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Zhang L, Yang J, Su R, Lan X, Song M, Zhang L, Xu J. Willingness to receive the second booster of COVID-19 vaccine among older adults with cancer: a stratified analysis in four provinces of China. Front Public Health 2024; 12:1298070. [PMID: 38454989 PMCID: PMC10917962 DOI: 10.3389/fpubh.2024.1298070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/13/2024] [Indexed: 03/09/2024] Open
Abstract
Background Despite the elevated COVID-19 risk for older adults with cancer, vaccine hesitancy poses a significant barrier to their immunization. Intriguingly, there is limited research on the prevalence of willingness to receive the second booster dose and associated determinants in older adults with cancer. Objective Our objective was to ascertain the level of awareness about COVID-19 vaccines and to uncover the factors influencing the willingness to receive the second booster among Chinese cancer patients aged 65 years and over. Methods To achieve our objective, we conducted a multicenter cross-sectional study in four tertiary hospitals from four provinces of China. This involved using a Health Belief Model (HBM) based self-administered questionnaire and medical records. Subsequently, we employed multivariable logistic regression to identify factors influencing the second COVID-19 booster vaccine willingness. Results Our results showed that among 893 eligible participants, 279 (31.24%) were aged 65 years and over, and 614 (68.76%) were younger. Interestingly, the willingness to receive the second COVID-19 booster vaccine was 34.1% (95/279) (OR: 1.043, 95% CI: 0.858, 1.267) in participants aged 65 years and over, which was similar to participants aged under 65 years (34.1% vs. 35.5%, p = 0.673). Furthermore, our findings revealed that a positive attitude toward the booster and recommendations from healthcare providers and family members were positively associated with vaccine willingness. Conversely, perceptions of negative impacts on cancer control and vaccine accessibility regarding the second COVID-19 booster were inversely related to the outcome event (all p < 0.05). Conclusion Our study concludes with the finding of a low willingness toward the second COVID-19 booster in Chinese cancer patients, particularly in the older adults, a fact which warrants attention. This reluctance raises their risk of infection and potential for severe outcomes. Consequently, we recommend using media and community outreach to dispel misconceptions, promote the booster's benefits, and encourage vaccine discussions with healthcare providers and family members.
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Affiliation(s)
- Liangyuan Zhang
- Clinical Research Academy, Peking University Shenzhen Hospital, Shenzhen, China
- Department of Epidemiology, China Medical University, Shenyang, Liaoning, China
| | - Jianzhou Yang
- Department of Public Health and Preventive Medicine, Changzhi Medical College, Changzhi, Shanxi, China
| | - Rila Su
- Cancer Center of Inner Mongolia People's Hospital, Hohhot, Inner Mongolia, China
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Xinquan Lan
- Clinical Research Academy, Peking University Shenzhen Hospital, Shenzhen, China
- Department of Epidemiology, China Medical University, Shenyang, Liaoning, China
| | - Moxin Song
- Clinical Research Academy, Peking University Shenzhen Hospital, Shenzhen, China
- Department of Epidemiology, China Medical University, Shenyang, Liaoning, China
| | - Lei Zhang
- Department of Oncology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Junjie Xu
- Department of Public Health and Preventive Medicine, Changzhi Medical College, Changzhi, Shanxi, China
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Sileo KM, Hirani IM, Luttinen RL, Hayward M, Fleming PJ. A Scoping Review on Gender/Sex Differences in COVID-19 Vaccine Intentions and Uptake in the United States. Am J Health Promot 2024; 38:242-274. [PMID: 37847250 PMCID: PMC10802093 DOI: 10.1177/08901171231200778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
OBJECTIVE To explore the empirical literature on gender/sex differences in vaccine acceptance among U.S.-based adults and adolescents in approximately the first 2 years of the pandemic. DATA SOURCE Embase, Medline, PsycINFO, EBSCO, CINAHL, Web of Science. STUDY INCLUSION AND EXCLUSION CRITERIA Peer-reviewed studies conducted in the U.S. with those aged 12 and older, published in English before January 12, 2022, examining the relationship between gender/sex on COVID-19 vaccine intentions and/or uptake. DATA EXTRACTION Three authors screened studies and extracted data. DATA SYNTHESIS Univariate and multivariate results are summarized. RESULTS A total of 53 studies met inclusion criteria (48 intentions, 7 uptake), using mostly cross-sectional designs (92.5%) and non-random sampling (83.0%). The majority of studies supported men's greater intentions to vaccinate compared to women, and men's greater vaccine uptake in univariate analyses, but most multivariate analyses supported no gender differences in uptake. Few studies examined gender beyond binary categories (women/men), highlighting a gap in the studies inclusive of transgender or gender-diverse populations in analyses. CONCLUSION Women may have been more hesitant to get the vaccine than men early in the pandemic, but these differences may not translate to actual behavior. Future research should include non-binary/transgender populations, explore the gender-specific reasons for hesitancy and differences by sub-populations, utilize more rigorous designs, and test gender-sensitive public health campaigns to mitigate vaccine concerns.
