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Ota MOC, de Moraes JC, Vojtek I, Constenla D, Doherty TM, Cintra O, Kirigia JM. Unveiling the contributions of immunization for progressing towards Universal Health Coverage. Hum Vaccin Immunother 2022; 18:2036048. [PMID: 35239460 PMCID: PMC9009948 DOI: 10.1080/21645515.2022.2036048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The aim of the United Nations' Sustainable Development Goal (SDG)3 is to ensure healthy lives and promote well-being for all, at all ages; including reducing maternal and child mortality, combating communicable and non-communicable diseases, and achieving Universal Health Coverage (UHC). UHC aims to provide everyone with equal access to quality essential and comprehensive healthcare services including preventions, interventions, and treatments, without exposing them to financial hardship. Making progress toward UHC requires significant investment in technical and financial resources and countries are pursuing the implementation of cost-saving measures within health systems to help them achieve UHC. Whilst many countries are far from attaining UHC, all countries, particularly low- and middle-income countries, can take steps toward achieving UHC. This paper discusses key data showing how immunization is a fundamental, cost-effective tool for reducing morbidity and mortality associated with infectious disease in all populations, creating more productive communities, reducing treatment costs, and consequently, facilitating social and economic advancement. Immunization is key to advancing toward UHC by relieving the burden that diseases place on the healthcare services, freeing essential resources to use elsewhere within the healthcare system. Immunization is an essential, readily available strategy that countries can deploy to achieve UHC and the SDG3 agenda.
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Affiliation(s)
| | - Jose C de Moraes
- Department of Collective Health, Faculty of Medical Sciences of Santa Casa de Sao Paulo, Sao Paulo, Brazil
| | - Ivo Vojtek
- Medical Affairs, GSK, Medical Affairs, Wavre, Belgium
| | - Dagna Constenla
- Medical Affairs, GSK, US Research & Development, Saloui Center, Rockville, MD,USA
| | - T Mark Doherty
- Medical Affairs, GSK, Medical Affairs, Brondfby, Denmark
| | - Otavio Cintra
- Medical Affairs, GSK, Medical Affairs, Rio de Janeiro, Brazil
| | - Joses M Kirigia
- African Sustainable Development Research Consortium (ASDRC), Nairobi, Kenya
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Ekirapa-Kiracho E, De Broucker G, Ssebagereka A, Mutebi A, Apolot RR, Patenaude B, Constenla D. The economic burden of pneumonia in children under five in Uganda. Vaccine X 2021; 8:100095. [PMID: 34036262 PMCID: PMC8135046 DOI: 10.1016/j.jvacx.2021.100095] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/07/2021] [Accepted: 03/29/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There were about 138 million new episodes of pneumonia and 0.9 million deaths globally in 2015. In Uganda, pneumonia was the fourth leading cause of death in children under five years of age in 2017-18. However, the economic burden of pneumonia, particularly for households and caregivers, is poorly documented. AIM To estimate the costs associated with an episode of pneumonia from the household, government, and societal perspectives. METHODS We selected 48 healthcare facilities from the public and private sector across all care levels (primary, secondary, and tertiary), based on the number of pneumonia episodes reported for 2015-16. Adult caregivers of children with pneumonia diagnosis at discharge were selected. Using an ingredient-based approach, we collected cost and utilization data from administrative databases, medical records, and patient caregiver surveys. Household costs included direct medical and non-medical costs, as well as indirect costs estimated through a human capital approach. All costs are presented in 2018 U.S. dollars. RESULTS The treatment of pneumonia puts a substantial economic burden on households. The average societal cost per episode of pneumonia across all sectors and types of visits was $42; hospitalized episodes costed an average of $62 per episode, while episodes only requiring ambulatory care was $16 per episode. Public healthcare facilities covered $12 and $7 on average per hospitalized or ambulatory episode, respectively. Caregivers using the public system faced lower out-of-pocket payments, evaluated at $17, than those who used private for-profit ($21) and not-for-profit ($50) for hospitalized care. For ambulatory care, out-of-pocket payments amounted to $8, $18, and $9 for public, private for-profit, and not-for-profit healthcare facilities, respectively. About 39% of households experienced catastrophic health expenditures due to out-of-pocket payments related to the treatment of pneumonia.
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Affiliation(s)
| | - Gatien De Broucker
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, United States
| | | | | | | | - Bryan Patenaude
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, United States
| | - Dagna Constenla
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, United States
- GlaxoSmithKline Plc., Panama City, Panama
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3
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Guzman-Holst A, Ortega-Barria E, Flores ÁA, Carreño-Manjarrez R, Constenla D, Cervantes-Apolinar MY. 15-year experience with rotavirus vaccination in Mexico: a systematic literature review. Hum Vaccin Immunother 2021; 17:3623-3637. [PMID: 34187326 PMCID: PMC8437458 DOI: 10.1080/21645515.2021.1936859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A systematic review was conducted in Mexico to consolidate and evaluate evidence after 15 years of rotavirus vaccination, according to the National Immunization Program. Five databases were screened to identify published articles (January 2000-February 2020) with evidence on all clinical and epidemiological endpoints (e.g. immunogenicity, safety, efficacy, impact/effectiveness) of rotavirus vaccination in Mexico. Twenty-two articles were identified (observational studies including health-economic models: 17; randomized controlled trials: 5). Fourteen studies evaluated a human attenuated vaccine (HRV), four studies evaluated both vaccines, and only two evaluated a bovine-human reassortant vaccine, with local efficacy data only for HRV. Local evidence shows vaccines are safe, immunogenic, efficacious, and provide an acceptable risk-benefit profile. The benefits of both vaccines in alleviating the burden of all-cause diarrhea mortality and morbidity are documented in several local post-licensure studies. Findings signify overall benefits of rotavirus vaccination and support the continued use of rotavirus vaccine in Mexico.
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Odihi D, De Broucker G, Hasan Z, Ahmed S, Constenla D, Uddin J, Patenaude B. Contingent Valuation: A Pilot Study for Eliciting Willingness to Pay for a Reduction in Mortality From Vaccine-Preventable Illnesses for Children and Adults in Bangladesh. Value Health Reg Issues 2021; 24:67-76. [PMID: 33508753 PMCID: PMC8163603 DOI: 10.1016/j.vhri.2020.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 09/21/2020] [Accepted: 10/28/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The contingent valuation (CV) method elicits willingness to pay (WTP) for calculating the value of statistical life (VSL). CV approaches for assessing VSL are uncommon in many low and middle-income countries (LMICs). Between 2008 and 2018 only 44 articles utilized WTP in a health-related field and of these only 5 (11%) utilized CV to assess the WTP for a mortality risk reduction. We elicit WTP estimates and compute VSL using the CV method in Bangladesh. METHODS The pilot study was primarily aimed at developing best practice guidelines for CV studies in LMICs to get more robust WTP estimates. To this end, we explored three methodological a) Varying the name of the intervention, keeping all other characteristics constant; b) varying the effectiveness of the health intervention and c) offering an overnight period to think about the WTP scenario. The survey was administered 413 randomly selected participants. VSL was for a 1/3000 mortality risk reduction. RESULTS We had more males (54%) than females (46%) and the mean annual self-reported income was $5,683.36. Mean VSL is $11,339.70 with a median of $10,413. The ratio of child: adult WTP is approximately 1 by both gender and age category. The vaccine intervention had the largest amount of $0 WTP and protest responses (52% and 58% respectively). 93% of the participants were able to describe (teach-back) the vaccine effectiveness using their own family as an example. CONCLUSION Our study provides empirical evidence on how to better generate CV surveys to produce more robust WTP estimates.
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Affiliation(s)
- Deborah Odihi
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Department of Internaional Health, Baltimore, MD, USA.
| | - Gatien De Broucker
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Department of Internaional Health, Baltimore, MD, USA
| | - Zahid Hasan
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sayem Ahmed
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Dagna Constenla
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Department of Internaional Health, Baltimore, MD, USA; GlaxoSmithKline Panama City, Panama
| | - Jasim Uddin
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Bryan Patenaude
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Department of Internaional Health, Baltimore, MD, USA
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Hasan MZ, Mehdi GG, De Broucker G, Ahmed S, Ali MW, Martin Del Campo J, Constenla D, Patenaude B, Uddin MJ. The economic burden of diarrhea in children under 5 years in Bangladesh. Int J Infect Dis 2021; 107:37-46. [PMID: 33864914 PMCID: PMC8208894 DOI: 10.1016/j.ijid.2021.04.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Diarrhea is a leading cause of morbidity and mortality among under-five children in Bangladesh. Hospitalization for diarrhea can pose a significant burden on households and health systems. The aim of this study was to estimate the cost of illness due to diarrhea from the healthcare facility, caregiver, and societal perspectives in Bangladesh. METHOD A cross-sectional study with an ingredient-based costing approach was conducted in 48 healthcare facilities in Bangladesh. In total, 899 caregivers of under-five children with diarrhea were interviewed face-to-face between August 2017 and May 2018, followed up over phone after 7-14 days of discharge, to capture all expenses and time costs related to the entire episode of diarrhea. RESULTS The average cost per episode for caregivers was US$62, with $29 direct and $34 indirect costs. From the societal perspective, average cost per episode of diarrhea was $71. In 2018, an estimated $79 million of economic costs were incurred for treating diarrhea in Bangladesh. Using 10% of income as threshold, over 46% of interviewed households faced catastrophic expenditure from diarrheal disease. CONCLUSION The economic costs incurred by caregivers for treating per-episode of diarrhea was around 4% of the annual national gross domestic product per-capita. Investment in vaccination can help to reduce the prevalence of diarrheal diseases and avert this public health burden.
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Affiliation(s)
- Md Zahid Hasan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b).
| | - Gazi Golam Mehdi
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Gatien De Broucker
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Sayem Ahmed
- Mathematical Modelling Group, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom; Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Md Wazed Ali
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Jorge Martin Del Campo
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Dagna Constenla
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; GlaxoSmithKline Plc., Panama City, Panama
| | - Bryan Patenaude
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Md Jasim Uddin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
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Sim SY, Watts E, Constenla D, Huang S, Brenzel L, Patenaude BN. Costs of Immunization Programs for 10 Vaccines in 94 Low- and Middle-Income Countries From 2011 to 2030. Value Health 2021; 24:70-77. [PMID: 33431156 PMCID: PMC7813215 DOI: 10.1016/j.jval.2020.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 05/22/2023]
Abstract
OBJECTIVES Understanding the level of investment needed for the 2021-2030 decade is important as the global community faces the next strategic period for vaccines and immunization programs. To assist with this goal, we estimated the aggregate costs of immunization programs for ten vaccines in 94 low- and middle-income countries from 2011 to 2030. METHOD We calculated vaccine, immunization delivery and stockpile costs for 94 low- and middle-income countries leveraging the latest available data sources. We conducted scenario analyses to vary assumptions about the relationship between delivery cost and coverage as well as vaccine prices for fully self-financing countries. RESULTS The total aggregate cost of immunization programs in 94 countries for 10 vaccines from 2011 to 2030 is $70.8 billion (confidence interval: $56.6-$93.3) under the base case scenario and $84.1 billion ($72.8-$102.7) under an incremental delivery cost scenario, with an increasing trend over two decades. The relative proportion of vaccine and delivery costs for pneumococcal conjugate, human papillomavirus, and rotavirus vaccines increase as more countries introduce these vaccines. Nine countries in accelerated transition phase bear the highest burden of the costs in the next decade, and uncertainty with vaccine prices for the 17 fully self-financing countries could lead to total costs that are 1.3-13.1 times higher than the base case scenario. CONCLUSION Resource mobilization efforts at the global and country levels will be needed to reach the level of investment needed for the coming decade. Global-level initiatives and targeted strategies for transitioning countries will help ensure the sustainability of immunization programs.
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Affiliation(s)
- So Yoon Sim
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Elizabeth Watts
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dagna Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; GlaxoSmithKline Plc., Panama City, Panama
| | - Shuoning Huang
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Bryan N Patenaude
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Watts E, Sim SY, Constenla D, Sriudomporn S, Brenzel L, Patenaude B. Economic Benefits of Immunization for 10 Pathogens in 94 Low- and Middle-Income Countries From 2011 to 2030 Using Cost-of-Illness and Value-of-Statistical-Life Approaches. Value Health 2021; 24:78-85. [PMID: 33431157 DOI: 10.1016/j.jval.2020.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/23/2020] [Accepted: 07/12/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Vaccination has prevented millions of deaths and cases of disease in low- and middle-income countries (LMICs). During the Decade of Vaccines (2011-2020), international organizations, including the World Health Organization and Gavi, the Vaccine Alliance, focused on new vaccine introduction and expanded coverage of existing vaccines. As Gavi, other organizations, and country governments look to the future, we aimed to estimate the economic benefits of immunization programs made from 2011 to 2020 and potential gains in the future decade. METHODS We used estimates of cases and deaths averted by vaccines against 10 pathogens in 94 LMICs to estimate the economic value of immunization. We applied 3 approaches-cost of illness averted (COI), value of statistical life (VSL), and value of statistical life-year (VSLY)-to estimate observable and unobservable economic benefits between 2011 and 2030. RESULTS From 2011 to 2030, immunization would avert $1510.4 billion ($674.3-$2643.2 billion) (2018 USD) in costs of illness in the 94 modeled countries, compared with the counterfactual of no vaccination. Using the VSL approach, immunization would generate $3436.7 billion ($1615.8-$5657.2 billion) in benefits. Applying the VSLY approach, $5662.7 billion ($2547.2-$9719.4) in benefits would be generated. CONCLUSION Vaccination has generated significant economic benefits in LMICs in the past decade. To reach predicted levels of economic benefits, countries and international donor organizations need to meet coverage projections outlined in the Gavi Operational Forecast. Estimates generated using the COI, VSL, or VSLY approach may be strategically used by donor agencies, decision makers, and advocates to inform investment cases and advocacy campaigns.
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Affiliation(s)
- Elizabeth Watts
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - So Yoon Sim
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneve, GE, CH
| | | | - Salin Sriudomporn
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Bryan Patenaude
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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De Broucker G, Ssebagereka A, Apolot RR, Aloysius M, Ekirapa Kiracho E, Patenaude B, Constenla D. The economic burden of measles in children under five in Uganda. Vaccine X 2020; 6:100077. [PMID: 33073228 PMCID: PMC7548439 DOI: 10.1016/j.jvacx.2020.100077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 11/24/2022] Open
Abstract
Measles costed over $135,627 in societal costs for 2018, incl. $59,357 to households. Ugandan caregivers faced $44 in economic costs incl. $23 in out-of-pocket payments. Measles deepens the inequalities in access to healthcare in the population.
Background There is very limited evidence about the economic cost of measles in low-income countries. We estimated the cost of treating measles in Uganda from a societal perspective. Methods We conducted an incidence-based cost-of-illness study in Uganda. We surveyed the facility staff, recording hospital-related expenditures for measles patients. We interviewed caregivers of children with measles at 48 selected healthcare facilities. We conducted phone interviews with caregivers 7–14 days post-discharge to capture additional out-of-pocket expenses and time costs. Results From a societal perspective, a hospitalized and an ambulatory episode of measles cost 2018 US$ 60 and $15, respectively. The government spent on average $12 and $5 per hospitalized and ambulatory episode of measles. Including both public and private facilities, caregivers incurred approximately $44 in economic costs, including $23 in out-of-pocket expenses. In 2018, 2614 cases of measles were confirmed, resulting in $135,627 in societal costs, including $59,357 in economic costs to Ugandan households. Conclusion This cost-of-illness study is the first to use empirical methods to quantify the economic burden of measles in a low-income country. Information related to the cost of treating measles is important for guiding decisions related to changes in measles control and prevention.
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Affiliation(s)
- Gatien De Broucker
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, United States
| | | | | | | | | | - Bryan Patenaude
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, United States
| | - Dagna Constenla
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, United States.,GlaxoSmithKline Plc., Panama City, Panama
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Gomez J, Moreno LE, Constenla D, Caceres D, Rodriguez E. Budget impact analysis of pneumococcal conjugate vaccines in Colombia. Expert Rev Pharmacoecon Outcomes Res 2020; 21:255-263. [PMID: 33249948 DOI: 10.1080/14737167.2021.1855978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Pneumococcal diseases including invasive pneumococcal disease (IPD), pneumonia, and acute otitis media (AOM) impose a substantial public health burden. This study performed a budget impact analysis of the use of pneumococcal conjugate vaccines (PCVs) in the National Immunization Program (NIP) in Colombia.Methods: We compared the direct medical cost of the scenario without and with PCV vaccination using either pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) or 13-valent pneumococcal conjugate vaccine (PCV-13) over 5 years (2020-2024) from the health-care system perspective. Vaccine efficacy estimates were obtained from published sources and vaccine prices were taken from the Pan-American Health Organization Revolving Fund. Vaccine coverage was assumed to be 90% based on Colombia data.Results: Using PHiD-CV in the NIP in Colombia would reduce the estimated cost for treating pneumococcal disease by US$46.1 m over the 2020-2024 period (US$40.2 m using PCV-13), with a budget impact of US$100.1 m for PHiD-CV (US$121.4 m for PCV-13), and would cost US$3.1 m less per year on vaccine doses than using PCV-13.Conclusion: These findings are potentially valuable for the selection of vaccines for their national immunization programs under conditions of budgetary constraint.
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Affiliation(s)
- Jorge Gomez
- GSK Vaccines, Health Outcomes, Buenos Aires, Argentina
| | | | | | - Diana Caceres
- GSK Vaccines, Medical Affair & Patient Access, Bogota, Colombia
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de Broucker G, Ahmed S, Hasan MZ, Mehdi GG, Martin Del Campo J, Ali MW, Uddin MJ, Constenla D, Patenaude B. The economic burden of measles in children under five in Bangladesh. BMC Health Serv Res 2020; 20:1026. [PMID: 33172442 PMCID: PMC7653835 DOI: 10.1186/s12913-020-05880-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/30/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This study estimated the economic cost of treating measles in children under-5 in Bangladesh from the caregiver, government, and societal perspectives. METHOD We conducted an incidence-based study using an ingredient-based approach. We surveyed the administrative staff and the healthcare professionals at the facilities, recording their estimates supported by administrative data from the healthcare perspective. We conducted 100 face-to-face caregiver interviews at discharge and phone interviews 7 to 14 days post-discharge to capture all expenses, including time costs related to measles. All costs are in 2018 USD ($). RESULTS From a societal perspective, a hospitalized and ambulatory case of measles cost $159 and $18, respectively. On average, the government spent $22 per hospitalized case of measles. At the same time, caregivers incurred $131 and $182 in economic costs, including $48 and $83 in out-of-pocket expenses in public and private not-for-profit facilities, respectively. Seventy-eight percent of the poorest caregivers faced catastrophic health expenditures compared to 21% of the richest. In 2018, 2263 cases of measles were confirmed, totaling $348,073 in economic costs to Bangladeshi society, with $121,842 in out-of-pocket payments for households. CONCLUSION The resurgence of measles outbreaks is a substantial cost for society, requiring significant short-term public expenditures, putting households into a precarious financial situation. Improving vaccination coverage in areas where it is deficient (Sylhet division in our study) would likely alleviate most of this burden.
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Affiliation(s)
- Gatien de Broucker
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, #530, Baltimore, MD, 21231, USA.
| | - Sayem Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Liverpool School of Tropical Disease (LSTM), Liverpool, UK
| | - Md Zahid Hasan
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Gazi Golam Mehdi
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Jorge Martin Del Campo
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, #530, Baltimore, MD, 21231, USA
| | - Md Wazed Ali
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Md Jasim Uddin
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Dagna Constenla
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, #530, Baltimore, MD, 21231, USA
- GlaxoSmithKline Plc, Panama City, Panama
| | - Bryan Patenaude
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, #530, Baltimore, MD, 21231, USA
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Sim SY, Watts E, Constenla D, Brenzel L, Patenaude BN. Return On Investment From Immunization Against 10 Pathogens In 94 Low- And Middle-Income Countries, 2011–30. Health Aff (Millwood) 2020; 39:1343-1353. [DOI: 10.1377/hlthaff.2020.00103] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- So Yoon Sim
- So Yoon Sim is a technical officer in the Department of Immunization, Vaccines, and Biologicals at the World Health Organization, in Geneva, Switzerland. She was a health economist and research associate in the Department of International Health, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland, when this work was performed. Sim and Elizabeth Watts share credit as co–first authors
| | - Elizabeth Watts
- Elizabeth Watts is a health economist and research associate in the Department of International Health and in the International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health. Watts and So Yoon Sim share credit as co–first authors
| | - Dagna Constenla
- Dagna Constenla is the director of Epidemiology and Health Outcomes at GSK Vaccines, Latin America and the Caribbean, in Panama City, Panama. She was an associate scientist in the Department of International Health, Johns Hopkins Bloomberg School of Public Health, when this work was performed
| | - Logan Brenzel
- Logan Brenzel is a senior program officer for economics and finance, Vaccine Delivery/Global Development, Bill & Melinda Gates Foundation, in Washington, D.C
| | - Bryan N. Patenaude
- Bryan N. Patenaude is an assistant professor in the Department of International Health, Johns Hopkins Bloomberg School of Public Health
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Debellut F, Hendrix N, Pitzer VE, Neuzil KM, Constenla D, Bar-Zeev N, Marfin A, Pecenka C. Forecasting Demand for the Typhoid Conjugate Vaccine in Low- and Middle-income Countries. Clin Infect Dis 2020; 68:S154-S160. [PMID: 30845321 PMCID: PMC6405267 DOI: 10.1093/cid/ciy1076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) released a position paper in March 2018 calling for integration of a novel typhoid conjugate vaccine (TCV) into routine immunization along with catch-up campaigns for children up to age 15. Gavi, the Vaccine Alliance, has committed funding to help resource-constrained countries introduce this vaccine. In this article, the Typhoid Vaccine Acceleration Consortium forecasts demand if WHO recommendations are followed. METHODS We built a model of global TCV introductions between 2020 and 2040 to estimate the demand of the vaccine for 133 countries. We estimated each country's year of introduction by examining its estimated incidence of typhoid fever, its history of introducing new vaccines, and any knowledge we have of its engagement with typhoid prevention, including intention to apply for Gavi funding. Our model predicted use in routine infant vaccination as well as campaigns targeting varying proportions of the unvaccinated population up to 15 years of age. RESULTS Between 2020 and 2025, demand will predominantly come from African countries, many receiving Gavi support. After that, Asian countries generate most demand until 2030, when campaigns are estimated to end. Demand will then track the birth cohort of participating countries, suggesting an annual routine demand between 90 and 100 million doses. Peak demand is likely to occur between 2023 and 2026, approaching 300 million annual doses if campaign implementation is high. CONCLUSIONS In our analysis, target population for catch-up campaigns is the main driver of uncertainty. At peak demand, there is some risk of exceeding presently estimated peak production capacity. Therefore, it will be important to carefully coordinate introductions, especially when accompanied by campaigns targeting large proportions of the eligible population.
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Affiliation(s)
| | - Nathaniel Hendrix
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health at the University of Maryland School of Medicine, Baltimore, MD
| | - Dagna Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Naor Bar-Zeev
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Anthony Marfin
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington
| | - Clint Pecenka
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington
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Abstract
Typhoid places a substantial economic burden on low- and middle-income countries. We performed a literature review and critical overview of typhoid-related economic issues to inform vaccine introduction. We searched 4 literature databases, covering 2000–2017, to identify typhoid-related cost-of-illness (COI) studies, cost-of-delivery studies, cost-effectiveness analyses (CEAs), and demand forecast studies. Manual bibliographic searches of reviews revealed studies in the gray literature. Planned studies were identified in conference proceedings and through partner organization outreach. We identified 29 published, unpublished, and planned studies. Published COI studies revealed a substantial burden in Asia, with hospitalization costs alone ranging from $159 to $636 (in 2016 US$) in India, but there was less evidence for the burden in Africa. Cost-of-delivery studies are largely unpublished, but 1 study found that $671 000 in government investments would avert $60 000 in public treatment costs. CEA evidence was limited, but generally found targeted vaccination programs to be cost-effective. This review revealed insufficient economic evidence for vaccine introduction. Countries considering vaccine introduction should have access to relevant economic evidence to aid in decision-making and planning. Planned studies will fill many of the existing gaps in the literature.
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Affiliation(s)
- K Luthra
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - E Watts
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - F Debellut
- Center for Vaccine Innovation and Access, PATH, Geneva, Switzerland
| | - C Pecenka
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington
| | - N Bar-Zeev
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - D Constenla
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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14
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Thompson R, Martin Del Campo J, Constenla D. A review of the economic evidence of Aedes-borne arboviruses and Aedes-borne arboviral disease prevention and control strategies. Expert Rev Vaccines 2020; 19:143-162. [PMID: 32077343 DOI: 10.1080/14760584.2020.1733419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Aedes-borne arboviruses contributes substantially to the disease and cost burden.Areas covered: We performed a systematic review of the economic evidence surrounding aedes-borne arboviruses and strategies to prevent and control these diseases to inform disease control policy decisions and research directions. We searched four databases covering an 18-year period (2000-2018) to identify arboviral disease-related cost of illness studies, cost studies of vector control and prevention strategies, cost-effectiveness analyses and cost-benefit analyses. We identified 74 published studies that revealed substantial global total costs in yellow fever virus and dengue virus ranging from 2.1 to 57.3 billion USD. Cost studies of vector control and surveillance programs are limited, but a few studies found that costs of vector control programs ranged from 5.62 to 73.5 million USD. Cost-effectiveness evidence was limited across Aedes-borne diseases, but generally found targeted dengue vaccination programs cost-effective. This review revealed insufficient economic evidence for vaccine introduction and implementation of surveillance and vector control programs.Expert opinion: Evidence of the economic burden of aedes-borne arboviruses and the economic impact of strategies for arboviral disease prevention and control is critical to inform policy decisions and to secure continued financial support for these preventive and control measures.
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Affiliation(s)
- Ryan Thompson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health (JHBSPH), International Vaccine Access Center (IVAC), Baltimore, MD, USA
| | | | - Dagna Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health (JHBSPH), International Vaccine Access Center (IVAC), Baltimore, MD, USA
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15
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Sim SY, Jit M, Constenla D, Peters DH, Hutubessy RCW. A Scoping Review of Investment Cases for Vaccines and Immunization Programs. Value Health 2019; 22:942-952. [PMID: 31426936 DOI: 10.1016/j.jval.2019.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 03/27/2019] [Accepted: 04/01/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Many investment cases have recently been published intending to show the value of new health investments, but without consistent methodological approaches. OBJECTIVES To conduct a scoping review of existing investment cases (using vaccines and immunization programs as an example), identify common characteristics that define these investment cases, and examine their role within the broader context of the vaccine development and introduction. METHODS A systematic search was conducted from January 1980 to November 2017 to identify investment cases in the area of vaccines and immunization programs from gray literature and electronic bibliographic databases. Investment case outcomes, objectives, key variables, target audiences, and funding sources were extracted and analyzed according to their reporting frequency. RESULTS We found 24 investment cases, and most of them aim to provide information for decisions (12 cases) or advocate for a specific agenda (9 cases). Outcomes presented fell into 4 broad categories-burden of disease, cost of investment, impact of investment, and other considerations for implementation. Number of deaths averted (70%), incremental cost-effectiveness ratios (67%), and reduction in health and socioeconomic inequalities (54%) were the most frequently reported outcome measures for impact of investment. Health system capacity (79%) and vaccine financing landscape (75%) were the most common considerations for implementation. A sizable proportion (41.4%) of investment cases did not reveal their funding sources. CONCLUSIONS This review describes information that is critical to decision making about resource mobilization and allocation concerning vaccines. Global efforts to harmonize investment cases more broadly will increase transparency and comparability.
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Affiliation(s)
- So Yoon Sim
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mark Jit
- London School of Hygiene & Tropical Medicine, London, UK; Modelling and Economics Unit, Public Health England, London, UK
| | - Dagna Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David H Peters
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Raymond C W Hutubessy
- Initiative for Vaccine Research, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland.
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16
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Popovich C, Pistonesi M, Hegel P, Constenla D, Bielsa GB, Martín L, Damiani M, Leonardi P. Unconventional alternative biofuels: Quality assessment of biodiesel and its blends from marine diatom Navicula cincta. ALGAL RES 2019. [DOI: 10.1016/j.algal.2019.101438] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Riumallo-Herl C, Chang AY, Clark S, Constenla D, Clark A, Brenzel L, Verguet S. Poverty reduction and equity benefits of introducing or scaling up measles, rotavirus and pneumococcal vaccines in low-income and middle-income countries: a modelling study. BMJ Glob Health 2018; 3:e000613. [PMID: 29662691 PMCID: PMC5898318 DOI: 10.1136/bmjgh-2017-000613] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 02/19/2018] [Accepted: 02/24/2018] [Indexed: 12/22/2022] Open
Abstract
Introduction Beyond their impact on health, vaccines can lead to large economic benefits. While most economic evaluations of vaccines have focused on the health impact of vaccines at a national scale, it is critical to understand how their impact is distributed along population subgroups. Methods We build a financial risk protection model to evaluate the impact of immunisation against measles, severe pneumococcal disease and severe rotavirus for birth cohorts vaccinated over 2016-2030 for three scenarios in 41 Gavi-eligible countries: no immunisation, current immunisation coverage forecasts and the current immunisation coverage enhanced with funding support. We distribute modelled disease cases per socioeconomic group and derive the number of cases of: (1) catastrophic health costs (CHCs) and (2) medical impoverishment. Results In the absence of any vaccine coverage, the number of CHC cases attributable to measles, severe pneumococcal disease and severe rotavirus would be approximately 18.9 million, 6.6 million and 2.2 million, respectively. Expanding vaccine coverage would reduce this number by up to 90%, 30% and 40% in each case. More importantly, we find a higher share of CHC incidence among the poorest quintiles who consequently benefit more from vaccine expansion. Conclusion Our findings contribute to the understanding of how vaccines can have a broad economic impact. In particular, we find that immunisation programmes can reduce the proportion of households facing catastrophic payments from out-of-pocket health expenses, mainly in lower socioeconomic groups. Thus, vaccines could have an important role in poverty reduction.
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Affiliation(s)
- Carlos Riumallo-Herl
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.,Department of Applied Economics, Erasmus School of Economics, Erasmus University of Rotterdam, Rotterdam, The Netherlands
| | - Angela Y Chang
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Samantha Clark
- Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, Washington, USA
| | - Dagna Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew Clark
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Logan Brenzel
- Bill and Melinda Gates Foundation, Washington DC, USA
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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18
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Chang AY, Riumallo-Herl C, Perales NA, Clark S, Clark A, Constenla D, Garske T, Jackson ML, Jean K, Jit M, Jones EO, Li X, Suraratdecha C, Bullock O, Johnson H, Brenzel L, Verguet S. The Equity Impact Vaccines May Have On Averting Deaths And Medical Impoverishment In Developing Countries. Health Aff (Millwood) 2018; 37:316-324. [PMID: 29401021 DOI: 10.1377/hlthaff.2017.0861] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
With social policies increasingly directed toward enhancing equity through health programs, it is important that methods for estimating the health and economic benefits of these programs by subpopulation be developed, to assess both equity concerns and the programs' total impact. We estimated the differential health impact (measured as the number of deaths averted) and household economic impact (measured as the number of cases of medical impoverishment averted) of ten antigens and their corresponding vaccines across income quintiles for forty-one low- and middle-income countries. Our analysis indicated that benefits across these vaccines would accrue predominantly in the lowest income quintiles. Policy makers should be informed about the large health and economic distributional impact that vaccines could have, and they should view vaccination policies as potentially important channels for improving health equity. Our results provide insight into the distribution of vaccine-preventable diseases and the health benefits associated with their prevention.
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Affiliation(s)
- Angela Y Chang
- Angela Y. Chang ( ) was a doctor of science candidate in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, in Boston, Massachusetts, at the time this article was completed. Currently she is a postdoctoral fellow at the Institute for Health Metrics and Evaluation, University of Washington, in Seattle
| | - Carlos Riumallo-Herl
- Carlos Riumallo-Herl was a doctor of science candidate in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, at the time this article was completed. Currently he is a postdoctoral fellow in the Department of Applied Economics, Erasmus School of Economics, in Rotterdam, the Netherlands
| | - Nicole A Perales
- Nicole A. Perales was a master of science student in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, at the time this article was completed. Currently she is a doctoral student at the University of California, Berkeley
| | - Samantha Clark
- Samantha Clark is a PhD candidate in the Pharmaceutical Outcomes Research and Policy Program, University of Washington
| | - Andrew Clark
- Andrew Clark is an assistant professor in health decision modelling, London School of Hygiene and Tropical Medicine, in the United Kingdom
| | - Dagna Constenla
- Dagna Constenla is an associate scientist and the director of Economics and Finance in the Vaccine Access Center of the Department of International Health, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Tini Garske
- Tini Garske is a lecturer in the MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, in the United Kingdom
| | - Michael L Jackson
- Michael L. Jackson is an associate investigator at the Kaiser Permanente Washington Health Research Institute, in Seattle
| | - Kévin Jean
- Kévin Jean is a lecturer in epidemiology in the laboratoire Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des Arts et Métiers, in Paris, France, and a visiting lecturer in the MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London
| | - Mark Jit
- Mark Jit is a professor of vaccine epidemiology in the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine
| | - Edward O Jones
- Edward O. Jones was a researcher in the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, when this article was completed
| | - Xi Li
- Xi Li is an independent health consultant in Manila, the Philippines
| | | | - Olivia Bullock
- Olivia Bullock is a program officer at Gavi, the Vaccine Alliance, in Geneva, Switzerland
| | - Hope Johnson
- Hope Johnson is director of monitoring and evaluation at Gavi, the Vaccine Alliance
| | - Logan Brenzel
- Logan Brenzel is a senior program officer for economics and finance, Vaccine Delivery/Global Development, Bill & Melinda Gates Foundation, in Washington, D.C
| | - Stéphane Verguet
- Stéphane Verguet is an assistant professor of global health in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health
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19
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Paternina-Caicedo A, De la Hoz-Restrepo F, Díaz-Quijano F, Caicedo-Torres W, Auxiliadora Badillo-Viloria M, Bula-Anichiarico D, Alvis-Guzmán N, Mattar S, Constenla D, Pinzón-Redondo H. Features of Dengue and Chikungunya Infections of Colombian Children under 24 Months of Age Admitted to the Emergency Department. J Trop Pediatr 2018; 64:31-37. [PMID: 28444295 DOI: 10.1093/tropej/fmx024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We aimed to assess clinical and laboratory differences between dengue and chikungunya in children <24 months of age in a comparative study. We collected retrospective clinical and laboratory data confirmed by NS1/IgM for dengue for 19 months (1 January 2013 to 17 August 2014). Prospective data for chikungunya confirmed by real-time polymerase chain reaction were collected for 4 months (22 September 2014-14 December 2014). Sensitivity and specificity [with 95% confidence interval (CI)] were reported for each disease diagnosis. A platelet count <150 000 cells/ml at emergency admission best characterized dengue, with a sensitivity of 67% (95% CI, 53-79) and specificity of 95% (95% CI, 82-99). The algorithm developed with classification and regression tree analysis showed a sensitivity of 93% (95% CI, 68-100) and specificity of 38% (95% CI, 9-76) to diagnose dengue. Our study provides potential differential characteristics between chikungunya and dengue in young children, especially low platelet counts.
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Affiliation(s)
- Angel Paternina-Caicedo
- Departamento de Epidemiologia, Hospital Infantil Napoleón Franco Pareja-La Casa del Niño, Cartagena, Colombia
| | | | - Fredi Díaz-Quijano
- Departamento de Epidemiologia, Faculdade de Saúde Publica, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Doris Bula-Anichiarico
- Departamento de Epidemiologia, Hospital Infantil Napoleón Franco Pareja-La Casa del Niño, Cartagena, Colombia
| | - Nelson Alvis-Guzmán
- Departamento de Epidemiologia, Hospital Infantil Napoleón Franco Pareja-La Casa del Niño, Cartagena, Colombia.,Facultad de Medicina, Universidad de Cartagena, Cartagena, Colombia
| | - Salim Mattar
- Instituto de Investigaciones Biologicas del Tropico, Universidad de Córdoba, Montería, Colombia
| | - Dagna Constenla
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Hernando Pinzón-Redondo
- Departamento de Epidemiologia, Hospital Infantil Napoleón Franco Pareja-La Casa del Niño, Cartagena, Colombia.,Facultad de Medicina, Universidad de Cartagena, Cartagena, Colombia
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20
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Cohen A, Kulikowski CA, Elbert T, Clark S, Constenla D, Sinha A. Decision-Tree Model for Support of Health Policy Choices Based on Pneumococcal Conjugate Vaccine (PCV) Program Outcomes. Stud Health Technol Inform 2017; 245:40-44. [PMID: 29295048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pneumococcal Conjugate Vaccine (PCV) has the potential to save lives in low-income countries. We have developed a computational model and web-based decision support software for comparing cost-benefit tradeoffs from alternative PCV program designs, considering their direct and indirect effects on early childhood populations in resource-poor settings. This supports policy-makers in estimating potential health outcomes and cost-effectiveness of different vaccination program strategies for a wide range of population coverage and vaccine effectiveness assumptions.
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Affiliation(s)
- Andre Cohen
- Department of Computer Science, Rutgers-The State University of New Jersey, Piscataway, New Jersey, USA
| | - Casimir A Kulikowski
- Department of Computer Science, Rutgers-The State University of New Jersey, Piscataway, New Jersey, USA
| | - Timothy Elbert
- Department of Computer Science, Rutgers-The State University of New Jersey, Piscataway, New Jersey, USA
| | - Samantha Clark
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dagna Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anushua Sinha
- Merck Research Laboratories, Rahway, New Jersey, USA
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21
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Haidari LA, Brown ST, Constenla D, Zenkov E, Ferguson M, de Broucker G, Ozawa S, Clark S, Lee BY. The economic value of increasing geospatial access to tetanus toxoid immunization in Mozambique. Vaccine 2016; 34:4161-4165. [PMID: 27372153 DOI: 10.1016/j.vaccine.2016.06.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/20/2016] [Accepted: 06/21/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND With tetanus being a leading cause of maternal and neonatal morbidity and mortality in low and middle income countries, ensuring that pregnant women have geographic access to tetanus toxoid (TT) immunization can be important. However, immunization locations in many systems may not be placed to optimize access across the population. Issues of access must be addressed for vaccines such as TT to reach their full potential. METHODS To assess how TT immunization locations meet population demand in Mozambique, our team developed and utilized SIGMA (Strategic Integrated Geo-temporal Mapping Application) to quantify how many pregnant women are reachable by existing TT immunization locations, how many cannot access these locations, and the potential costs and disease burden of not covering geographically harder-to-reach populations. Sensitivity analyses covered a range of catchment area sizes to include realistic travel distances and to determine the area some locations would need to cover in order for the existing system to reach at least 99% of the target population. RESULTS For 99% of the population to reach health centers, people would be required to travel up to 35km. Limiting this distance to 15km would result in 5450 (3033-7108) annual cases of neonatal tetanus that could be prevented by TT, 144,240 (79,878-192,866) DALYs, and $110,691,979 ($56,180,326-$159,516,629) in treatment costs and productivity losses. A catchment area radius of 5km would lead to 17,841 (9929-23,271) annual cases of neonatal tetanus that could be prevented by TT, resulting in 472,234 (261,517-631,432) DALYs and $362,399,320 ($183,931,229-$522,248,480) in treatment costs and productivity losses. CONCLUSION TT immunization locations are not geographically accessible by a significant proportion of pregnant women, resulting in substantial healthcare and productivity costs that could potentially be averted by adding or reconfiguring TT immunization locations. The resulting cost savings of covering these harder to reach populations could help pay for establishing additional immunization locations.
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Affiliation(s)
- Leila A Haidari
- Pittsburgh Supercomputing Center (PSC), Carnegie Mellon University, Pittsburgh, PA, United States
| | - Shawn T Brown
- Pittsburgh Supercomputing Center (PSC), Carnegie Mellon University, