5 Istituto Malattie Infettive, Università degli Studi, Palermo
To determine the direct and indirect costs associated with a measles epidemic occurring between September 1996 and August 1997 in Palermo in paediatric-aged patients.
Senza l’Expanded Programme on Immunization (EPI), lanciato nel 1974 dalla World Health Organization (WHO), si stima che ci sarebbero circa 3,2 milioni di decessi ogni anno, dovuti a morbillo, pertosse e tetano neonatale; tuttavia, malgrado l’EPI, queste tre malattie continuano a provocare ogni anno 1,7 milioni di morti. .
TL;DR: A study in Piemonte (Italy) to describe incidence, treatment, hospitalizations and costs of herpes zoster (HZ), in population over 14 years of age, and to provide background data for setting-up either mathematical models aimed to estimate the impact of vaccination on HZ, and the cost-benefit analyses of various preventive and therapeutic scenarios.
Abstract: In 2004, we conducted a study in Piemonte (Italy), in order to describe incidence, treatment, hospitalizations and costs of herpes zoster (HZ), in population over 14 years of age. Twenty-four regional general practitioners, with 26,394 patients >14 years in charge (0.71% of the regional population), reported prospectively all diagnosed HZ cases. In addition, all regional hospital discharge records were reviewed. Forty-six HZ cases treated at home were reported, accounting for a total incidence of 1.74 cases/1000 population >14 years per year. HZ rate standardized by age on regional population 14 years older is 1.59/1000. The cost per observed home case was 136.06 euros. The incidence of hospital admissions was 0.12/1000 inhabitants. The mean cost of hospitalized cases was 4082.59 euros. These results contribute to depict the impact of HZ in the general population, and to provide background data for setting-up either mathematical models aimed to estimate the impact of vaccination on HZ, and the cost-benefit analyses of various preventive and therapeutic scenarios.
TL;DR: It is suggested that routine ZVZ vaccination may be cost saving from both a societal and a health system perspective in the base case, and in the worst-case scenario of the sensitivity analysis, vaccination remains cost effective.
Abstract: Aim: To determine the economic impact (cost-benefit analysis) of childhood varicella vaccination, with the Oka/Merck varicella zoster virus vaccine live (Varivax®) in Italy. Methods: This analysis is based on an epidemiological model of varicella zoster virus (VZV) dynamics adapted to the Italian situation. Cost data (€, 2002 values) were collected through a literature review. Several vaccination scenarios were analysed: (i) routine vaccination programme for children aged 1–2 years with different levels of vaccination coverage (90%, 70% and 45%) without any catch-up programme; (ii) routine vaccination programme for children aged 1–2 years with different levels of vaccination coverage (90%, 70% and 45%) completed by a catch-up programme for 6-year-old children over the first 5 years of vaccine marketing; and (iii) routine vaccination programme for children aged 1–2 years with different levels of vaccination coverage (90%, 70% and 45%) completed by a catch-up programme during the first year of vaccine marketing for children aged 2–11 years. Perspectives: A societal perspective, including both direct and indirect costs, and a health-system perspective, limited to costs supported by Italian Health Authorities, were considered. Results: A routine vaccination programme has a clearly positive impact on chickenpox morbidity. Respectively, 68% and 57% of chickenpox-related hospitalisations and deaths could be prevented with a 90% coverage rate. With vaccination costs being more than offset by a reduction in chickenpox treatment costs in the base case, such a programme could also induce savings from both a societal and a health-system perspective (40% and 12% savings, respectively for a 90% coverage rate). A lower coverage rate reduces cost savings, but there is still a 9% decrease in overall societal costs for a 45% coverage rate. Although the reduction in total societal costs was robust to the sensitivity analyses performed, a slight uncertainty remains regarding cost reduction from a health-system perspective. However, in this latter perspective, even in the worst-case scenario of the sensitivity analysis, routine vaccination programmes may be cost effective, the worst-case scenario for cost parameters leading to cost per life-year gained of €2853. Catch-up programmes combined with routine vaccination should lead to further cost reductions from a societal perspective: 15% for a massive catch-up during the first year of vaccine marketing compared with toddlers’ vaccination alone, and 11% for a catch-up focused on 6-year-old children for a period of 5 years. However, the impact of catch-up programmes on the costs from an Italian health-system perspective remains close to zero (±1%). Conclusion: This model suggests, with its underlying assumptions and data, that routine ZVZ vaccination may be cost saving from both a societal and a health system perspective in the base case. In the worst-case scenario of the sensitivity analysis, vaccination remains cost effective.
