Cost-effectiveness Of Vaccination Program Research Articles

Prevalence of SARS-CoV-2 Among Deported Guatemalan Migrants in Tecun Uman, Guatemala

Abstract Background Migrant populations in Central America face complex disease burdens, including respiratory viruses. A frequently overlooked sub-group within the migrant populations is the returned migrants. Assessment of COVID-19 disease burden and associated risk factors are important for identifying high-risk groups, as well as for informing disease reduction efforts, including vaccination programs. Methods As a sub-study within a larger (AGRI-CASA) cohort study, we screened and offered enrollment to returned migrants on a weekly basis in El Centro de Retornados de Ayutla, located in the Tecun Uman community along the Guatemala-Mexico border. The existing screening program includes symptomatic screening of all returnees for cough or fever; we then performed SARS-CoV-2 rapid antigen testing from nasopharyngeal swab on all symptomatic and 10% of asymptomatic individuals. In our sub-study of this screened population, we collected additional clinical and exposure data and a second mid-turbinate nasal swab on all consenting adults available with COVID-like illness (CLI). The samples underwent PCR testing at the Trifinio Center for Human Development (CHD) laboratory. We did not enroll minors due to uncertainty of legal guardians. Results From January-September 2023, 10,570 Guatemalans were deported through El Centro de Salud de Ayutla, of which 5,373 (50.8%) were tested for SARS-CoV-2 and 42 (0.8%) were positive, a decrease from 2021 (n=40,927 migrants, 12,181 tested, and 714 [5.9%) positive) and 2022 (n=36,865 migrants, 12,406 tested, 403 [3.2%] positive). Our sub-study enrolled 197 (30.1%) of 655 symptomatic participants with CLI from January-September 2023. Of those, median age (SD) was 26 (7.87) years and 174 (88%) were male. The most commonly reported symptoms were cough (34.5%) nasal congestion (27.9%), sore throat (21.3%), and headache (19.3%). Of 197 participants, 163 samples were available for testing; 4 (2.5%) of those were SARS-CoV-2 antigen positive via POC testing and 5 (3.1%) of those samples were PCR-positive at the Trifinio Center for Human Development (CHD) laboratory. The PCR-confirmed SARS-CoV-2 positive samples contained XBB1.15, XBB1.5.11, and XBB.1.5 variants. According to Guatemala’s Laboratorio Nacional de Salud, the main variant in the country in February and June 2023 was Omicron, especially the XBB variant. Conclusion Despite the crowding conditions for deported migrants returning from Mexico, SARS-CoV-2 positivity for symptomatic individuals was relatively low. Further studies should evaluate additional pathogens and migrants traveling in both directions to characterize the full disease burden of this vulnerable population. Combined with additional information on the vaccination status of the deported migrants, these results will be crucial in calculating the number-needed-to-vaccinate (NNV) among the departed migrant populations and the local Guatemalans as well as assessing the cost effectiveness of vaccination programs targeting these populations.

Financing strategies and cost estimates of influenza vaccination for the elderly in China: explore a multi-party co-payment mechanism

The disease burden and economic burden of seasonal influenza is substantial in China, and the Coronavirus disease 2019 (COVID-19) pandemic has brought new challenges to the prevention and control of influenza. As a priority group of influenza vaccination, the elderly are at higher risk of influenza-associated severe symptoms and deaths, and they are more price-sensitive vaccine users with better cost-effectiveness of vaccination program. Therefore, a reasonable financing mechanism of influenza vaccination should be designed for the elderly to increase their vaccination rate. This study proposes three financing strategies of influenza vaccination for the elderly in China, trying to explore the distribution of vaccination costs among individuals, central government and local governments under different financing strategies, including the individual-central-local mechanism (strategy 1), the central-local mechanism (strategy 2), and the local payment mechanism (strategy 3). Strategy 1 is feasible and sustainable for most regions in the short term. Strategy 2 is conducive to further increasing the vaccine coverage rate of the elderly. Strategy 3 encourages local fiscal payments to help relieve the financial pressure of the central government. The results revealed a relatively heavy financial burden of influenza vaccination for the elderly, and it is recommended to promote the development of a multiparty co-payment mechanism gradually based on local conditions.

A systematic review and meta-analysis of the direct epidemiological and economic effects of seasonal influenza vaccination on healthcare workers.

BackgroundInfluenza 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.MethodsWe 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.ResultsThirteen 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.DiscussionOur 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.

The societal role of lifelong vaccination

The full economic and societal value of vaccination is complex to assess. Although direct protection is the immediate goal of vaccination programmes, it is rare that 100% uptake is attained. An important facet of vaccines value comes from the indirect (or herd) protection they provide. The evolving dynamics of our society, including the increase in the proportion of older individuals enhances the value of indirect protection in reducing disease transmission within the family setting and the society as a whole. For example, grandparents are increasingly involved in childcare, putting them at risk of disease transmission if they or the children are not vaccinated. Preventing disease in children can also reduce absenteeism for parents who otherwise would take days off work to care for their sick children, leading to a substantial societal burden. Preventing disease in working adults reduces absenteeism and presenteeism, enhancing productivity and contributing in turn to economic growth. Quality of life is essential at all ages. It is fundamental in children for their life chances, educational achievements, and healthy wellbeing. Additionally, preventing common diseases in adults and the elderly also contributes to their quality of life and helps to assure healthy ageing for growing ageing populations. These wider economic and societal values, although difficult to measure, should be taken into consideration in assessments of the economic value and cost-effectiveness of vaccination programmes.

HPV vaccination programs have not been shown to be cost-effective in countries with comprehensive Pap screening and surgery

Pap screening combined with loop electrosurgical excision procedures (LEEP) is almost 100% effective in preventing cervical cancer mortality yet many countries with these procedures have now implemented broad HPV vaccination programs. HPV vaccines have not been demonstrated to be more effective or safer than Pap screening in the prevention of cervical cancer and Pap screening will still be required even in vaccinated women. The HPV vaccine costs Au$450 per person and it does not protect against ~30% of cancer. This investigation analyses the cost-effectiveness of using the HPV vaccine in countries where Pap screening and surgical procedures have already reduced cervical cancer mortality to very low rates. Cost-effectiveness of vaccination programs is being determined by mathematical models which are founded on many assumptions. It is necessary to examine the rigor of these assumptions to be certain of the health benefits that are predicted. In 2002 scientists concluded that HPV 16 and 18 were the central and independent cause of most cervical cancer. This conclusion was based on molecular technology. If HPV 16 and 18 infections are the central and independent cause of most cervical cancer then the incidence of HPV 16 and 18 should vary with the incidence and mortality of cervical cancer worldwide. This correlation does not exist. It is also observed that the majority of HPV 16/18 infections do not lead to cervical cancer. This indicates that other etiological or ‘risk’ factors are necessary for persistent HPV infection to progress to cancer. The benefits of HPV vaccines have been determined by using pre-cancerous lesions in young women as a surrogate for cervical cancer. This surrogate is found to be inadequate as an end-point for cervical cancer. Clinical trials have only provided speculative benefits for the efficacy of HPV vaccines against cancer and the long-term risks of the vaccine have not been established. Pap screening will still be required in vaccinated women hence HPV vaccination programs are not cost-effective, and may do more harm than good, in countries where regular Pap screening and surgery has already reduced the burden of this disease.

PIN6 Japanese Encephalitis in Asia: Clinical Burden and Cost-Effectiveness of Vaccination Program

To report clinical burden of Japanese encephalitis (JE) in Asia and cost-effectiveness of JE vaccination program. Systematic literature searches were conducted using Embase®, MEDLINE®, WHO, and Google scholar platforms to identify relevant studies in patients with JE. Eligibility of trials was assessed by two reviewers with any discrepancy reconciled by a third, independent reviewer. A total of 10 studies out of 41 retrieved, met the inclusion criteria for the clinical review. Approximately 35,000-50,000 JE cases and 10,000–15,000 deaths due to JE were reported every year in Asia. Incidence of JE was high in China and India, with China accounting for 50% of the JE cases reported worldwide. The incidence of JE in China was reported to be 0.01-1.53 residents/year/100,000. The number of JE cases reported in China, India, Nepal, Sri Lanka, and Bangladesh were 5,000-10,000, 1,500-4,000, 1,000-3,000, 100-200, and 56, respectively. JE caused 12,038 and 2,496 deaths in Southeast Asia and Western Pacific, respectively (2008). JE was associated with 491,797 disability-adjusted life years (DALYs) in the Southeast Asia and 185,573 DALYs in the Western Pacific region (2004). Four studies out of 59 retrieved, met the eligibility criteria for evaluating cost-effectiveness of JE vaccination. JE vaccination prevented 117 cases and 12 deaths (Vietnam), 103 cases and 18 deaths (Thailand), 420 cases and 105 deaths (China), and 175-316 cases and 36-65 deaths (India). Total savings in the direct medical costs witnessed as a consequence of JE vaccination were $51,122 (Vietnam), $58,776 (Thailand), $614,762 (China), and $178,558-$319,627 (India). JE has lead to significant morbidity in survivors and mortality in Asian countries. Existing evidence from cost-effectiveness studies demonstrated that vaccination program markedly reduced the burden of JE in Asia.

Impact of Program Scale and Indirect Effects on the Cost-Effectiveness of Vaccination Programs

Impact of Program Scale and Indirect Effects on the Cost-Effectiveness of Vaccination Programs

Cost-Effectiveness Analyses of Vaccination Programmes

Cost effectiveness is becoming an increasingly important factor for stakeholders faced with decisions about adding a new vaccine into national immunization programmes versus alternative use of resources. Evaluating cost effectiveness, taking into account the relevant biological, clinical, epidemiological and economic factors of a vaccination programme, generally requires use of a model. This review examines the modelling approaches used in cost-effectiveness analyses (CEAs) of vaccination programmes.After overviewing the key attributes of models used in CEAs, a framework for categorising theoretical models is presented. Categories are based on three main attributes: static/dynamic; stochastic/deterministic; and aggregate/individual based. This framework was applied to a systematic review of CEAs of all currently available vaccines for the period of 1976 to May 2007. The systematic review identified 276 CEAs of vaccination programmes. The great majority (83%) of CEAs were conducted in the setting of high-income countries. Only a few vaccines were widely studied, with 57% of available CEAs being focused on the varicella, influenza, hepatitis A, hepatitis B or pneumococcal vaccine. Several time trends were evident, indicating that the number of vaccine CEAs being published is increasing; the main health outcome measures are moving away from the number of cases prevented towards quality-adjusted and unadjusted life-years gained, and more complex models are beginning to be used. The modelling approach was often not adequately described. Of the 208 CEAs that could be categorized according to the framework, around 90% were deterministic, aggregate-level static models. Although a dynamic transmission model is required to account for herd-immunity effects, only 23 of the CEAs were dynamic. None of the CEAs were individual based. To improve communication about the cost effectiveness of vaccination programmes, we believe the first step is for analysts to be more transparent with each other. A clear description of the model type using consistent terminology and justification for the model choice must begin to accompany all CEAs. As a minimum, we urge modellers to provide an explicit statement about the following attributes: static/dynamic; stochastic/deterministic; aggregate/individual based; open/closed. Where relevant, time intervals (discrete/continuous) and (non)linearity should also be described. Enhanced methods of assessing model performance and validity are also required. Our results emphasize the need to improve modelling methods for CEAs of vaccination programmes; specifically, model choice, construction, assessment and validation.

The prevalence of hepatitis B in employees of small, rural hospitals--implications for vaccine administration.

The Centers for Disease Control Advisory Committee on Immunization Practices has based recommendations for hepatitis B vaccine for hospital employees on studies done in large urban hospitals. Data on the prevalence of hepatitis B in employees of small hospitals have been lacking. We measured hepatitis B surface and core antibody in 422 employees of six small, rural hospitals who were exposed to blood. The overall prevalence among those "high-risk" employees was 5.5%. The highest prevalence was found in General Nursing, Intensive Care Nursing, Recovery Room, IV Therapy, Laboratory, and Respiratory Therapy, although differences were seen between hospitals. Results of such testing for individual hospitals may have a major impact on the cost-effectiveness of vaccination programs for their employees.