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Affiliation(s)
- Katelyn M. Sileo
- The Department of Public Health, College of Health, Community, and Policy, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Inara M. Hirani
- The Department of Public Health, College of Health, Community, and Policy, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Rebecca L. Luttinen
- The Department of Demography, College of Health, Community, and Policy, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Matt Hayward
- The John Peace Library, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Paul J. Fleming
- The Department of Health Behavior and Health Education, The School of Public Health at the University of Michigan, Ann Arbor, MI, USA
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Sevilla JP. COVID-19 vaccines should be evaluated from the societal perspective. J Med Econ 2024; 27:1-9. [PMID: 38014424 DOI: 10.1080/13696998.2023.2287935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023]
Abstract
The COVID-19 pandemic demonstrates the importance of valuing vaccines from a broad societal perspective (SP), as opposed to a narrower health-payer perspective (HPP). COVID-19's catastrophic global impacts extend not only to its health-related effects, but also to the profound macroeconomic losses caused by lockdowns required for disease control, leading to the worst global economic crisis in a century. COVID-19 vaccination (CV) has been the central policy tool for resolving this economic crisis, and it has been hypothesized that this macroeconomic benefit alone justifies the cost of CV many times over. Yet HPP-based vaccine valuations are wholly insensitive to this enormous benefit, not allowing it to influence the allocation of given health budgets nor the determination of the magnitudes of such budgets, thereby risking inadequate societal spending on CV. HPP allocates given health budgets to maximize only health, giving no weight to macroeconomic outcomes, causing allocative inefficiency by not allowing welfare-improving trade-offs of health for wealth. HPP assumes health budgets are optimal, not scrutinizing whether their scale adequately reflects the macroeconomic benefits of health spending, thereby risking productive inefficiency by foregoing health spending increases such as on CV that could raise both population-level health and wealth. These allocative and productive inefficiencies in turn distort for-profit R&D incentives, risking dynamic inefficiency. And since the socio-economic and health burdens of COVID-19 are disproportionately borne by the worse off, HPP's failure to promote optimal levels of societal investment in CV may disproportionately burden the worse off as well, exacerbating inequality. Vaccine valuations from the societal perspective allow the allocation and determination of health budgets to reflect macroeconomic and distributional values, thereby promoting allocative, productive, and dynamic efficiency, as well as equity. These considerations of efficiency and equity support evaluating CV, and to ensure a level playing field, all vaccines, from a societal perspective.
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Kyaw MH, Spinardi J, Zhang L, Oh HML, Srivastava A. Evidence synthesis and pooled analysis of vaccine effectiveness for COVID-19 mRNA vaccine BNT162b2 as a heterologous booster after inactivated SARS-CoV-2 virus vaccines. Hum Vaccin Immunother 2023; 19:2165856. [PMID: 36727201 PMCID: PMC9980688 DOI: 10.1080/21645515.2023.2165856] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Introduction of primary COVID-19 vaccination has helped reduce severe disease and death caused by SARS-CoV-2 infection. Understanding the protection conferred by heterologous booster regimens informs alternative vaccination strategies that enable programmatic resilience and can catalyze vaccine confidence and coverage. Inactivated SARS-CoV-2 vaccines are among the most widely used vaccines worldwide. This review synthesizes the available evidence identified as of May 26, 2022, on the safety, immunogenicity, and effectiveness of a heterologous BNT162b2 (Pfizer-BioNTech) mRNA vaccine booster dose after an inactivated SARS-CoV-2 vaccine primary series, to help protect against COVID-19. Evidence showed that the heterologous BNT16b2 mRNA vaccine booster enhances immunogenicity and improves vaccine effectiveness against COVID-19, and no new safety concerns were identified with heterologous inactivated primary series with mRNA booster combinations.
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Affiliation(s)
- Moe H Kyaw
- Vaccine Medical Affairs, Emerging Markets, Pfizer Inc, Gaithersburg, MD, USA
| | - Julia Spinardi
- Vaccine Medical Affairs, Emerging Markets, Pfizer Inc, Sao Paulo, Brazil
| | - Ling Zhang
- Real World Evidence Analytics Center of Excellence, Boehringer Ingelheim, Ridgefield, CT, USA
| | - Helen May Lin Oh
- Department of Infectious Diseases, Changi General Hospital, Singapore
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Adler AV, Nadone HR, Dafinone ME, Facemyer KC. Social justice in medical education: a student-led approach to addressing COVID-19 vaccine equity in the Hispanic/Latinx community. MEDICAL EDUCATION ONLINE 2023; 28:2241169. [PMID: 37499134 PMCID: PMC10375929 DOI: 10.1080/10872981.2023.2241169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/28/2023] [Accepted: 07/23/2023] [Indexed: 07/29/2023]
Abstract
The current healthcare system disproportionately affects vulnerable populations, leading to disparities in health outcomes. As a result, medical schools need to equip future physicians with the tools to identify and address healthcare disparities. The University of Nevada, Reno School of Medicine implemented a Scholarly Concentration in Medical Social Justice (SCiMSJ) program to address this issue. Three medical students joined the program and pioneered a project to address the equitable vaccine distribution within the local Hispanic/Latinx community. After identifying the disparity in vaccine uptake and high levels of vaccine hesitancy, they collaborated with local organizations to address vaccine misinformation and accessibility. They organized outreach events, provided vaccine education, and hosted a vaccine clinic at a Catholic church with a high Hispanic/Latinx congregation. Through their efforts, they administered 1,456 vaccines. The estimated economic and societal impacts of their work was 879 COVID-19 cases avoided, 5 deaths avoided, 45 life years saved, and $29,286 in economic value. The project's success highlights the effectiveness of a student-led approach to promote skill development in social justice training. Leadership skills and coalition building were crucial in overcoming resource limitations and connecting organizations with the necessary volunteer force. Building trust with the Hispanic/Latinx community through outreach efforts and addressing vaccine hesitancy contributed to the well-attended vaccine clinic. The project's framework and approach can be adopted by other medical students and organizations to address health disparities and improve health outcomes in their communities.
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Affiliation(s)
- Audrey V. Adler
- University of Nevada, Reno School of Medicine, Reno, Nevada, USA
| | - Haley R. Nadone
- University of Nevada, Reno School of Medicine, Reno, Nevada, USA
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Oh A, Gan S, John Boscardin W, Neilands TB, Stewart AL, Nguyen TT, Smith AK. Effect of the COVID-19 pandemic on meaningful activity engagement in racially and ethnically diverse older adults. J Am Geriatr Soc 2023; 71:2924-2934. [PMID: 37317827 PMCID: PMC10524549 DOI: 10.1111/jgs.18466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Participation and active engagement in meaningful activities support the emotional and physical well-being of older adults. In 2020, the onset of the COVID-19 pandemic altered lives, including the ability to participate in meaningful activities. This study compared meaningful activity engagement before and at the beginning of the COVID-19 pandemic in a nationally representative, diverse sample >65 years between 2015 and 2020. METHODS We described the proportions and characteristics of National Health and Aging Trends Study participants and their engagement in four activities: visiting friends or family, attending religious services, participating in clubs/classes/other organized activities, and going out for enjoyment. We used mixed effects logistic regressions to compare probabilities of activity engagement before 2020 and in 2020, adjusting for age, sex, functional status, income, geographic region, anxiety-depression, and transportation issues. RESULTS Of 6815 participants in 2015, the mean age was 77.7 (7.6) years; 57% of participants were female; 22% were Black, 5% Hispanic, 2% were American Indian, and 1% were Asian; 20% had disability; and median income was $33,000. Participation in all four activities remained consistent between 2015 and 2019 and declined in 2020. Significant differences existed in attending religious services (p < 0.01) and going out for enjoyment (p < 0.001) by race and ethnicity, before and after the start of COVID-19. Black and Hispanic participants experienced the largest decline in attending religious services (-32%, -28%) while Asian and White participants experienced the largest decline in going out for enjoyment (-49%, -56%). CONCLUSIONS Potential quality of life tradeoffs should be considered to a greater extent in future pandemic emergencies.
