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Ogwel B, Mzazi V, Nyawanda BO, Otieno G, Omore R. Predictive modeling for infectious diarrheal disease in pediatric populations: A systematic review. Learn Health Syst 2024; 8:e10382. [PMID: 38249852 PMCID: PMC10797570 DOI: 10.1002/lrh2.10382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 07/09/2023] [Accepted: 07/17/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Diarrhea is still a significant global public health problem. There are currently no systematic evaluation of the modeling areas and approaches to predict diarrheal illness outcomes. This paper reviews existing research efforts in predictive modeling of infectious diarrheal illness in pediatric populations. Methods We conducted a systematic review via a PubMed search for the period 1990-2021. A comprehensive search query was developed through an iterative process and literature on predictive modeling of diarrhea was retrieved. The following filters were applied to the search results: human subjects, English language, and children (birth to 18 years). We carried out a narrative synthesis of the included publications. Results Our literature search returned 2671 articles. After manual evaluation, 38 of these articles were included in this review. The most common research topic among the studies were disease forecasts 14 (36.8%), vaccine-related predictions 9 (23.7%), and disease/pathogen detection 5 (13.2%). Majority of these studies were published between 2011 and 2020, 28 (73.7%). The most common technique used in the modeling was machine learning 12 (31.6%) with various algorithms used for the prediction tasks. With change in the landscape of diarrheal etiology after rotavirus vaccine introduction, many open areas (disease forecasts, disease detection, and strain dynamics) remain for pathogen-specific predictive models among etiological agents that have emerged as important. Additionally, the outcomes of diarrheal illness remain under researched. We also observed lack of consistency in the reporting of results of prediction models despite the available guidelines highlighting the need for common data standards and adherence to guidelines on reporting of predictive models for biomedical research. Conclusions Our review identified knowledge gaps and opportunities in predictive modeling for diarrheal illness, and limitations in existing attempts whilst advancing some precursory thoughts on how to address them, aiming to invigorate future research efforts in this sphere.
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Affiliation(s)
- Billy Ogwel
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI‐CGHR)KisumuKenya
- Department of Information SystemsUniversity of South AfricaPretoriaSouth Africa
| | - Vincent Mzazi
- Department of Information SystemsUniversity of South AfricaPretoriaSouth Africa
| | - Bryan O. Nyawanda
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI‐CGHR)KisumuKenya
| | - Gabriel Otieno
- Department of ComputingUnited States International UniversityNairobiKenya
| | - Richard Omore
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI‐CGHR)KisumuKenya
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Nymark LS, Miller A, Vassall A. Inclusion of Additional Unintended Consequences in Economic Evaluation: A Systematic Review of Immunization and Tuberculosis Cost-Effectiveness Analyses. PHARMACOECONOMICS - OPEN 2021; 5:587-603. [PMID: 33948928 PMCID: PMC8096359 DOI: 10.1007/s41669-021-00269-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Our objective was to review economic evaluations of immunization and tuberculosis to determine the extent to which additional unintended consequences were taken into account in the analysis and to describe the methodological approaches used to estimate these, where possible. METHODS We sourced the vaccine economic evaluations from a previous systematic review by Nymark et al. (2009-2015) and searched PubMed/MEDLINE and Embase from 2015 to 2019 using the same search strategy. For tuberculosis economic evaluations, we extracted studies from 2009 to 2019 that were published in a previous review by Siapka et al. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Studies were classified according to the categories and subcategories (e.g., herd immunity, non-specific effects, and labor productivity) defined in a framework identifying additional unintended consequences by Nymark and Vassall. Where possible, methods for estimating the additional unintended consequences categories and subcategories were described. We evaluated the reporting quality of included studies according to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) extraction guideline. RESULTS We identified 177 vaccine cost-effectiveness analyses (CEAs) between 2009 and 2019 that met the inclusion criteria. Of these, 98 included unintended consequences. Of the total 98 CEAs, overall health consequence categories were included 73 times; biological categories: herd immunity 43 times; pathogen response: resistance 15 times; and cross-protection 15 times. For health consequences pertaining to the supply-side (health systems) categories, side effects were included five times. On the nonhealth demand side (intrahousehold), labor productivity was included 60 times. We identified 29 tuberculosis CEAs from 2009 to 2019 that met the inclusion criteria. Of these, six articles included labor productivity, four included indirect transmission effects, and one included resistance. Between 2009 and 2019, only 34% of tuberculosis CEAs included additional unintended consequences, compared with 55% of vaccine CEAs. CONCLUSIONS The inclusion of additional unintended consequences in economic evaluations of immunization and tuberculosis continues to be limited. Additional unintended consequences of economic benefits, such as those examined in this review and especially those that occur outside the health system, offer valuable information to analysts. Further work on appropriate ways to value these additional unintended consequences is still warranted.
