Public Health Costs Research Articles

Introduction of a hexavalent vaccine containing acellular pertussis into the national immunization program for infants in Peru: a cost-consequence analysis of vaccination coverage

BackgroundInfant vaccination coverage rates in Peru have declined in recent years, exacerbated by the COVID-19 pandemic. Introduction of the fully-liquid diphtheria, tetanus, and acellular pertussis (DTaP)-inactivated polio vaccine (IPV)-hepatitis B (HB)-Haemophilus influenzae type B (Hib) hexavalent vaccine (DTaP-IPV-HB-Hib) in Peru’s infant National Immunization Program may help improve coverage. We evaluated costs and healthcare outcomes, including coverage, of switching from a pentavalent vaccine containing whole-cell pertussis component (DTwP-HB-Hib) plus IPV/oral polio vaccine (IPV/OPV) to the hexavalent vaccine for the primary vaccination scheme (2, 4 and 6 months).MethodsThe analysis was performed over a 5-year period on a cohort of children born in Peru in 2020 (N = 494,595). Four scenarios were considered: the pentavalent plus IPV/OPV scheme (S1); replacing the pentavalent plus IPV/OPV scheme with the hexavalent scheme (S2); expanded delivery of the pentavalent plus IPV/OPV scheme (S3); expanded delivery of the hexavalent scheme (S4). Vaccine coverage and incidence of adverse reactions (ARs) were estimated using Monte Carlo simulations and previous estimates from the literature. Cases of vaccine-preventable diseases were estimated using a Markov model. Logistical and healthcare costs associated with these outcomes were estimated. Impact of key variables (including coverage rates, incidence of ARs and vaccine prices) on costs was evaluated in sensitivity analyses.ResultsThe overall cost from a public health payer perspective associated with the pentavalent plus IPV/OPV vaccine scheme (S1) was estimated at $56,719,350, increasing to $61,324,263 (+ 8.1%), $59,121,545 (+ 4.2%) and $64,872,734 (+ 14.4%) in scenarios S2, S3 and S4, respectively. Compared with the status quo (S1), coverage rates were estimated to increase by 3.1% points with expanded delivery alone, and by 9.4 and 14.3% points, if the hexavalent vaccine is deployed (S2 and S4, respectively). In both scenarios with the hexavalent vaccine (S2 and S4), pertussis cases would also be 5.7% and 8.7% lower, and AR rates would decrease by 32%. The cost per protected child would be reduced when the hexavalent vaccine scheme. Incidence of ARs was an important driver of cost variability in the sensitivity analysis.ConclusionsImplementation of the hexavalent vaccine in Peru’s National Immunization Program has a positive public health cost consequence.

Pharmacists as educators: Enhancing patient understanding and access to specialty medications through community workshops

Pharmacists are increasingly recognized as vital educators within the healthcare system, particularly in improving patient understanding and access to specialty medications. This review explores the expanding role of pharmacists as educators, emphasizing their unique expertise in providing accurate, accessible information and their impact on patient outcomes. The paper highlights community workshops as an effective tool for delivering education, focusing on the structure, content, and accessibility of these workshops to diverse patient populations. Furthermore, it examines patients' barriers to accessing specialty medications and how pharmacists can help overcome these challenges through education, support, and coordination with other healthcare providers. The review also discusses future directions for enhancing the educator role of pharmacists, the need for supportive policies, and the potential long-term benefits of pharmacist-led education on public health and healthcare costs. Recommendations for implementing and expanding community-based education initiatives are provided, emphasizing integrating these efforts into broader healthcare strategies. Keywords: Pharmacist-led education; Specialty medications; Community workshops; Healthcare access; Patient outcomes; Public health

Harnessing Pharmacogenomics in Clinical Research on Psychedelic-Assisted Therapy.

Psychedelics have recently re-emerged as potential treatments for various psychiatric conditions that impose major public health costs and for which current treatment options have limited efficacy. At the same time, personalized medicine is increasingly being implemented in psychiatry to provide individualized drug dosing recommendations based on genetics. This review brings together these topics to explore the utility of pharmacogenomics (a key component of personalized medicine) in psychedelic-assisted therapies. We summarized the literature and explored the potential implications of genetic variability on the pharmacodynamics and pharmacokinetics of psychedelic drugs including lysergic acid diethylamide (LSD), psilocybin, N,N-dimethyltryptamine (DMT), 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT), ibogaine and 3,4-methylenedioxymethamphetamine (MDMA). Although existing evidence is limited, particularly concerning pharmacodynamics, studies investigating pharmacokinetics indicate that genetic variants in drug-metabolizing enzymes, such as cytochrome P450, impact the intensity of acute psychedelic effects for LSD and ibogaine, and that a dose reduction for CYP2D6 poor metabolizers may be appropriate. Furthermore, based on the preclinical evidence, it can be hypothesized that CYP2D6 metabolizer status might contribute to altered acute psychedelic experiences with 5-MeO-DMT and psilocybin when combined with monoamine oxidase inhibitors. In conclusion, considering early evidence that genetic factors can influence the effects of certain psychedelics, we suggest that pharmacogenomic testing should be further investigated in clinical research. This is necessary to evaluate its utility in improving the safety and therapeutic profile of psychedelic therapies and a potential future role in personalizing psychedelic-assisted therapies, should these treatments become available.

Current Evidence on and Clinical Implications of Vitamin D Levels in Pain and Functional Management of Knee Osteoarthritis: A Systematic Review.

Osteoarthritis is a common chronic disease that affects quality of life and increases public health costs. Knee osteoarthritis is a frequent form, marked by joint degeneration, pain, stiffness, and functional restrictions. Factors such as age, genetics, joint injuries, obesity, and vitamin D deficiency can affect knee osteoarthritis progression. While the exact link between vitamin D and osteoarthritis is still being studied, recent research indicates that low vitamin D levels might influence the articular cartilage's structure and function, potentially accelerating osteoarthritis. This review aims to analyze the last decade of research on vitamin D's role in osteoarthritis. A systematic review of the literature was conducted in accordance with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Relevant studies from the last ten years were included to evaluate the association between vitamin D levels and knee osteoarthritis. The inclusion criteria were studies examining the role of vitamin D in cartilage health and osteoarthritis progression and the potential clinical implications for disease management. This review identified a variety of studies exploring the connection between vitamin D and osteoarthritis, with mixed findings. The relationship between vitamin D and knee osteoarthritis remains inconclusive, highlighting the need for further research. An updated evaluation of the literature is crucial for osteoarthritis management strategies and to potentially include vitamin D supplementation in therapeutic protocols.

The Role of Health Education in Preventing Chronic Diseases

Health education is a critical element in the preventive medicine toolkit, particularly for chronic diseases, which pose a significant burden globally. Chronic diseases such as diabetes, cardiovascular diseases, and cancer are leading causes of morbidity and mortality worldwide, significantly impacting public health and healthcare costs. This paper reviews the impact of health education programs on preventing chronic diseases and discusses the effectiveness of various educational strategies. The review will focus on the role of technology in enhancing health education, examine implementation obstacles, and highlight successful interventions based on recent studies. Additionally, the review will identify gaps in current research and provide recommendations for future studies, emphasising the need for culturally tailored and sustainable health education programs.

Factors impacting hospitalisation and related health service costs in cancer survivors in Australia: Results from a population data linkage study in Queensland (COS-Q).

The global economic cost of cancer and the costs of ongoing care for survivors are increasing. Little is known about factors affecting hospitalisations and related costs for the growing number of cancer survivors. Our aim was to identify associated factors of cancer survivors admitted to hospital in the public system and their costs from a health services perspective. A population-based, retrospective, data linkage study was conducted in Queensland (COS-Q), Australia, including individuals diagnosed with a first primary cancer who incurred healthcare costs between 2013 and 2016. Generalised linear models were fitted to explore associations between socio-demographic (age, sex, country of birth, marital status, occupation, geographic remoteness category and socio-economic index) and clinical (cancer type, year of/time since diagnosis, vital status and care type) factors with mean annual hospital costs and mean episode costs. Of the cohort (N = 230,380) 48.5% (n = 111,820) incurred hospitalisations in the public system (n = 682,483 admissions). Hospital costs were highest for individuals who died during the costing period (cost ratio 'CR': 1.79, p < 0.001) or living in very remote or remote location (CR: 1.71 and CR: 1.36, p < 0.001) or aged 0-24 years (CR: 1.63, p < 0.001). Episode costs were highest for individuals in rehabilitation or palliative care (CR: 2.94 and CR: 2.34, p < 0.001), or very remote location (CR: 2.10, p < 0.001). Higher contributors to overall hospital costs were 'diseases and disorders of the digestive system' (AU$661 m, 21% of admissions) and 'neoplastic disorders' (AU$554 m, 20% of admissions). We identified a range of factors associated with hospitalisation and higher hospital costs for cancer survivors, and our results clearly demonstrate very high public health costs of hospitalisation. There is a lack of obvious means to reduce these costs in the short or medium term which emphasises an increasing economic imperative to improving cancer prevention and investments in home- or community-based patient support services.

Development of a novel crAss-like phage detection method with a broad spectrum for microbial source tracking

CrAssphage has been recognized as the most abundant and human-specific bacteriophage in the human gut. Consequently, crAssphage has been used as a microbial source tracking (MST) marker to monitor human fecal contamination. Many crAss-like phages (CLPs) have been recently discovered, expanding the classification into the new order Crassvirales. This study aims to assess CLP prevalence in South Korea and develop a detection system for MST applications. Thirteen CLPs were identified in six human fecal samples and categorized into seven genera via metagenomic analysis. The major head protein (MHP) displayed increased sequence similarity within each genus. Eight PCR primer candidates, designed from MHP sequences, were evaluated in animal and human feces. CLPs were absent in animal feces except for those from raccoons, which hosted genera VI, VIIa, and VIIb. CLPs were detected in 91.52% (54/59) of humans, with genus VI (38 out of 59) showing the highest prevalence, nearly double that of p-crAssphage in genus I (22 out of 59). This study highlights genus VI as a potent MST marker, broadening the detection range for CLPs. Human-specific and selectively targeted MST markers can significantly impact hygiene regulations, lowering public health costs through their application in screening liver, sewage, wastewater, and various environmental samples.

State Policies Regulating Firearms and Changes in Firearm Mortality

Despite high social and public health costs of firearm violence in the United States, the effects of many policies designed to reduce firearm mortality remain uncertain. To estimate the individual and joint effect sizes of state firearm policies on firearm-related mortality. In this comparative effectiveness study, bayesian methods were used to model panel data of annual, state-level mortality rates (1979-2019) for all US firearm decedents, with analyses conducted in October 2023. Six classes of firearms policies: background checks, minimum age, waiting periods, child access, concealed carry, and stand-your-ground laws. Primary outcomes (total firearm deaths, firearm homicide deaths, and firearm suicide deaths) were assessed using the National Vital Statistics System. Bayesian estimation was used to estimate the partial association of changes in firearms policies with subsequent changes in firearm mortality. The estimated effect sizes of individual policies 5 or more years after implementation were generally small in magnitude and had considerable uncertainty. The policy class with the highest probability of reducing firearm deaths was child-access prevention laws, estimated to reduce overall firearm mortality by 6% (80% credible interval [CrI], -2% to -9%). The policy class with the highest probability of increasing firearm deaths was stand-your-ground laws, estimated to increase firearm homicides by 6% (80% CrI, 0% to 13% increase). Estimates of association of implementing multiple firearm restrictions with subsequent changes in firearm mortality yielded larger effect sizes. Moving from the most permissive to most restrictive set of firearm policies was associated with an estimated 20% reduction in firearm deaths (80% CrI, 10% to 28% reduction), with a 0.99 probability of any reductions in firearm death rates. In this comparative effectiveness study of state firearm policies, the joint effect estimates of combinations of firearm laws were calculated, showing that restrictive firearm policies were associated with substantial reductions in firearm mortality. Although policymakers would benefit from knowing the effects of individual policies, the estimated changes in firearm mortality following implementation of individual policies were often small and uncertain.

Impact of Rapid Economic Development with Rising Carbon Emissions on Public Health And Healthcare Costs in Bangladesh

Background: Bangladesh, a rapidly developing country, is experiencing a critical phase where economic growth and environmental sustainability must be balanced. The swift industrialization and urbanization have led to increased energy consumption and carbon emissions, negatively impacting public health and healthcare expenditures. This study determined the intricate relationships between healthcare expenditure and its determinants—economic growth, CO2 emissions, urbanization, and natural resource use—in Bangladesh. Methods: Utilizing a dataset from 2004 to 2023, this study applies advanced econometric methods, including the dual adjustment approach, spectral causality, fully modified ordinary least squares (FMOLS), dynamic ordinary least squares (DOLS), and canonical cointegrating regression (CCR). Results: Results demonstrate a significant positive correlation between economic growth, urbanization, natural resources, and CO2 emissions on healthcare spending. The findings underscore that CO2 emissions and urbanization are substantial contributors to rising healthcare costs, while natural resources and economic growth present varying impacts based on different econometric models. The dual adjustment approach provides robust evidence of cointegration, revealing the long-term interactions among these variables. Conclusion: In conclusion, the study emphasizes the urgent need for effective national policies to mitigate healthcare costs driven by environmental degradation and economic growth. By understanding these relationships, policymakers can better manage health expenditures while promoting sustainable development in Bangladesh. The research highlights the necessity of integrating environmental and health policies to achieve a balanced growth trajectory.

Symptomatic Gallbladder Stones: From Occasional to Everyday in Pediatric Surgery

Introduction: Gallbladder stones (GS) in children were once considered rare. In recent years, the rate of cholecystectomies appears to have increased. GS may present with symptoms in 60% of cases and can be simple GS (biliary colic) or complicated GS (cholecystitis, pancreatitis, choledocholithiasis). Laparoscopic cholecystectomy (LC) is the treatment of choice. The disease often leads to multiple emergency department visits and even hospitalizations, generating an increase in morbidity and public health costs. The objective of this study is to evaluate the clinical presentation, risk factors, complications, treatment, and evolution of GS in children. Materials and Methods: Retrospective, cross-sectional study in children from 0 to 14 years of age, who underwent cholecystectomy for symptomatic GS at the Hospital Nacional Prof. A. Posadas between January 2018 and July 2022 (54 months). Results: A total of 219 LCs were performed, 36 (2018), 39 (2019), 36 (2020), 62 (2021) and 47 (first half of 2022) in patients with a mean age of 12.3 years (3-14), 68% female, 25% overweight, 23% obese, 86 patients with family GS. 36% complicated GS (CGS); 29 patients presented cholecystitis, 26 choledochal syndrome, and 33 pancreatitis. 15% had 3 or more consultations prior to surgery and 12% began as biliary colic and later presented CGS. 62% of patients with cholecystitis presented microlithiasis as an ultrasound finding and 88% of patients with pancreatitis presented microlithiasis. ERCP was required in 17 patients, IOC in 6 (2.7%), Rendez Vous in 3 (1.37%). 21 patients (9%) with postoperative complications were reported, of which 1 required relaparotomy. Conclusions: The incidence of GS has increased considerably in the period studied. The data suggest that poor diet and family GS are factors to be considered in its development. Finally, the time of evolution and the delay in surgical resolution has led to a higher prevalence of CGS in our population, which is why we believe that patients with symptomatic GS should be operated on after diagnosis.

Temporal Dynamics and Influential Factors of Taste and Odor Compounds in the Eastern Drinking Water Source of Chaohu Lake, China: A Comparative Analysis of Global Freshwaters.

The escalating proliferation of cyanobacteria poses significant taste and odor (T/O) challenges, impacting freshwater ecosystems, public health, and water treatment costs. We examined monthly variations in four T/O compounds from September 2011 to August 2012 in Chaohu Lake's eastern drinking water source (DECL). More importantly, we compared the reported T/O occurrence and the related factors in freshwater bodies worldwide. The assessment of T/O issues indicated a severe and widespread problem, with many cases surpassing odor threshold values. Remarkably, China reported the highest frequency and severity of odor-related problems. A temporal analysis revealed variations in odor occurrences within the same water body across different years, emphasizing the need to consider high values in all seasons for water safety. Globally, T/O issues were widespread, demanding attention to variations within the same water body and across different layers. Algae were crucial contributors to odor compounds, necessitating targeted interventions due to diverse odorant sources and properties. A correlation analysis alone lacked definitive answers, emphasizing the essential role of further validation, such as algae isolation. Nutrients are likely to have influenced the T/O, as GSM and MIB correlated positively with nitrate and ammonia nitrogen in DECL, resulting in proposed control recommendations. This study offers recommendations for freshwater ecosystem management and serves as a foundation for future research and management strategies to address T/O challenges.

Understanding the Health Impacts of Vehicular Emissions in South Florida: A Comprehensive Analysis

South Florida is famous for its diverse cultural scene and year-round sunshine. This success, however, has not been without its consequences. While the region enjoys economic prosperity, the hidden cost of deteriorating air quality and adverse health effects from vehicle emissions necessitates urgent attention. Electric vehicles (EVs) have emerged as a potential solution, promising reduced emissions, and increased energy efficiency. However, the intricate life cycle emissions associated with EV energy production raise questions about their net benefits. Using predictive modeling and historical data, the study forecasts emissions trajectories and assesses their health implications. Results indicate a substantial reduction in pollutants like PM2.5 and NOx by 2050, particularly in counties with higher vehicle miles traveled (VMT). However, challenges remain, such as Broward County’s heightened dependence on polluting electricity sources for EV charging, leading to increased SO2 emissions and public health costs. The analysis underscores the importance of transitioning to cleaner energy sources, highlighting the potential benefits of renewable resources in reducing emissions and improving public health outcomes. By incorporating comprehensive data and predictive models, this study provides valuable insights for policymakers and communities, advocating for a concerted effort towards sustainable transportation solutions. Ultimately, the findings emphasize the necessity of proactive measures to mitigate the adverse effects of vehicle emissions and foster a healthier, more sustainable future for South Florida.

Predicting aggressive behaviors: Examining unique and interactive roles of PTSD and emotion dysregulation in a minority sample.

Aggression is a costly public health problem with severe and multi-faceted negative consequences and thus, identifying factors that contribute to aggression, particularly in understudied populations, is necessary to develop more effective interventions to reduce the public health cost of aggression. The goal this study was to test whether difficulties regulating emotions moderated the association between posttraumatic stress disorder (PTSD) symptoms and aggression in a community sample of predominantly Black females with high levels of trauma exposure. Furthermore, we explored unique relations between PTSD symptom clusters and distinct subscales of difficulties regulating emotions and aggression. The sample included 601 community participants recruited from an urban public hospital. Symptoms were assessed using self-report measures including the Difficulties in Emotion Regulation Scale (DERS) and Behavioral Questionnaire-Short. Regression analyses were conducted using PTSD symptoms and total DERS to test their interaction as predictors for aggression (using BQ-Short). We found that higher levels of PTSD arousal symptoms and difficulty controlling impulses when upset were positively related to aggression. We also conducted an exploratory analysis to examine the association between PTSD symptom clusters using the Alternative Symptom Clusters hybrid model. The results suggest that some PTSD symptoms (externalizing behavior) and some emotion dysregulation processes (difficulties controlling impulses when upset), relate to aggression in independent, rather than multiplicative ways. These results offer insights for new directions of research that focuses on the independent association between specific emotion dysregulation processes and PTSD symptoms on aggression.

Are facemasks effective against particulate matter pollution? Evidence from the field

The use of anti-pollution facemasks (APFs) in defense against particulate matter (PM) pollution is subject to debate as air pollution and wildfire events intensify. Inward leakage due to imperfect fitting and the Peltzman effect of people spending more time outdoors when wearing masks have led to mixed evidence regarding the effectiveness of APFs, which in turn has contributed to conflicting public messages about APFs with potentially large public health costs. We conduct a large-scale randomized field study on individuals' daily outdoor time and mask wearing behaviors and the associated health outcomes during an entire winter heating season in a provincial capital city in Northeastern China. We find that APFs used in everyday life achieved an overall efficiency of 80% in reducing respiratory or cardiovascular disease related doctor visits. Mask wearing, due to its discomfort, reduced outdoor time. However, the added protection provided by masks against PM led respondents to spend more time outdoors on smog days, and this relative Peltzman effect wiped out about 12% of APFs' health benefits. Taken together, APFs’ health benefits far exceed their financial costs. These findings call for affirmatory but careful messaging to the public about using APFs as personal protection against PM pollution.

Profitability and cost-effectiveness analysis of brucellosis control in Armenia: A One Health approach

Abstract Brucellosis is endemic in the Republic of Armenia and constitutes a financial and public health burden on the nation. Control of the disease is currently using the test-and-slaughter strategy, reportedly at a coverage level deemed insufficient to interrupt transmission by the authorities responsible for disease control. A key aspect of this control strategy is the shared costs between the agricultural and public health sectors. An earlier study conducted by the Advanced One Health Class at the Swiss Tropical and Public Health Institute developed a mathematical-compartmental transmission model to represent the transmission of Brucella between cattle, sheep, and humans. The study simulated the performance of the existing control strategy and three other upgraded scenarios over a decade, giving the cumulative incidence of human and livestock prevalence (2022–2031). Based on the cumulative incidence of human and livestock prevalence from 10-year simulations, this study evaluates Armenia’s current brucellosis control program’s profitability, cost-effectiveness, and cost distribution for the existing test-and-slaughter level and three proposed upgraded scenarios in cattle and sheep. In these scenarios, the percentages represent the proportion of animals that were culled when they tested positive for brucellosis: Scenario 1 – 86% of cattle and 65% of sheep; Scenario 2 – 88% of cattle and 70% of sheep; Scenario 3 – 90% of cattle and 75% of sheep. Further estimations were made on public and private health costs, and income loss of human brucellosis patients averted through the different livestock-level interventions. The incremental livestock production and the averted human health cost were summed up as societal benefits of brucellosis interventions. From a societal perspective, the most profitable scenario is estimated to have a net present value of US$ 41.82 million, from an overall cost of US$ 48.27 million and a benefit of US$ 6.45 million, resulting in a benefit-cost ratio of 0.133 at 80% compensation for farmers’ losses and discounted at 5%. From a public health perspective, the cost-effectiveness ratio for the same intervention scenario is US$ 1587 per DALY averted (95% CI: US$ 1268–US$ 2009). When private costs, which are the private income loss and out-of-pocket costs of patients, are added to the public health costs, the cost-effectiveness decreases to US$ 6727 per DALY averted at a 5% discount rate (95% CI: US$ 5371–US$ 8504). These cost-effectiveness and benefit-cost ratios highlight the remarkable disparity in the cost of the test-and-slaughter strategy across the agriculture and public health sectors. Our study highlights the need to reassess the cost-effectiveness of the test-and-slaughter strategy for brucellosis control in Armenia and consider an equitable distribution of the cost of the test-and-slaughter strategy among the sectors as this could facilitate better disease control and cost-effectiveness of the strategy. Armenia should view brucellosis elimination as a public good, justifying public spending for compensation. As seen in other countries, its elimination could boost the economy by lowering trade barriers, making brucellosis-free status a societal benefit. One Health impact statement Our study focuses on controlling brucellosis in Armenia using an integrated approach called One Health, which seeks to demonstrate the incremental benefit of closer cooperation between human and animal health and other sectors. We evaluate how profitable and cost-effective test-and-slaughter interventions are in improving the health of both humans and animals while also considering the costs for farmers and the state. Using a One Health approach, we can better understand the cross-sector expenses related to the disease and develop more efficient strategies to interrupt transmission and eventually eliminate the disease. The result is improved animal and human health outcomes, enhanced livelihoods, and a positive contribution to the economy’s overall growth (Narrod et al ., 2012 ). To carry out this study, we collaborated closely with non-academic partners from the Food Safety and Inspectorate Body (FSIB) and the National Centre for Disease Control in Armenia (NCDC). This collaboration resulted in the creation of valuable knowledge and practical solutions, underscoring the importance of working together across different sectors, including indigenous communities, academia, and non-academic organizations.

Updated Public Health Impact and Cost Effectiveness of Recombinant Zoster Vaccine in Canadian Adults Aged 50 Years and Older.

The aim of this study was to update previously estimated public health impact and cost effectiveness of recombinant zoster vaccine (RZV) for the prevention of herpes zoster (HZ) in Canadians aged ≥50 years using longer-term RZV efficacy and waning data and real-world coverage and completion. A multicohort Markov model was used to conduct a cost-utility analysis comparing RZV with no HZ vaccination among Canadians aged ≥50 years. Real-world data were used for first-dose coverage (17.5%) and second-dose completion (65%). Vaccine efficacy and waning data were applied from up to 8-year follow-up from the ZOE-50 and ZOE-70 clinical trials. Incremental costs and benefits were calculated using a lifetime horizon from the healthcare payer (base case) and societal perspectives. A discount rate of 1.5% was applied to costs and quality-adjusted life-years (QALYs). The model estimated that RZV would prevent 303,835 HZ cases, 83,256 post-herpetic neuralgia (PHN) cases, 39,653 other complications, and 99 HZ-related deaths compared with no HZ vaccination. Incremental cost-effectiveness ratios (ICERs) were estimated to be $27,486 and $22,097 per QALY (2022 Canadian dollars [CAN$]) from the healthcare payer and societal perspectives, respectively. The base-case ICER was most sensitive to a lower percentage of initial HZ cases with PHN. Almost all probabilistic sensitivity analysis simulations (98.1%) resulted in ICERs <CAN$50,000 per QALY. RZV is expected to remain a cost-effective option for Canadian adults aged ≥50 years when using longer-term RZV efficacy and waning estimates, although the estimated public health impact was smaller than in the previous analysis (due to lower coverage/completion estimates).

A single dose for me, A wealth of protection for us: The public health cost of individualism in the rollout of COVID-19 vaccine

ObjectiveThis study examines whether individualism weakens the effectiveness of the COVID-19 vaccine eligibility expansions in the United States in 2021, and assesses the associated social benefits or costs associated with individualism. MethodsWe construct a county-level composite individualism index as a proxy of culture and the fraction of vaccine eligible population as a proxy of vaccination campaign (mean: 41.34%). We estimate whether the COVID-19 vaccine eligibility policy is less effective in promoting vaccine coverage, reducing in COVID-19 related hospitalization and death using a linear two-way fixed effect model in a sample of 2866 counties for the period between early December 2020 and July 1, 2021. We also test whether individualism shapes people's attitudes towards vaccine using a linear probability model in a sample of 625,308 individuals aged 18–65 (mean age: 43.3; 49% male; 59.1% non-Hispanic white, 19.1% Hispanic, 12% African American; 5.9% Asian) from the Household Pulse Survey. ResultsThe effects of expanded vaccine eligibility are diminished in counties with greater individualism, as evidenced by lower effectiveness in increasing vaccination rates and reducing outpatient doctor visits primarily for COVID-related symptoms and COVID deaths. Moreover, our results show that this cultural influence on attitudes towards vaccine is more pronounced among the less educated, but unrelated to race. ConclusionAssuming an average level of vaccine eligibility policies and an average intensity of individualism across the nation, we calculate that the average social cost associated with an individualistic culture amid the pandemic is approximately $50.044 billion, equivalent to 1.32% of the total U.S. health care spending in 2019. Our paper suggests that strategies to promote public policy compliance should be tailored to accommodate cultural and social contexts.

COVID-19 and short-term housing: economic and social impacts and implications

The rapid spread of the new coronavirus (COVID-19) around the world since early 2020 has caused significant economic, social, psychological, and public health costs. The COVID-19 pandemic hit almost all economic sectors including the hospitality and tourism industry. This review paper examined the impacts of COVID-19 on short-term housing and the factors influencing these impacts. The existing literature reported generally negative effects of COVID-19 on the operating performance of the short-term accommodation industry. COVID-19 impacted on travellers’ perceptions, host-guest interactions and psychological well-being when choosing short-term accommodation. This review also provides implications for minimising the impacts of COVID-19 or similar future disruptive events on short-term accommodation operations and surviving the crisis in the short-term accommodation sector.

Policy Evaluation of Primary Care Doctor Practice Based on PCMH in Shenzhen

This work is to conduct a comprehensive policy evaluation of the Patient-Centered Medical Home (PCMH) in Shenzhen since the year of 2009. Main stakeholders of the primary care policy are community residents, government, general hospitals, health agencies, community service providers and medical insurance institutions, drug suppliers. Equity is improved through better community service coverage condition, increase of outpatients in community health service centers, decrease in medical expenditure and the implementation of zero price addition policy of drugs. Better performance in terms of public health cost saving upon primary care doctor policy based on PCMH in Shenzhen are reflected in the reduced proportion of government grant by 7.1%. Each community health service center provided medical services are increased from an average of 97.1 to 156.1 person-times per day, and every doctor servicing with an average of 27.1 to 53.2 person-times per day from 2009 to 2013. Every 1 million from government found brings 2.2 million in operational revenue in 2013, with ratio 1:2.2 compared to 1:1.6 in 2008. Based on the findings from this policy evaluations, it appears that the introduction of PCMH model in public health may improve health care equity, efficiency of community service utilization and cost saving in Shenzhen. However, the extent in which PCMH might be useful also depends on the stakeholders’ effort, as well as the validity of the data used in this evaluation report.

COVID-19 post-pandemic reflections from sub-Saharan Africa: what we know now that we wish we knew then

The commonly heard aphorism about history repeating itself suggests an endless cycle of recurring events. However, George Santayana offered a similar sentiment when he said, "Those who do not learn from history are doomed to repeat it". This emphasises that the responsibility for the recurrence of events lies not with history itself, but with humanity. It underscores that if we desire change, it is our responsibility to initiate it, rather than attributing it to external forces such as fate, luck, or time. With this thought in mind, here we offer a narrative view from sub-Saharan Africa, focusing primarily on our own experiences in Nigeria and Uganda, on what harsh lessons can be learnt from the COVID-19 pandemic regarding emergency preparedness to respond effectively to the next major infectious disease outbreak. Four strategies are suggested, the implementation of which may contribute substantially to safeguarding against an experience similar to the catastrophic public health, social and economic costs borne by African nations during COVID-19 and in its immediate aftermath.