were used, and cost data were drawn mainly from a health insurance claims data analysis and supplemented by estimates from literature. Uncertainty is explored via scenario, deterministic, and probabilistic sensitivity analyses. RESULTS: Vaccinating 2- to 9-year-olds with QIV assuming a vaccine uptake of 40% is cost-saving with a benefit-cost ratio of 1.66 from a societal perspective and an incremental cost-effectiveness ratio of €998/QALY from a TPP perspective. Lower and higher vaccine uptakes show marginal effects, while extending the target group to 2- to 17-year-olds further increases the health benefits while still being below the willingness-to-pay (WTP) threshold. Assuming no vaccine-induced herd protection has a negative effect on the cost-effectiveness ratio, but childhood vaccination remains cost-effective. CONCLUSION: Routine childhood vaccination against seasonal influenza in Germany is most likely to be cost-saving from a societal perspective and highly cost-effective from a TPP perspective.


Assuntos
Vacinas contra Influenza/administração & dosagem , Vacinas contra Influenza/economia , Influenza Humana/prevenção & controle , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Alemanha/epidemiologia , Gastos em Saúde , Humanos , Programas de Imunização/economia , Lactente , Vacinas contra Influenza/imunologia , Influenza Humana/economia , Influenza Humana/epidemiologia , Pessoa de Meia-Idade , Modelos Econômicos , Anos de Vida Ajustados por Qualidade de Vida , Adulto Jovem
12.
PLoS Comput Biol ; 16(10): e1008278, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33021983

RESUMO

For infectious disease prevention, policy-makers are typically required to base policy decisions in light of operational and monetary restrictions, prohibiting implementation of all candidate interventions. To inform the evidence-base underpinning policy decision making, mathematical and health economic modelling can be a valuable constituent. Applied to England, this study aims to identify the optimal target age groups when extending a seasonal influenza vaccination programme of at-risk individuals to those individuals at low risk of developing complications following infection. To perform this analysis, we utilise an age- and strain-structured transmission model that includes immunity propagation mechanisms which link prior season epidemiological outcomes to immunity at the beginning of the following season. Making use of surveillance data from the past decade in conjunction with our dynamic model, we simulate transmission dynamics of seasonal influenza in England from 2012 to 2018. We infer that modified susceptibility due to natural infection in the previous influenza season is the only immunity propagation mechanism to deliver a non-negligible impact on the transmission dynamics. Further, we discerned case ascertainment to be higher for young infants compared to adults under 65 years old, and uncovered a decrease in case ascertainment as age increased from 65 to 85 years of age. Our health economic appraisal sweeps vaccination age space to determine threshold vaccine dose prices achieving cost-effectiveness under differing paired strategies. In particular, we model offering vaccination to all those low-risk individuals younger than a given age (but no younger than two years old) and all low-risk individuals older than a given age, while maintaining vaccination of at-risk individuals of any age. All posited strategies were deemed cost-effective. In general, the addition of low-risk vaccination programmes whose coverage encompassed children and young adults (aged 20 and below) were highly cost-effective. The inclusion of elder age-groups to the low-risk programme typically lessened the cost-effectiveness. Notably, elderly-centric programmes vaccinating from 65-75 years and above had the least permitted expense per vaccine.


Assuntos
Vacinas contra Influenza , Influenza Humana/prevenção & controle , Vacinação , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Biologia Computacional , Análise Custo-Benefício , Inglaterra , Humanos , Lactente , Recém-Nascido , Vacinas contra Influenza/administração & dosagem , Vacinas contra Influenza/economia , Vacinas contra Influenza/uso terapêutico , Influenza Humana/economia , Influenza Humana/epidemiologia , Pessoa de Meia-Idade , Modelos Teóricos , Vacinação/economia , Vacinação/estatística & dados numéricos , Adulto Jovem
13.
BMC Public Health ; 20(1): 1374, 2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-32907562

RESUMO

BACKGROUND: Influenza epidemics significantly weight on the Brazilian healthcare system and its society. Public health authorities have progressively expanded recommendations for vaccination against influenza, particularly to the pediatric population. However, the potential mismatch between the trivalent influenza vaccine (TIV) strains and those circulating during the season remains an issue. Quadrivalent vaccines improves vaccines effectiveness by preventing any potential mismatch on influenza B lineages. METHODS: We evaluate the public health and economic benefits of the switch from TIV to QIV for the pediatric influenza recommendation (6mo-5yo) by using a dynamic epidemiological model able to consider the indirect impact of vaccination. Results of the epidemiological model are then imputed in a health-economic model adapted to the Brazilian context. We perform deterministic and probabilistic sensitivity analysis to account for both epidemiological and economical sources of uncertainty. RESULTS: Our results show that switching from TIV to QIV in the Brazilian pediatric population would prevent 406,600 symptomatic cases, 11,300 hospitalizations and almost 400 deaths by influenza season. This strategy would save 3400 life-years yearly for an incremental direct cost of R$169 million per year, down to R$86 million from a societal perspective. Incremental cost-effectiveness ratios for the switch would be R$49,700 per life-year saved and R$26,800 per quality-adjusted life-year gained from a public payer perspective, and even more cost-effective from a societal perspective. Our results are qualitatively similar in our sensitivity analysis. CONCLUSIONS: Our analysis shows that switching from TIV to QIV to protect children aged 6mo to 5yo in the Brazilian influenza epidemiological context could have a strong public health impact and represent a cost-effective strategy from a public payer perspective, and a highly cost-effective one from a societal perspective.


Assuntos
Análise Custo-Benefício , Vacinas contra Influenza , Influenza Humana/prevenção & controle , Saúde Pública , Vacinação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Economia Médica , Feminino , Hospitalização/economia , Humanos , Lactente , Vírus da Influenza B/classificação , Vírus da Influenza B/imunologia , Vacinas contra Influenza/economia , Vacinas contra Influenza/imunologia , Influenza Humana/economia , Influenza Humana/epidemiologia , Influenza Humana/virologia , Pessoa de Meia-Idade , Modelos Econômicos , Anos de Vida Ajustados por Qualidade de Vida , Estações do Ano , Incerteza , Vacinação/economia , Adulto Jovem
14.
BMC Public Health ; 20(1): 1464, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993588

RESUMO

BACKGROUND: The winter pressure often experienced by NHS hospitals in England is considerably contributed to by severe cases of seasonal influenza resulting in hospitalisation. The prevention planning and commissioning of the influenza vaccination programme in the UK does not always involve those who control the hospital budget. The objective of this study was to describe the direct medical costs of secondary care influenza-related hospital admissions across different age groups in England during two consecutive influenza seasons. METHODS: The number of hospital admissions, length of stay, and associated costs were quantified as well as determining the primary costs of influenza-related hospitalisations. Data were extracted from the Hospital Episode Statistics (HES) database between September 2017 to March 2018 and September 2018 to March 2019 in order to incorporate the annual influenza seasons. The use of international classification of disease (ICD)-10 codes were used to identify relevant influenza hospitalisations. Healthcare Resource Group (HRG) codes were used to determine the costs of influenza-related hospitalisations. RESULTS: During the 2017/18 and 2018/19 seasons there were 46,215 and 39,670 influenza-related hospital admissions respectively. This resulted in a hospital cost of £128,153,810 and £99,565,310 across both seasons. Results showed that those in the 65+ year group were associated with the highest hospitalisation costs and proportion of in-hospital deaths. In both influenza seasons, the HRG code WJ06 (Sepsis without Interventions) was found to be associated with the longest average length of stay and cost per admission, whereas PD14 (Paediatric Lower Respiratory Tract Disorders without Acute Bronchiolitis) had the shortest length of stay. CONCLUSION: This study has shown that influenza-related hospital admissions had a considerable impact on the secondary healthcare system during the 2017/18 and 2018/19 influenza seasons, before taking into account its impact on primary health care.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Influenza Humana/economia , Vacinação/economia , Adulto , Inglaterra , Feminino , Recursos em Saúde , Hospitalização/estatística & dados numéricos , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Estações do Ano , Vacinação/estatística & dados numéricos
15.
BMC Med ; 18(1): 223, 2020 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-32814581

RESUMO

BACKGROUND: There is substantial burden of seasonal influenza in Kenya, which led the government to consider introducing a national influenza vaccination programme. Given the cost implications of a nationwide programme, local economic evaluation data are needed to inform policy on the design and benefits of influenza vaccination. We set out to estimate the cost-effectiveness of seasonal influenza vaccination in Kenya. METHODS: We fitted an age-stratified dynamic transmission model to active surveillance data from patients with influenza from 2010 to 2018. Using a societal perspective, we developed a decision tree cost-effectiveness model and estimated the incremental cost-effectiveness ratio (ICER) per disability-adjusted life year (DALY) averted for three vaccine target groups: children 6-23 months (strategy I), 2-5 years (strategy II) and 6-14 years (strategy III) with either the Southern Hemisphere influenza vaccine (Strategy A) or Northern Hemisphere vaccine (Strategy B) or both (Strategy C: twice yearly vaccination campaigns, or Strategy D: year-round vaccination campaigns). We assessed cost-effectiveness by calculating incremental net monetary benefits (INMB) using a willingness-to-pay (WTP) threshold of 1-51% of the annual gross domestic product per capita ($17-$872). RESULTS: The mean number of infections across all ages was 2-15 million per year. When vaccination was well timed to influenza activity, the annual mean ICER per DALY averted for vaccinating children 6-23 months ranged between $749 and $1385 for strategy IA, $442 and $1877 for strategy IB, $678 and $4106 for strategy IC and $1147 and $7933 for strategy ID. For children 2-5 years, it ranged between $945 and $1573 for strategy IIA, $563 and $1869 for strategy IIB, $662 and $4085 for strategy IIC, and $1169 and $7897 for strategy IID. For children 6-14 years, it ranged between $923 and $3116 for strategy IIIA, $1005 and $2223 for strategy IIIB, $883 and $4727 for strategy IIIC and $1467 and $6813 for strategy IIID. Overall, no vaccination strategy was cost-effective at the minimum ($17) and median ($445) WTP thresholds. Vaccinating children 6-23 months once a year had the highest mean INMB value at $872 (WTP threshold upper limit); however, this strategy had very low probability of the highest net benefit. CONCLUSION: Vaccinating children 6-23 months once a year was the most favourable vaccination option; however, the strategy is unlikely to be cost-effective given the current WTP thresholds.


Assuntos
Transmissão de Doença Infecciosa/economia , Transmissão de Doença Infecciosa/prevenção & controle , Vacinas contra Influenza/economia , Influenza Humana/economia , Influenza Humana/prevenção & controle , Análise Custo-Benefício , Feminino , Humanos , Lactente , Quênia , Masculino
16.
Int J Public Health ; 65(7): 1003-1009, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32712691

RESUMO

OBJECTIVES: To present a historical-critical analysis of the configuration process of the 2009-2010 flu pandemic in order to show the relationships between this process and the organization of world power, and to promote social and political mobilization. METHODS: Primary and secondary sources on the dynamics of the 2009-2010 flu pandemic were studied. The sources were validated by plausibility assessment and historiographical analysis. From a historical-territorial and critical approach, the relations between the world configuration of the pandemic and the economic, political, and ideological power relations of contemporary capitalism were identified. RESULTS: It is revealed that the expanding monopoly of the pig industry provided favorable conditions for the evolutionary explosion of the influenza A(H1N1) virus. The World Health Organization (WHO) made decisions that were inclined toward the economic interests of the pig and pharmaceutical industries within the framework of financial-cognitive capitalism. CONCLUSIONS: The modes of conduct of these institutions and companies materialized the world relations of economic, political, and ideological power of our time, which determined the configuration process of the pandemic. The worldwide spreading of the virus is barely a trail of the process.


Assuntos
Capitalismo , Indústria Farmacêutica/economia , Indústria Farmacêutica/história , Influenza Humana/economia , Influenza Humana/epidemiologia , Pandemias/economia , Pandemias/história , Política , Indústria Farmacêutica/estatística & dados numéricos , História do Século XXI , Humanos , Pandemias/estatística & dados numéricos , Organização Mundial da Saúde
17.
BMJ Case Rep ; 13(7)2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32611659

RESUMO

Since December 2019, coronavirus disease 2019 (COVID-19) has been an international public health emergency. The possibility of COVID-19 should be considered primarily in patients with new-onset fever or respiratory tract symptoms. However, these symptoms can occur with other viral respiratory illnesses. We reported a case of severe acute respiratory syndrome coronavirus 2 and influenza A virus coinfection. During the epidemic, the possibility of COVID-19 should be considered regardless of positive findings for other pathogens.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Vírus da Influenza A/isolamento & purificação , Influenza Humana/complicações , Influenza Humana/diagnóstico , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Amidas/uso terapêutico , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , COVID-19 , Coinfecção , Infecções por Coronavirus/tratamento farmacológico , Diagnóstico Diferencial , Glucocorticoides/uso terapêutico , Humanos , Influenza Humana/economia , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/tratamento farmacológico , Pregnenodionas/uso terapêutico , Pirazinas/uso terapêutico , Radiografia , Reação em Cadeia da Polimerase em Tempo Real , SARS-CoV-2
18.
J Infect Dis ; 222(7): 1138-1144, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32386323

RESUMO

BACKGROUND: The protection that an influenza vaccine offers can vary significantly from person to person due to differences in immune systems, body types, and other factors. The question, then, is what is the value of efforts to reduce this variability such as making vaccines more personalized and tailored to individuals. METHODS: We developed a compartment model of the United States to simulate different influenza seasons and the impact of reducing the variability in responses to the influenza vaccine across the population. RESULTS: Going from a vaccine that varied in efficacy (0-30%) to one that had a uniform 30% efficacy for everyone averted 16.0-31.2 million cases, $1.9-$3.6 billion in direct medical costs, and $16.1-$42.7 billion in productivity losses. Going from 0-50% in efficacy to just 50% for everyone averted 27.7-38.6 million cases, $3.3-$4.6 billion in direct medical costs, and $28.8-$57.4 billion in productivity losses. Going from 0-70% to 70% averted 33.6-54.1 million cases, $4.0-$6.5 billion in direct medical costs, and $44.8-$64.7 billion in productivity losses. CONCLUSIONS: This study quantifies for policy makers, funders, and vaccine developers and manufacturers the potential impact of efforts to reduce variability in the protection that influenza vaccines offer (eg, developing vaccines that are more personalized to different individual factors).


Assuntos
Transmissão de Doença Infecciosa/prevenção & controle , Epidemias , Vacinas contra Influenza/administração & dosagem , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , 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 , Farmácias , Estações do Ano , Resultado do Tratamento , Estados Unidos/epidemiologia , Vacinação/economia , Cobertura Vacinal , Adulto Jovem
19.
PLoS One ; 15(5): e0233526, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32437476

RESUMO

PURPOSE: Quadrivalent influenza vaccine (QIV) includes the same strains as trivalent influenza vaccine (TIV) plus an additional B strain of the other B lineage. The aim of the study was to analyse the public health and economic impact of replacing TIV with QIV in different scenarios in Spain. METHODS: A dynamic transmission model was developed to estimate the number of influenza B cases prevented under TIV and QIV strategies (<65 years (high risk) and ≥65 years). This model considers cross-protective immunity induced by different lineages of influenza B. The output of the transmission model was used as input for a decision tree model that estimated the economic impact of switching TIV to QIV. The models were populated with Spanish data whenever possible. Deterministic univariate and probabilistic multivariate sensitivity analyses were performed. RESULTS: Replacing TIV with QIV in all eligible patients with current vaccine coverage in Spain may have prevented 138,707 influenza B cases per season and, therefore avoided 10,748 outpatient visits, 3,179 hospitalizations and 192 deaths. The replacement could save €532,768 in outpatient visit costs, €13 million in hospitalization costs, and €3 million in costs of influenza-related deaths per year. An additional €5 million costs associated with productivity loss could be saved per year, from the societal perspective. The budget impact from societal perspective would be €6.5 million, and the incremental cost-effectiveness ratio (ICER) €1,527 per quality-adjusted life year (QALY). Sensitivity analyses showed robust results. In additional scenarios, QIV also showed an impact at public health level reducing influenza B related cases, outpatient visits, hospitalizations and deaths. CONCLUSIONS: Our results show public health and economic benefits for influenza prevention with QIV. It would be an efficient intervention for the Spanish National Health Service with major health benefits especially in the population ≥65-year.


Assuntos
Vacinas contra Influenza/economia , Influenza Humana/economia , Vacinação/economia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Humanos , Lactente , Vacinas contra Influenza/uso terapêutico , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Pessoa de Meia-Idade , Saúde Pública , Espanha , Adulto Jovem
20.
BMC Med ; 18(1): 90, 2020 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-32284056

RESUMO

BACKGROUND: China has an aging population with an increasing number of adults aged ≥ 60 years. Influenza causes a heavy disease burden in older adults, but can be alleviated by vaccination. We assessed the cost-effectiveness of a potential government-funded seasonal influenza vaccination program in older adults in China. METHODS: We characterized the health and economic impact of a fully funded influenza vaccination program for older adults using China-specific influenza disease burden, and related cost data, etc. Using a decision tree model, we calculated the incremental costs per quality-adjusted life year (QALY) gained of vaccination from the societal perspective, at a willingness-to-pay threshold equivalent to GDP per capita (US$8840). Moreover, we estimated the threshold vaccination costs, under which the fully funded vaccination program is cost-effective using GDP per capita as the willingness-to-pay threshold. RESULTS: Compared to current self-paid vaccination, a fully funded vaccination program is expected to prevent 19,812 (95% uncertainty interval, 7150-35,783) influenza-like-illness outpatient consultations per year, 9418 (3386-17,068) severe acute respiratory infection hospitalizations per year, and 8800 (5300-11,667) respiratory excess deaths due to influenza per year, and gain 70,212 (42,106-93,635) QALYs per year. Nationally, the incremental costs per QALY gained of the vaccination program is US$4832 (3460-8307), with a 98% probability of being cost-effective. The threshold vaccination cost is US$10.19 (6.08-13.65). However, variations exist between geographical regions, with Northeast and Central China having lower probabilities of cost-effectiveness. CONCLUSIONS: Our results support the implementation of a government fully funded older adult vaccination program in China. The regional analysis provides results across settings that may be relevant to other countries with similar disease burden and economic status, especially for low- and middle-income countries where such analysis is limited.


Assuntos
Análise Custo-Benefício/métodos , Programas de Imunização/economia , Influenza Humana/economia , Vacinação/economia , Idoso , Idoso de 80 Anos ou mais , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vacinação/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...