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Affiliation(s)
- Liv Solvår Nymark
- Department of Global Health, The Academic Medical Center (AMC), The University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | | | - Anna Vassall
- Department of Global Health, The Academic Medical Center (AMC), The University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
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Bruun T, Watle SSV, Tveteraas IH, Flem E. Intussusception among Norwegian children: What to expect after introduction of rotavirus vaccination? Vaccine 2019; 37:5717-5723. [PMID: 31255303 DOI: 10.1016/j.vaccine.2019.06.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/14/2019] [Accepted: 06/18/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND To reduce the risk of vaccine-associated intussusception, rotavirus vaccination in Norway was implemented under strict age limits (the first dose given by 12 weeks of age and the second dose by 16 weeks of age) in 2014. We estimated the incidence of intussusception in children <2 years old before vaccine introduction and the number of vaccine-associated cases under current and extended age limits for vaccine administration in Norway. METHODS To estimate the baseline incidence, we validated all diagnoses in children <2 years old registered in the national hospital registry during the pre-vaccine period of 2008-2013. Using national vaccine coverage data and international estimates of intussusception risk after rotavirus vaccination, we calculated the numbers of expected vaccine-associated intussusception cases to compare with the estimated numbers of averted rotavirus cases. Uncertainty was accounted for by several scenario analyses using current and extended age limits for vaccine administration. RESULTS The pre-vaccine incidence of intussusception was 26.7 (95% CI 23.1-30.6) cases/year per 100,000 children <2 years old and 37.1 (95% CI 31.2-43.8) cases/year per 100,000 children <1 year old. In the 2016 birth cohort (approx. 60,000) vaccinated under the current age limits, 1.3 (95% CI 0.7-2.0) vaccine-associated intussusception cases were expected to occur. If age limits were extended to 16 weeks for the first vaccine dose and 24 weeks for the second dose, leading to more children vaccinated at an older age, 2.2 (95% CI 1.2-3.5) excess cases would be expected in the same cohort. Simultaneously, an estimated 1768 rotavirus hospitalizations/year in children <5 years old would be averted under current age limits, with 98 additional rotavirus hospitalizations averted under extended age limits. CONCLUSIONS Administering rotavirus vaccines beyond current age limits in Norway would lead to a marginal increase in the number of intussusception cases, which would be offset by the benefits of vaccination.
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Affiliation(s)
- Tone Bruun
- Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213 Oslo, Norway.