TL;DR: An economic evaluation was performed to assess five varicella vaccination scenarios targeted to 11-year-old Italian adolescents, and "both tests" and "anamnestic screening" were the most appealing options.
Abstract: An economic evaluation was performed to assess five varicella vaccination scenarios targeted to 11-year-old Italian adolescents. The scenarios were: "compulsory vaccination" of all adolescents, recommended vaccination of susceptible adolescents on the basis of an "anamnestic screening", a "blood test" or a combination of both ("both tests") and vaccination of adolescents in the private sector, at the parents' charge ("private vaccination"). Probabilities and unit costs were taken from published sources and experts opinion. The accuracy of the anamnestic screening (81.6% sensitivity and 87.3% specificity) was derived from a separate descriptive study among 344 Italian adolescents. The costs and benefits of each scenario were simulated using a Markov model and cost-effectiveness, budget-impact and cost-benefit analyses were conducted. Of all considered scenarios, "both tests" and "anamnestic screening" were the most appealing options with an estimated net direct cost of 5058 and 8929 per life-year gained (compared to no vaccination) versus 14,693-42,842 for the other scenarios. These two scenarios further resulted in substantial net savings for society (over 600,000 per cohort, BCR: 2.17). The need for a serological confirmation was highly dependent on the sensitivity of the anamnestic screening, which is believed to increase once such a program is launched. For practical considerations, "anamnestic screening" seems to be the most convenient option.
TL;DR: The costs of measles and measles control in 11 industrialised countries with varying levels of measles vaccine coverage can be used to estimate potential savings that might accrue from changes to measles control programmes.
Abstract: The aim of this study is to estimate the costs of measles and measles control in 11 industrialised countries with varying levels of measles vaccine coverage. Country-specific annual incidence of measles, measles immunization policy, coverage and costs data were collected. The average societal costs of measles cases and immunisation programme per capita were calculated. These 11 countries spend together over US$ 151 million every year to treat and control measles. Per capita costs of measles control tend to be higher in countries with poorer measles control programmes (for instance, Italy has the highest incidence and highest overall costs), though many other factors, such as the number of antigens given per clinic visit and the local price of MMR also affect the efficiency of the programme. The costs estimates presented here can be used to estimate potential savings that might accrue from changes to measles control programmes.
TL;DR: Italian pharmacoeconomists are far from reaching any consensus on methods for evaluating indirect costs, and methods need to be standardized particularly with respect to the parameters used to quantify productive time lost in monetary terms.
Abstract: CESAV—Center for Health Economics AA Valenti, Mario Negri Institute for Pharmacological Research, Ranica, Italy Objectives: To investigate how indirect costs are evaluated in pharmacoeconomic studies in Italy and the attitude of Italian pharmacoeconomists toward indirect costs. Methods: A literature review was conducted, specifically focused on pharmacoeconomic studies including indirect costs carried out in Italy, and a suevey among Italian pharmacoeconomics experts. Results: Nineteen studies were available for review. Although the methods used to calculate the value of production loss due to morbidity were all based on the Human Capital Approach (HCA), there was a wide variability among studies in practical methods. The parameters used to value production losses varied widely too. Of the 25 survey responders, 20 considered it important to include indirect costs in pharmacoeconomic studies; 56% of those interviewed stated that health authorities should require indirect cost evaluations. Most of these experts would include indirect cost estimates in drug-pricing calculation. Conclusions: In Italy studies evaluating indirect costs are still only few, although there is evidence of an increase. Italian pharmacoeconomists are far from reaching any consensus on methods for evaluating these costs. Methods need to be standardized particularly with respect to the parameters used to quantify productive time lost in monetary terms.