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Affiliation(s)
- Anna Oh
- Office of Research and Patient Care Services, Stanford Health Care, Stanford, California
- Department of Social & Behavioral Sciences, School of Nursing, University of California San Francisco, San Francisco, California
| | - Siqi Gan
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California
| | - W. John Boscardin
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California
- Division of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California
| | - Torsten B. Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Anita L. Stewart
- Institute for Health & Aging, University of California San Francisco, San Francisco, California
| | - Tung T. Nguyen
- Division of General Internal Medicine, University of California San Francisco, San Francisco, California
| | - Alexander K. Smith
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California
- Geriatrics and Palliative Care, San Francisco VA Health Care System, San Francisco, California
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Bagshaw SM, Abbott A, Beesoon S, Bowker SL, Zuege DJ, Thanh NX. A population-based assessment of avoidable hospitalizations and resource use of non-vaccinated patients with COVID-19. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:547-554. [PMID: 37165140 PMCID: PMC10171151 DOI: 10.17269/s41997-023-00777-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 04/13/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has precipitated a prolonged public health crisis. Numerous public health protections were widely implemented. The availability of effective and safe vaccines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presented an opportunity to resolve this crisis; however, vaccine uptake was slow and inconsistent. This study evaluated the potential for preventable hospitalizations and avoidable resource use among eligible non-vaccinated persons hospitalized for COVID-19 had these persons been vaccinated. METHODS This was a retrospective, population-based cohort study. The population-at-risk were persons aged ≥ 12 years in Alberta (mid-year 2021 population ~ 4.4 million). The primary exposure was vaccination status. The primary outcome was hospitalization with confirmed SARS-CoV-2, and secondary outcomes included avoidable hospitalizations, avoidable hospital bed-days, and the potential cost avoidance related to COVID-19. The study inception period was 27 September 2021 to 25 January 2022. Data on COVID-19 hospitalizations, vaccination status, health services, and costs were obtained from the Government of Alberta and from the Discharge Abstract Database. RESULTS Hospitalizations occurred in 3835, 1907, and 481 persons who were non-vaccinated, fully vaccinated, and boosted (risk of hospitalization/100,000 population: 886, 92, and 43), respectively. For non-vaccinated persons compared with fully vaccinated and boosted persons, the risk ratios (95%CI) of hospitalization were 9.7 (7.9-11.8) and 20.6 (17.9-23.6), respectively. For non-vaccinated persons, estimates of avoidable hospitalizations and bed-days used were 3439 and 36,331 if fully vaccinated and 3764 and 40,185 if boosted. Estimates of cost avoidance for non-vaccinated persons were $101.46 million if fully vaccinated and $110.24 million if boosted. CONCLUSION Eligible non-vaccinated persons with COVID-19 had tenfold and 21-fold higher risks of hospitalization relative to whether they had been fully vaccinated or boosted, resulting in considerable avoidable hospital bed-days and costs.
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Affiliation(s)
- Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, AB, Canada.
- Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada.
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
| | - Annalise Abbott
- Department of Surgery, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Sanjay Beesoon
- Department of Surgery, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Community Engagement, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Surgery Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - Samantha L Bowker
- Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - Danny J Zuege
- Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Nguyen X Thanh
- Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Surgery Strategic Clinical Network, Alberta Health Services, Alberta, Canada
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Fu Y, Zhao J, Han P, Zhang J, Wang Q, Wang Q, Wei X, Yang L, Ren T, Zhan S, Li L. Cost-effectiveness of COVID-19 vaccination: A systematic review. J Evid Based Med 2023. [PMID: 37186130 DOI: 10.1111/jebm.12525] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 03/17/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE The COVID-19 vaccination strategy has been widely used to protect population health worldwide. This study aims to summarize the cost-effectiveness evidence of economic evaluation of COVID-19 vaccination strategies to provide evidence supporting the usage of COVID-19 vaccination, especially where the supply of COVID-19 vaccine is limited. METHODS A systematic literature review was performed by searching both English and Chinese databases, including PubMed, Embase, Science Direct, Web of Science, Medline, Scopus, and CNKI. Articles published from January 1, 2020 to August 1, 2022 (PROSPERO registration number: CRD42022355442). RESULTS Of the 1035 papers identified, a total of 28 English studies that met the preset criteria were included. COVID-19 vaccination and booster vaccination were cost-effective or cost-saving regardless of the vaccine type; vaccine efficacy, vaccine price, vaccine supply or prioritization, and vaccination pace were the influential factors of cost-effectiveness among different population groups. When supply is adequate, mass vaccination should be encouraged, while when supply is inadequate, prioritizing the high risk and the elderly is more cost-effective. CONCLUSIONS COVID-19 vaccination strategies are economically favorable in a wide range of countries and population groups, and further research on suitable strategies for booster COVID-19 vaccination is needed.