| | | | | | - Elmira Flem
- Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213 Oslo, Norway
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Abstract
The mumps vaccine is not included in the national immunisation programme (NIP) of approximately 80 countries including Japan. To investigate the vaccine's cost-effectiveness, we developed a dynamic transmission model for routine one- and two-dose mumps vaccination programs in Japan. We calculated the incremental cost-effectiveness ratio compared with a current programme over a projected 50-year period. We created a Japanese population model and performed dynamic simulation to estimate the number of patients enrolled in the current programme, the routine one-dose programme, and the routine two-dose programme over the next 50 years using the Berkeley Madonna program. We estimated the medical and social costs of natural mumps infections and vaccinations to analyse cost-effectiveness. Finally, we performed a sensitivity analysis with parameters including vaccine cost, vaccine efficacy, medical costs per case, social costs per case, incidence of adverse events and discount rate. Base case analysis showed that both the one-dose and two-dose programmes predominated and that quality-adjusted life years (QALYs) were saved, compared with the current programme. The medical costs, total cost and QALYs saved during the study period in the two-dose programme compared with the current programme were 217 billion JPY, 860 billion JPY and 184 779, respectively. The two-dose programme surpassed the one-dose programme throughout the study period. In all the scenarios of the sensitivity analysis, two-dose vaccination was better than the one-dose programme. This simulation confirmed that the routine two-dose vaccination programme was more cost-effective and QALY-saving than either the one-dose programme or the current programme. Because of the variability of the results between the various models, further simulations with different models should be conducted.
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Nymark LS, Sharma T, Miller A, Enemark U, Griffiths UK. Inclusion of the value of herd immunity in economic evaluations of vaccines. A systematic review of methods used. Vaccine 2017; 35:6828-6841. [PMID: 29146380 DOI: 10.1016/j.vaccine.2017.10.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 10/04/2017] [Accepted: 10/12/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objectives of this review were to identify vaccine economic evaluations that include herd immunity and describe the methodological approaches used. METHODS We used Kim and Goldie's search strategy from a systematic review (1976-2007) of modelling approaches used in vaccine economic evaluations and additionally searched PubMed/MEDLINE and Embase for 2007-2015. Studies were classified according to modelling approach used. Methods for estimating herd immunity effects were described, in particular for the static models. RESULTS We identified 625 economic evaluations of vaccines against human-transmissible diseases from 1976 to 2015. Of these, 172 (28%) included herd immunity. While 4% of studies included herd immunity in 2001, 53% of those published in 2015 did this. Pneumococcal, human papilloma and rotavirus vaccines represented the majority of studies (63%) considering herd immunity. Ninety-five of the 172 studies utilised a static model, 59 applied a dynamic model, eight a hybrid model and ten did not clearly state which method was used. Relatively crude methods and assumptions were used in the majority of the static model studies. CONCLUSION The proportion of economic evaluations using a dynamic model has increased in recent years. However, 55% of the included studies used a static model for estimating herd immunity. Values from a static model can only be considered reliable if high quality surveillance data are incorporated into the analysis. Without this, the results are questionable and they should only be included in sensitivity analysis.
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Affiliation(s)
- Liv S Nymark
- Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark; Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serums Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Tarang Sharma
- Nordic Cochrane Centre, Rigshospitalet, Blegdamsvej 9, DK- 2100 Copenhagen Ø, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200 København N, Denmark
| | | | - Ulrika Enemark
- Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark; Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serums Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
| | - Ulla Kou Griffiths
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK; UNICEF, 3 UN Plaza, New York, NY 10007, USA
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Park J, Goldstein J, Haran M, Ferrari M. An ensemble approach to predicting the impact of vaccination on rotavirus disease in Niger. Vaccine 2017; 35:5835-5841. [PMID: 28941619 PMCID: PMC7185385 DOI: 10.1016/j.vaccine.2017.09.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/16/2017] [Accepted: 09/05/2017] [Indexed: 01/20/2023]
Abstract
Recently developed vaccines provide a new way of controlling rotavirus in sub-Saharan Africa. Models for the transmission dynamics of rotavirus are critical both for estimating current burden from imperfect surveillance and for assessing potential effects of vaccine intervention strategies. We examine rotavirus infection in the Maradi area in southern Niger using hospital surveillance data provided by Epicentre collected over two years. Additionally, a cluster survey of households in the region allows us to estimate the proportion of children with diarrhea who consulted at a health structure. Model fit and future projections are necessarily particular to a given model; thus, where there are competing models for the underlying epidemiology an ensemble approach can account for that uncertainty. We compare our results across several variants of Susceptible-Infectious-Recovered (SIR) compartmental models to quantify the impact of modeling assumptions on our estimates. Model-specific parameters are estimated by Bayesian inference using Markov chain Monte Carlo. We then use Bayesian model averaging to generate ensemble estimates of the current dynamics, including estimates of R0, the burden of infection in the region, as well as the impact of vaccination on both the short-term dynamics and the long-term reduction of rotavirus incidence under varying levels of coverage. The ensemble of models predicts that the current burden of severe rotavirus disease is 2.6–3.7% of the population each year and that a 2-dose vaccine schedule achieving 70% coverage could reduce burden by 39–42%.
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Affiliation(s)
- Jaewoo Park
- Department of Statistics, The Pennsylvania State University, University Park, PA 16802, USA.
| | - Joshua Goldstein
- Social and Data Analytics Laboratory, 900 N Glebe Rd, Virginia Tech, Arlington, VA 22203, USA.
| | - Murali Haran
- Department of Statistics, The Pennsylvania State University, University Park, PA 16802, USA.
| | - Matthew Ferrari
- Department of Biology, The Pennsylvania State University, University Park, PA 16802, USA.
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Re-evaluation of the cost-effectiveness and effects of childhood rotavirus vaccination in Norway. PLoS One 2017; 12:e0183306. [PMID: 28817621 PMCID: PMC5560584 DOI: 10.1371/journal.pone.0183306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 07/25/2017] [Indexed: 11/20/2022] Open
Abstract
Background Rotavirus vaccination was included into the Norwegian childhood immunisation programme in 2014. Before implementation, rotavirus vaccination was found to be cost–effective from a societal perspective, but not from a healthcare perspective. Since introduction, new data on the incidence and economic effects of rotavirus disease have become available. We assessed early epidemiological effects of the rotavirus vaccination programme and re–evaluated its cost–effectiveness in Norway for the years 2015–2019. Methods Using a dynamic transmission model, we compared the epidemiological effects of the ongoing two–dose vaccination programme with Rotarix®, and a hypothetical 3–dose programme with RotaTeq® with no vaccination. A baseline cost of € 54 per fully vaccinated child was used. Cost–effectiveness was computed from a healthcare and societal perspective, using a decision analytical model. Data on healthcare use and costs, productivity losses and health utilities were based on published and own estimates. Uncertainty was accounted for in one–way, multi–way, and probabilistic sensitivity analyses. Results During 2015–2019, 114,658 home care cases, 34,571 primary care cases, 7,381 severe cases, and 2 deaths associated with rotavirus disease were avoided due to vaccination. Under baseline assumptions vaccination was cost–effective from a healthcare perspective with a cost per QALY of € 47,447 for Rotarix® and € 52,709 for RotaTeq®. The break–even price was € 70 for Rotarix® and € 67 for RotaTeq®. Vaccination was cost–saving from the societal perspective, and also from a healthcare perspective for vaccine prices below € 25 and € 22 per vaccinated child for Rotarix® and RotaTeq®, respectively. Conclusion Ongoing childhood rotavirus vaccination in Norway has reduced the rotavirus disease burden substantially, and is cost–effective compared with no vaccination.
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Kotirum S, Vutipongsatorn N, Kongpakwattana K, Hutubessy R, Chaiyakunapruk N. Global economic evaluations of rotavirus vaccines: A systematic review. Vaccine 2017; 35:3364-3386. [PMID: 28504193 DOI: 10.1016/j.vaccine.2017.04.051] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 04/17/2017] [Accepted: 04/19/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION World Health Organization (WHO) recommends Rotavirus vaccines to prevent and control rotavirus infections. Economic evaluations (EE) have been considered to support decision making of national policy. Summarizing global experience of the economic value of rotavirus vaccines is crucial in order to encourage global WHO recommendations for vaccine uptake. Therefore, a systematic review of economic evaluations of rotavirus vaccine was conducted. METHODS We searched Medline, Embase, NHS EED, EconLit, CEA Registry, SciELO, LILACS, CABI-Global Health Database, Popline, World Bank - e-Library, and WHOLIS. Full economic evaluations studies, published from inception to November 2015, evaluating Rotavirus vaccines preventing Rotavirus infections were included. The methods, assumptions, results and conclusions of the included studies were extracted and appraised using WHO guide for standardization of EE of immunization programs. RESULTS 104 relevant studies were included. The majority of studies were conducted in high-income countries. Cost-utility analysis was mostly reported in many studies using incremental cost-effectiveness ratio per DALY averted or QALY gained. Incremental cost per QALY gained was used in many studies from high-income countries. Mass routine vaccination against rotavirus provided the ICERs ranging from cost-saving to highly cost-effective in comparison to no vaccination among low-income countries. Among middle-income countries, vaccination offered the ICERs ranging from cost-saving to cost-effective. Due to low- or no subsidized price of rotavirus vaccines from external funders, being not cost-effective was reported in some high-income settings. CONCLUSION Mass vaccination against rotavirus was generally found to be cost-effective, particularly in low- and middle-income settings according to the external subsidization of vaccine price. On the other hand, it may not be a cost-effective intervention at market price in some high-income settings. This systematic review provides supporting information to health policy-makers and health professionals when considering rotavirus vaccination as a national program.
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Affiliation(s)
- Surachai Kotirum
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; Social and Administrative Pharmacy Department, Faculty of Pharmacy, Rangsit University, Muang, Pathumthani, Thailand
| | - Naaon Vutipongsatorn
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
| | | | - Raymond Hutubessy
- World Health Organization, Initiative for Vaccine Research, Geneva, Switzerland
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; School of Pharmacy, University of Wisconsin, Madison, USA; Health and Well-being Cluster, Global Asia in the 21(st) Centuary (GA21) Platform, Monash University Malaysia, Selangor, Malaysia.
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Drake TL, Devine A, Yeung S, Day NPJ, White LJ, Lubell Y. Dynamic Transmission Economic Evaluation of Infectious Disease Interventions in Low- and Middle-Income Countries: A Systematic Literature Review. HEALTH ECONOMICS 2016; 25 Suppl 1:124-39. [PMID: 26778620 PMCID: PMC5066646 DOI: 10.1002/hec.3303] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Economic evaluation using dynamic transmission models is important for capturing the indirect effects of infectious disease interventions. We examine the use of these methods in low- and middle-income countries, where infectious diseases constitute a major burden. This review is comprised of two parts: (1) a summary of dynamic transmission economic evaluations across all disease areas published between 2011 and mid-2014 and (2) an in-depth review of mosquito-borne disease studies focusing on health economic methods and reporting. Studies were identified through a systematic search of the MEDLINE database and supplemented by reference list screening. Fifty-seven studies were eligible for inclusion in the all-disease review. The most common subject disease was HIV/AIDS, followed by malaria. A diverse range of modelling methods, outcome metrics and sensitivity analyses were used, indicating little standardisation. Seventeen studies were included in the mosquito-borne disease review. With notable exceptions, most studies did not employ economic evaluation methods beyond calculating a cost-effectiveness ratio or net benefit. Many did not adhere to health care economic evaluations reporting guidelines, particularly with respect to full model reporting and uncertainty analysis. We present a summary of the state-of-the-art and offer recommendations for improved implementation and reporting of health economic methods in this crossover discipline.
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Affiliation(s)
- Tom L Drake
- University of Oxford, Oxford, UK
- Mahidol University, Bangkok, Thailand
| | - Angela Devine
- University of Oxford, Oxford, UK
- Mahidol University, Bangkok, Thailand
| | - Shunmay Yeung
- London School of Hygiene and Tropical Medicine, London, UK
| | - Nicholas P J Day
- University of Oxford, Oxford, UK
- Mahidol University, Bangkok, Thailand
| | - Lisa J White
- University of Oxford, Oxford, UK
- Mahidol University, Bangkok, Thailand
| | - Yoel Lubell
- University of Oxford, Oxford, UK
- Mahidol University, Bangkok, Thailand
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Suwantika AA, Beutels P, Postma MJ. Cost-effectiveness of hepatitis A vaccination in Indonesia. Hum Vaccin Immunother 2015; 10:2342-9. [PMID: 25424941 DOI: 10.4161/hv.29353] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE This study aims to assess the cost-effectiveness of hepatitis A immunization in Indonesia, including an explicit comparison between one-dose and two-dose vaccines. METHODS An age-structured cohort model based on a decision tree was developed for the 2012 Indonesia birth cohort. Using the model, we made a comparison on the use of two-dose and one-dose vaccines. The model involved a 70-year time horizon with 1-month cycles for children less than 2 years old and annually thereafter. Monte Carlo simulations were used to examine the economic acceptability and affordability of the hepatitis A vaccination. RESULTS Vaccination would save US$ 3,795,148 and US$ 2,892,920 from the societal perspective, for the two-dose and one-dose vaccine schedules, respectively, in the context of hepatitis A treatment. It also would save 8917 and 6614 discounted quality-adjusted-life-years (QALYs), respectively. With the vaccine price of US$ 3.21 per dose, the implementation of single dose vaccine would yield an incremental cost-effectiveness ratio (ICER) of US$ 4933 per QALY gained versus no vaccination, whereas the two-dose versus one-dose schedule would cost US$ 14 568 per QALY gained. Considering the 2012 gross-domestic-product (GDP) per capita in Indonesia of US$ 3557, the results indicate that hepatitis A vaccination would be a cost-effective intervention, both for the two-dose and one-dose vaccine schedules in isolation, but two-dose vaccination would no longer be cost-effective if one-dose vaccination is a feasible option. Vaccination would be 100% affordable at budgets of US$ 71,408 000 and US$ 37,690,000 for the implementation of the two-dose and one-dose vaccine schedules, respectively. CONCLUSIONS The implementation of hepatitis A vaccination in Indonesia would be a cost-effective health intervention under the market vaccine price. Given the budget limitations, the use of a one-dose-vaccine schedule would be more realistic to be applied than a two-dose schedule. The vaccine price, mortality rate and discount rate were the most influential parameters impacting the ICERs.
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Affiliation(s)
- Auliya A Suwantika
- a Unit of PharmacoEpidemiology&PharmacoEconomics (PE2); Department of Pharmacy; University of Groningen; Groningen, The Netherlands
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Bilcke J, Chapman R, Atchison C, Cromer D, Johnson H, Willem L, Cox M, Edmunds WJ, Jit M. Quantifying Parameter and Structural Uncertainty of Dynamic Disease Transmission Models Using MCMC: An Application to Rotavirus Vaccination in England and Wales. Med Decis Making 2015; 35:633-47. [PMID: 25623063 DOI: 10.1177/0272989x14566013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 11/23/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Two vaccines (Rotarix and RotaTeq) are highly effective at preventing severe rotavirus disease. Rotavirus vaccination has been introduced in the United Kingdom and other countries partly based on modeling and cost-effectiveness results. However, most of these models fail to account for the uncertainty about several vaccine characteristics and the mechanism of vaccine action. METHODS A deterministic dynamic transmission model of rotavirus vaccination in the United Kingdom was developed. This improves on previous models by 1) allowing for 2 different mechanisms of action for Rotarix and RotaTeq, 2) using clinical trial data to understand these mechanisms, and 3) accounting for uncertainty by using Markov Chain Monte Carlo. RESULTS In the long run, Rotarix and RotaTeq are predicted to reduce the overall rotavirus incidence by 50% (39%-63%) and 44% (30%-62%), respectively but with an increase in incidence in primary school children and adults up to 25 y of age. The vaccines are estimated to give more protection than 1 or 2 natural infections. The duration of protection is highly uncertain but has only impact on the predicted reduction in rotavirus burden for values lower than 10 y. The 2 vaccine mechanism structures fit equally well with the clinical trial data. Long-term postvaccination dynamics cannot be predicted reliably with the data available. CONCLUSION Accounting for the joint uncertainty of several vaccine characteristics resulted in more insight into which of these are crucial for determining the impact of rotavirus vaccination. Data for up to at least 10 y postvaccination and covering older children and adults are crucial to address remaining questions on the impact of widespread rotavirus vaccination.