TL;DR: Computer simulations show that the persistence of the biennial pattern of measles outbreaks implies that the vaccine is not being used uniformly throughout the population, for populations in which most members are vaccinated.
Abstract: London, W. P. (Mathematical Research Branch, National Institute of Arthritis, Metabolism, and Digestive Diseases, Bethesda, Md. 20014) and J. A. Yorke. Recurrent outbreaks of measles, chickenpox and mumps. I. Seasonal variation in contact rates. Am J Epidemiol 98:453-468, 1973. —Recurrent outbreaks of measles, chickenpox and mumps in cities are studied with a mathematical model of ordinary differential delay equations. For each calendar month a mean contact rate (fraction of susceptibles contacted per day by an infective) is estimated from the monthly reported cases over a 30to 35-year period. For each disease the mean monthly contact rate is 1.7 to 2 times higher in the winter months than in the summer months; the seasonal variation is attributed primarily to the gathering of children in school. Computer simulations that use the seasonally varying contact rates reproduce the observed pattern of undamped recurrent outbreaks: annual outbreaks of chickenpox and mumps and biennial outbreaks of measles. The two-year period of measles outbreaks is the signature of an endemic infectious disease that would exhaust itself and become nonendemic if there were a minor increase in infectivity or a decrease in the length of the incubation period. For populations in which most members are vaccinated, simulations show that the persistence of the biennial pattern of measles outbreaks implies that the vaccine is not being used uniformly throughout the population.
TL;DR: An age-structured epidemiologic model is investigated here, which also pays attention to the fact that children are promoted grade-wise into and out of school, and is shown to perform better than previous global mass-action models.
Abstract: An infection like measles does not spread uniformly in populations from Europe and North America. Of special importance is a pronounced age-dependency in the contact rates, because of increased infection transmission within schools. Therefore an age-structured epidemiologic model is investigated here, which also pays attention to the fact that children are promoted grade-wise into and out of school. Simulation results are contrasted with pre- and post-vaccination measles data from England and Wales and the model is shown to perform better than previous global mass-action models.
TL;DR: The theoretical results indicate that the advantages and disadvantages of a pulse strategy should be seriously examined in Israel and in countries with similar patterns of measles virus transmission.
Abstract: Although vaccines against measles have been routinely applied over a quarter of a century, measles is still persistent in Israel, with major epidemics roughly every 5 years. Recent serological analyses have shown that only 85% of Israelis aged 18 years have anti-measles IgG antibodies. Considering the high transmissibility of the virus and the high level of herd immunity required for disease eradication, the Israeli vaccination policy against measles is now being reevaluated. Motivated by theoretical studies of populations in perturbed environments, we examined the possibility of replacing the conventional cohort vaccination strategy by a pulse strategy--i.e., periodic vaccination of several age cohorts at the same time. Numerical studies of a deterministic age-structured model suggest that vaccination, which renders immunity to no more than 85% of the susceptible children aged 1-7 years, once every 5 years will suffice to prevent epidemics in Israel, where infection rate is highest amongst schoolchildren. The model suggests that by using such a strategy the density of susceptible individuals is always kept below the threshold above which recurrent epidemics will be maintained. Analysis of simpler, non-age-structured, models serves to clarify the basic properties of the proposed strategy. Our theoretical results indicate that the advantages and disadvantages of a pulse strategy should be seriously examined in Israel and in countries with similar patterns of measles virus transmission.
Q1. What are the contributions in "Il costo sociale del morbillo in età pediatrica. l’epidemia a palermo nel 1996-97*" ?
Included in the study was a group of previously vaccinated patients ( 6 % ). The demographic and economic data obtained highlights not only the social and economic impact of the epidemic, but also provides relevant information useful for cost-effectiveness analysis.