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Affiliation(s)
- Yaqun Fu
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Jingyu Zhao
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Peien Han
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Jiawei Zhang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Quan Wang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- Brown School, Washington University in St. Louis, St. Louis MO, U.S., St. Louis, United States
| | - Qingbo Wang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Xia Wei
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Li Yang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Tao Ren
- School of Public Health, Peking University, Beijing, China
| | - Siyan Zhan
- Department of Epidemiology and Health Statistics, School of Public Health, Peking University, Beijing, China
| | - Liming Li
- Department of Epidemiology and Health Statistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China
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Di Fusco M, Marczell K, Thoburn E, Wiemken TL, Yang J, Yarnoff B. Public health impact and economic value of booster vaccination with Pfizer-BioNTech COVID-19 vaccine, bivalent (original and omicron BA.4/BA.5) in the United States. J Med Econ 2023; 26:509-524. [PMID: 36942976 DOI: 10.1080/13696998.2023.2193067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To assess the public health impact and economic value of booster vaccination with the Pfizer-BioNTech COVID-19 Vaccine, Bivalent in the United States. METHODS A combined cohort Markov decision tree model estimated the cost-effectiveness and budget impact of booster vaccination compared to no booster vaccination in individuals aged ≥5 years. Analyses prospectively assessed three scenarios (base case, low, high) defined based upon the emergence (or not) of subvariants, using list prices. Age-stratified parameters were informed by literature. The cost-effectiveness analysis estimated cases, hospitalizations and deaths averted, Life Years (LYs) and Quality Adjusted Life Years (QALYs) gained, the incremental cost-effectiveness ratio (ICER), the net monetary benefit (NMB), and the Return on Investment (ROI). The budget impact analyses used the perspective of a hypothetical 1-million-member plan. Sensitivity analyses explored parameter uncertainty. Conservatively, indirect effects and broad societal benefits were not considered. RESULTS The base case predicted that, compared to no booster vaccination, the Pfizer-BioNTech COVID-19 Vaccine, Bivalent could result in ∼3.7 million fewer symptomatic cases, 162 thousand fewer hospitalizations, 45 thousand fewer deaths, 373 thousand fewer discounted QALYs lost, and was cost-saving. Using a conservative value of $50,000 for 1 LY, every $1 invested yielded estimated $4.67 benefits. Unit costs, health outcomes and effectiveness had the greatest impact on results. At $50,000 per QALY gained, the booster generated a 34.2 billion NMB and probabilistic sensitivity analyses indicated a 92% chance of being cost-saving and 98% of being cost-effective. The bivalent was cost-saving or highly cost-effective in high and low scenarios. In a hypothetical 1-million-member health plan population, the vaccine was predicted to be a budget-efficient solution for payers. CONCLUSIONS Booster vaccination with the Pfizer-BioNTech COVID-19 Vaccine, Bivalent for the US population aged ≥5 years could generate notable public health impact and be cost-saving based on the findings of our base case analyses.
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Affiliation(s)
| | - Kinga Marczell
- Evidera, Bocskai út 134-146, Dorottya Udvar, E épület 2. emelet, Budapest, Hungary
| | | | | | - Jingyan Yang
- Pfizer Inc., New York, NY USA
- Institute for Social and Economic Research and Policy, Columbia University, New York, NY, USA
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Di Fusco M, Mendes D, Steuten L, Bloom DE, Drummond M, Hauck K, Pearson-Stuttard J, Power R, Salisbury D, Towse A, Roiz J, Szabo G, Yang J, Marczell K. The Societal Value of Vaccines: Expert-Based Conceptual Framework and Methods Using COVID-19 Vaccines as a Case Study. Vaccines (Basel) 2023; 11:234. [PMID: 36851112 PMCID: PMC9961127 DOI: 10.3390/vaccines11020234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/13/2023] [Accepted: 01/15/2023] [Indexed: 01/22/2023] Open
Abstract
Health technology assessments (HTAs) of vaccines typically focus on the direct health benefits to individuals and healthcare systems. COVID-19 highlighted the widespread societal impact of infectious diseases and the value of vaccines in averting adverse clinical consequences and in maintaining or resuming social and economic activities. Using COVID-19 as a case study, this research work aimed to set forth a conceptual framework capturing the broader value elements of vaccines and to identify appropriate methods to quantify value elements not routinely considered in HTAs. A two-step approach was adopted, combining a targeted literature review and three rounds of expert elicitation based on a modified Delphi method, leading to a conceptual framework of 30 value elements related to broader health effects, societal and economic impact, public finances, and uncertainty value. When applying the framework to COVID-19 vaccines in post-pandemic settings, 13 value elements were consensually rated highly important by the experts for consideration in HTAs. The experts reviewed over 10 methods that could be leveraged to quantify broader value elements and provided technical forward-looking recommendations. Limitations of the framework and the identified methods were discussed. This study supplements ongoing efforts aimed towards a broader recognition of the full societal value of vaccines.
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Affiliation(s)
- Manuela Di Fusco
- Health Economics and Outcomes Research, Pfizer Inc., New York, NY 10017, USA
| | - Diana Mendes
- Health & Value, Pfizer Co., Ltd., Tadworth KT20 7NS, UK
| | | | - David E Bloom
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Michael Drummond
- Centre for Health Economics, Alcuin A Block, University of York, Heslington, York YO10 5DD, UK
| | - Katharina Hauck
- Department of Infectious Disease Epidemiology, Faculty of Medicine, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Jonathan Pearson-Stuttard
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK
- Health Analytics, Lane Clark & Peacock, London W1U 1DQ, UK
| | - Rachel Power
- The Patients Association, PO Box 935, Harrow HA1 3YJ, UK
| | - David Salisbury
- Programme for Global Health, Royal Institute of International Affairs, Chatham House, London SW1Y 4LE, UK
| | | | - Julie Roiz
- Evidence, Value and Access by PPD, Evidera, London W6 8BJ, UK
| | - Gabor Szabo
- Evidence, Value and Access by PPD, Evidera, H-1113 Budapest, Hungary
| | - Jingyan Yang
- Health Economics and Outcomes Research, Pfizer Inc., New York, NY 10017, USA
- Institute for Social and Economic Research and Policy, Graduate School of Arts and Science, Columbia University, New York, NY 10027, USA
| | - Kinga Marczell
- Evidence, Value and Access by PPD, Evidera, H-1113 Budapest, Hungary
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11
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Yang J, Vaghela S, Yarnoff B, De Boisvilliers S, Di Fusco M, Wiemken TL, Kyaw MH, McLaughlin JM, Nguyen JL. Estimated global public health and economic impact of COVID-19 vaccines in the pre-omicron era using real-world empirical data. Expert Rev Vaccines 2023; 22:54-65. [PMID: 36527724 DOI: 10.1080/14760584.2023.2157817] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Limited data are available describing the global impact of COVID-19 vaccines. This study estimated the global public health and economic impact of COVID-19 vaccines before the emergence of the Omicron variant. METHODS A static model covering 215 countries/territories compared the direct effects of COVID-19 vaccination to no vaccination during 13 December 2020-30 September 2021. After adjusting for underreporting of cases and deaths, base case analyses estimated total cases and deaths averted, and direct outpatient and productivity costs saved through averted health outcomes. Sensitivity analyses applied alternative model assumptions. RESULTS COVID-19 vaccines prevented an estimated median (IQR) of 151.7 (133.7-226.1) million cases and 620.5 (411.1-698.1) thousand deaths globally through September 2021. In sensitivity analysis applying an alternative underreporting assumption, median deaths averted were 2.1 million. Estimated direct outpatient cost savings were $21.2 ($18.9-30.9) billion and indirect savings of avoided productivity loss were $135.1 ($121.1-206.4) billion, yielding a total cost savings of $155 billion globally through averted infections. CONCLUSIONS Using a conservative modeling approach that considered direct effects only, we estimated that COVID-19 vaccines have averted millions of infections and deaths, generating billions of cost savings worldwide, which underscore the continued importance of vaccination in public health response to COVID-19.
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Affiliation(s)
- Jingyan Yang
- Pfizer Inc, New York, NY, USA.,Institute for Social and Economic Research and Policy, Columbia University, New York, NY, USA
| | | | - Benjamin Yarnoff
- Evidera, 7101 Wisconsin Ave., Suite 1400, Bethesda, Washington, USA
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12
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Abraham I, Lee KKC, Gregg M. Journal of Medical Economics in review: high impact articles from 2022. J Med Econ 2023; 26:303-307. [PMID: 36840388 DOI: 10.1080/13696998.2023.2178690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- Ivo Abraham
- Professor of Pharmacy, Medicine, and Clinical Translational Sciences, University of Arizona, Tucson, AZ, USA
| | - Kenneth K C Lee
- Professor of Pharmacy, School of Pharmacy, Taylors University, Malaysia
| | - Mike Gregg
- Executive Editor, Taylor & Francis, London, UK
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13
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Bagshaw SM, Abbott A, Beesoon S, Zuege DJ, Wasylak T, Manns B, Nguyen TX. Avoidable intensive care unit resource use and costs of unvaccinated patients with COVID-19: a historical population-based cohort study. Can J Anaesth 2022; 69:1399-1404. [PMID: 35879485 PMCID: PMC9313940 DOI: 10.1007/s12630-022-02299-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/22/2022] [Accepted: 04/30/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE SARS-CoV-2 vaccines have been proven effective at preventing poor outcomes from COVID-19; however, voluntary vaccination rates have been suboptimal. We assessed the potential avoidable intensive care unit (ICU) resource use and associated costs had unvaccinated or partially vaccinated patients hospitalized with COVID-19 been fully vaccinated. METHODS We conducted a retrospective, population-based cohort study of persons aged 12 yr or greater in Alberta (2021 population ~ 4.4 million) admitted to any ICU with COVID-19 from 6 September 2021 to 4 January 2022. We used publicly available aggregate data on COVID-19 infections, vaccination status, and health services use. Intensive care unit admissions, bed-days, lengths of stay, and costs were estimated for patients with COVID-19 and stratified by vaccination status. RESULTS In total, 1,053 patients admitted to the ICU with COVID-19 were unvaccinated, 42 were partially vaccinated, and 173 were fully vaccinated (cumulative incidence 230.6, 30.8, and 5.5 patients/100,000 population, respectively). Cumulative incidence rate ratios of ICU admission were 42.2 (95% confidence interval [CI], 39.7 to 44.9) for unvaccinated patients and 5.6 (95% CI, 4.1 to 7.6) for partially vaccinated patients when compared with fully vaccinated patients. During the study period, 1,028 avoidable ICU admissions and 13,015 bed-days were recorded for unvaccinated patients and the total avoidable costs were CAD 61.3 million. The largest opportunity to avoid ICU bed-days and costs was in unvaccinated patients aged 50 to 69 yr. CONCLUSIONS Unvaccinated patients with COVID-19 had substantially greater rates of ICU admissions, ICU bed-days, and ICU-related costs than vaccinated patients did. This increased resource use would have been potentially avoidable had these unvaccinated patients been vaccinated against SARS-CoV-2.
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Affiliation(s)
- Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, 2-124E Clinical Sciences Building, 8440-112 St NW, Edmonton, AB, T6G 2B7, Canada.
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada.
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
| | - Annalise Abbott
- Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Sanjay Beesoon
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Danny J Zuege
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Tracy Wasylak
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Braden Manns
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Thanh X Nguyen
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
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14
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Zhou L, Yan W, Li S, Yang H, Zhang X, Lu W, Liu J, Wang Y. Cost-effectiveness of interventions for the prevention and control of COVID-19: Systematic review of 85 modelling studies. J Glob Health 2022; 12:05022. [PMID: 35712857 PMCID: PMC9196831 DOI: 10.7189/jogh.12.05022] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background We aimed to quantitatively summarise the health economic evaluation evidence of prevention and control programs addressing COVID-19 globally. Methods We did a systematic review and meta-analysis to assess the economic and health benefit of interventions for COVID-19. We searched PubMed, Embase, Web of Science, and Cochrane Library of economic evaluation from December 31, 2019, to March 22, 2022, to identify relevant literature. Meta-analyses were done using random-effects models to estimate pooled incremental net benefit (INB). Heterogeneity was assessed using I2 statistics and publication bias was assessed by Egger's test. This study is registered with PROSPERO, CRD42021267475. Results Of 16 860 studies identified, 85 articles were included in the systematic review, and 25 articles (10 studies about non-pharmacological interventions (NPIs), five studies about vaccinations and 10 studies about treatments) were included in the meta-analysis. The pooled INB of NPIs, vaccinations, and treatments were $1378.10 (95% CI = $1079.62, $1676.59), $254.80 (95% CI = $169.84, $339.77) and $4115.11 (95% CI = $1631.09, $6599.14), respectively. Sensitivity analyses showed similar findings. Conclusions NPIs, vaccinations, and treatments are all cost-effective in combating the COVID-19 pandemic. However, evidence was mostly from high-income and middle-income countries. Further studies from lower-income countries are needed.
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Affiliation(s)
- Lihui Zhou
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wenxin Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Shu Li
- School of Management, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Hongxi Yang
- School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Xinyu Zhang
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wenli Lu
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin, China
- Health Science and Engineering College, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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15
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Di Fusco M, Marczell K, Deger KA, Moran MM, Wiemken TL, Cane A, de Boisvilliers S, Yang J, Vaghela S, Roiz J. Public health impact of the Pfizer-BioNTech COVID-19 vaccine (BNT162b2) in the first year of rollout in the United States. J Med Econ 2022; 25:605-617. [PMID: 35574613 DOI: 10.1080/13696998.2022.2071427] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND As the body of evidence on COVID-19 and post-vaccination outcomes continues to expand, this analysis sought to evaluate the public health impact of the Pfizer-BioNTech COVID-19 Vaccine, BNT162b2, during the first year of its rollout in the US. METHODS A combined Markov decision tree model compared clinical and economic outcomes of the Pfizer-BioNTech COVID-19 Vaccine (BNT162b2) versus no vaccination in individuals aged ≥12 years. Age-stratified epidemiological, clinical, economic, and humanistic parameters were derived from existing data and published literature. Scenario analysis explored the impact of using lower and upper bounds of parameters on the results. The health benefits were estimated as the number of COVID-19 symptomatic cases, hospitalizations and deaths averted, and Quality Adjusted Life Years (QALYs) saved. The economic benefits were estimated as the amount of healthcare and societal cost savings associated with the vaccine-preventable health outcomes. RESULTS It was estimated that, in 2021, the Pfizer-BioNTech COVID-19 Vaccine (BNT162b2) contributed to averting almost 9 million symptomatic cases, close to 700,000 hospitalizations, and over 110,000 deaths, resulting in an estimated $30.4 billion direct healthcare cost savings, $43.7 billion indirect cost savings related to productivity loss, as well as discounted gains of 1.1 million QALYs. Scenario analyses showed that these results were robust; the use of alternative plausible ranges of parameters did not change the interpretation of the findings. CONCLUSIONS The Pfizer-BioNTech COVID-19 Vaccine (BNT162b2) contributed to generate substantial public health impact and vaccine-preventable cost savings in the first year of its rollout in the US. The vaccine was estimated to prevent millions of COVID-19 symptomatic cases and thousands of hospitalizations and deaths, and these averted outcomes translated into cost-savings in the billions of US dollars and thousands of QALYs saved. As only direct impacts of vaccination were considered, these estimates may be conservative.
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Affiliation(s)
- Manuela Di Fusco
- Health Economics & Outcomes Research, Pfizer Inc, New York, NY, USA
| | - Kinga Marczell
- Evidence, Value & Access by PPD, Evidera, Budapest, Hungary
| | | | | | | | - Alejandro Cane
- Health Economics & Outcomes Research, Pfizer Inc, New York, NY, USA
| | | | - Jingyan Yang
- Health Economics & Outcomes Research, Pfizer Inc, New York, NY, USA
- Institute for Social and Economic Research and Policy, Columbia University, New York, NY, USA
| | | | - Julie Roiz
- Evidence, Value & Access by PPD, Evidera, London, UK
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