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Affiliation(s)
- Joke Bilcke
- Centre for Health Economics Research & Modeling of Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium (JB, LW),Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK (JB, HJ, WJE, MJ)
| | - Ruth Chapman
- Modelling and Economics Unit, Public Health England, London, UK (RC, MJ)
| | - Christina Atchison
- Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK (CA)
| | - Deborah Cromer
- Complex Systems in Biology Group, Centre for Vascular Research, UNSW Australia, Sydney, New South Wales, Australia (DC)
| | - Helen Johnson
- Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK (JB, HJ, WJE, MJ)
| | - Lander Willem
- Centre for Health Economics Research & Modeling of Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium (JB, LW),Department of Mathematics and Computer Science, University of Antwerp, Antwerp, Belgium (LW),Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium (LW)
| | - Martin Cox
- Department of Applied Sciences and Health, Coventry University, Coventry, UK (MC)
| | - William John Edmunds
- Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK (JB, HJ, WJE, MJ)
| | - Mark Jit
- Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK (JB, HJ, WJE, MJ),Modelling and Economics Unit, Public Health England, London, UK (RC, MJ)
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Rheingans R, Amaya M, Anderson JD, Chakraborty P, Atem J. Systematic review of the economic value of diarrheal vaccines. Hum Vaccin Immunother 2014; 10:1582-94. [PMID: 24861846 PMCID: PMC5396238 DOI: 10.4161/hv.29352] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 05/24/2014] [Indexed: 01/23/2023] Open
Abstract
Diarrheal disease is a leading cause of child mortality in low-income settings and morbidity across a range of settings. A growing number of studies have addressed the economic value of new and emerging vaccines to reduce this threat. We conducted a systematic review to assess the economic value of diarrheal vaccines targeting a range of pathogens in different settings. The majority of studies focused on the economic value of rotavirus vaccines in different settings, with most of these concluding that vaccination would provide significant economic benefits across a range of vaccine prices. There is also evidence of the economic benefits of cholera vaccines in specific contexts. For other potential diarrheal vaccines data are limited and often hypothetical. Across all target pathogens and contexts, the evidence of economic value focuses the short-term health and economic gains. Additional information is needed on the broader social and long-term economic value of diarrhea vaccines.
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Affiliation(s)
- Richard Rheingans
- Department of Environmental and Global Health; Emerging Pathogens Institute; University of Florida; Gainesville, FL USA
- Department of Health Services Research, Management & Policy; College of Public Health and Health Professions; University of Florida; Gainesville, FL USA
| | - Mirna Amaya
- Department of Health Services Research, Management & Policy; College of Public Health and Health Professions; University of Florida; Gainesville, FL USA
| | - John D Anderson
- Department of Environmental and Global Health; Emerging Pathogens Institute; University of Florida; Gainesville, FL USA
| | - Poulomy Chakraborty
- Department of Environmental and Global Health; Emerging Pathogens Institute; University of Florida; Gainesville, FL USA
| | - Jacob Atem
- Department of Environmental and Global Health; Emerging Pathogens Institute; University of Florida; Gainesville, FL USA
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