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1.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(10): 993-999, 2019 Oct 06.
Artigo em Chinês | MEDLINE | ID: mdl-31607044

RESUMO

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


Assuntos
Vacinas contra Influenza/economia , Influenza Humana , Idoso , Idoso de 80 Anos ou mais , China , Análise Custo-Benefício , Humanos , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Estações do Ano
2.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(10): 1000-1006, 2019 Oct 06.
Artigo em Chinês | MEDLINE | ID: mdl-31607045

RESUMO

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


Assuntos
Diabetes Mellitus , Vacinas contra Influenza/economia , Influenza Humana , Vacinação/economia , China , Análise Custo-Benefício , Governo , Humanos , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida
3.
BMC Infect Dis ; 19(1): 805, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31521116

RESUMO

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


Assuntos
Creches , Comportamentos Relacionados com a Saúde , Influenza Humana/prevenção & controle , Percepção , Professores Escolares/psicologia , Vacinação/psicologia , Coqueluche/prevenção & controle , Adulto , Austrália , Criança , Pré-Escolar , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Vacinas contra Influenza/economia , Vacinas contra Influenza/uso terapêutico , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Vacina contra Coqueluche/uso terapêutico , Inquéritos e Questionários , Vacinação/economia , Local de Trabalho
4.
BMC Health Serv Res ; 19(1): 407, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234842

RESUMO

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


Assuntos
Programas de Imunização/economia , Vacinas contra Influenza/economia , Serviços de Saúde Escolar/economia , Instituições Acadêmicas/estatística & dados numéricos , Adolescente , Criança , Análise Custo-Benefício , Humanos , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , New York , Avaliação de Programas e Projetos de Saúde
5.
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
7.
Hum Vaccin Immunother ; 15(5): 1035-1047, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30735465

RESUMO

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


Assuntos
Adjuvantes Imunológicos/administração & dosagem , Análise Custo-Benefício , Vacinas contra Influenza/economia , Influenza Humana/prevenção & controle , Polissorbatos/administração & dosagem , Esqualeno/administração & dosagem , Vacinação/economia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais/sangue , Humanos , Vacinas contra Influenza/imunologia , Fatores de Risco
9.
PLoS One ; 14(1): e0209643, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30682030

RESUMO

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


Assuntos
Vacinas contra Influenza/economia , Vacinas contra Influenza/imunologia , Vacinação/métodos , Adjuvantes Imunológicos/uso terapêutico , Adjuvantes Farmacêuticos/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício/métodos , Feminino , Humanos , Influenza Humana/prevenção & controle , Masculino , Cadeias de Markov , República da Coreia , Fatores de Risco , Resultado do Tratamento
10.
Hum Vaccin Immunother ; 15(2): 487-495, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30204043

RESUMO

Influenza vaccination is an important public health intervention for older adults, yet vaccination rates remain suboptimal. We conducted an online survey of Canadians ≥ 65 years to explore satisfaction with publicly-funded standard-dose influenza vaccines, and perceptions of the need for a more effective product. They were provided with information about currently approved influenza vaccines, and were asked about their preferences should all formulations be available for free, and should the recently approved high-dose (HD) vaccine for seniors be available at a cost. From March to April 2017, 5014 seniors completed the survey; mean age was 71.3 ± 5.17 years, 50% were female, and 42.6% had one or more chronic conditions. 3403 (67.9%) had been vaccinated against influenza in the 2016/17 season. Of all respondents, 3460 (69%) were satisfied with the standard-dose influenza vaccines, yet 3067 (61.1%) thought that a more effective vaccine was/may be needed. If HD was only available at a cost, 1426 (28.4%) respondents would consider it, of whom 62.9% would pay $20 or less. If all vaccines were free next season, 1914 (38.2%) would opt for HD (including 12.2% of those who previously rejected influenza vaccines), 856 (17.1%) would choose adjuvanted vaccine, and 558 (11.1%) standard-dose vaccine. 843 (16.8%) of respondents were against vaccines, 451 (9.0%) had no preference and 392 (7.8%) were uncertain. Making this product available through publicly funded programs may be a strategy to increase immunization rates in this population.


Assuntos
Custos de Medicamentos , Conhecimentos, Atitudes e Prática em Saúde , Vacinas contra Influenza/economia , Influenza Humana/prevenção & controle , Saúde Pública/economia , Idoso , Feminino , Humanos , Vacinas contra Influenza/classificação , Masculino , Sistemas On-Line , Saúde Pública/estatística & dados numéricos , Inquéritos e Questionários , Cobertura Vacinal/economia
11.
Vaccine ; 37(1): 25-33, 2019 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-30471956

RESUMO

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


Assuntos
Prioridades em Saúde , Recursos em Saúde , Vacinas contra Influenza/economia , Influenza Humana/prevenção & controle , Vacinação/economia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Feminino , Infecções por HIV/epidemiologia , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Vacinas contra Influenza/uso terapêutico , Influenza Humana/mortalidade , Masculino , Pessoa de Meia-Idade , Gravidez , Fatores de Risco , África do Sul , Tuberculose/epidemiologia , Adulto Jovem
12.
Vaccine ; 37(2): 226-234, 2019 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-30527660

RESUMO

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


Assuntos
Análise Custo-Benefício , Vacina contra Difteria, Tétano e Coqueluche/economia , Vacinas contra Influenza/economia , Vacinas Pneumocócicas/economia , Vacinação/economia , Adulto , Fatores Etários , Canadá , Difteria/prevenção & controle , Vacina contra Difteria, Tétano e Coqueluche/uso terapêutico , Hepatite B/prevenção & controle , Humanos , Esquemas de Imunização , Vacinas contra Influenza/uso terapêutico , Influenza Humana/prevenção & controle , Vacinas Pneumocócicas/uso terapêutico , Pneumonia Pneumocócica/prevenção & controle , Tétano/prevenção & controle , Estados Unidos
14.
Ned Tijdschr Geneeskd ; 1622018 09 06.
Artigo em Holandês | MEDLINE | ID: mdl-30306759

RESUMO

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


Assuntos
Vacinas contra Influenza , Influenza Humana/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto/ética , Vacinação , Idoso , Análise Custo-Benefício , Método Duplo-Cego , Hospitalização/estatística & dados numéricos , Humanos , Vacinas contra Influenza/economia , Pessoa de Meia-Idade , Países Baixos , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Vacinação/economia
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.
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
18.
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
19.
Zhonghua Liu Xing Bing Xue Za Zhi ; 39(8): 1045-1050, 2018 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-30180426

RESUMO

Influenza can be prevented through annual appropriate vaccination against the virus concerned. In China, influenza vaccine is categorized as "Class Ⅱ" infectious diseases which the cost is paid out of the user's pockets. The annual coverage of influenza vaccination had been 2%-3%. The main reasons for the low coverage would include the following factors: lacking awareness on both the disease and vaccine, poor accessibility of vaccination service, and the cost of vaccination. To reduce the health and economic burden associated with influenza, comprehensive policies should be improved, targeting the coverage of seasonal influenza vaccination. These items would include: ① Different financing reimbursement schemes and mechanisms to improve the aspiration on vaccination and on the vaccine coverage in high-risk groups, as young children, elderly, people with underlying medical conditions; ② to ameliorate equality of vaccination services; ③ to improve knowledge of the health care workers (HCWs) and the public on influenza and related vaccines; ④ to improve clinical and preventive medical practice and vaccination among HCWs through revising clinical guidelines, pathway and consensus of experts; ⑤ to provide more convenient, accessible and normative vaccination service system; ⑥ to strengthen research and development as well as marketing on novel influenza vaccines; ⑦ to revise items regarding the contraindication for influenza vaccine on pregnancy women, stated in the Chinese Pharmacopoeia.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Promoção da Saúde/métodos , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Vacinação , Idoso , Conscientização , Criança , China , Custos e Análise de Custo , Feminino , Humanos , Vacinas contra Influenza/economia , Masculino , Gravidez
20.
PLoS One ; 13(6): e0199470, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29933402

RESUMO

Immunization of pregnant women against seasonal influenza remains limited in low- and lower-middle-income countries despite being recommended by the World Health Organization (WHO). The WHO/PATH Maternal Influenza Immunization Project was created to identify and address obstacles to delivering influenza vaccines to pregnant women in low resource setting. To gain a better understanding of potential demand from this target group, we developed a model simulating pregnant women populations eligible for vaccination during antenatal care (ANC) services in all low- and lower-middle-income countries. We assessed potential vaccine demand in the context of both seasonal and year-round vaccination strategies and identified the ways that immunization programs may be affected by availability gaps in supply linked to current vaccine production cycles and shelf life duration. Results of our analysis, which includes 54 eligible countries in 2015 for New Vaccine Support from Gavi, the Vaccine Alliance, suggest the demand for influenza vaccines could be 7.7 to 16.0 million doses in 2020, and 27.0 to 61.7 million doses by 2029. If current trends in production capacity and actual production of seasonal influenza vaccines were to continue, global vaccine supply would be sufficient to meet this additional demand-although a majority of countries would face implementation issues linked to timing of supply.


Assuntos
Países em Desenvolvimento/economia , Previsões , Imunização/economia , Renda , Vacinas contra Influenza/economia , Vacinas contra Influenza/imunologia , Feminino , Humanos , Modelos Teóricos , Gravidez , Estações do Ano , Fatores de Tempo
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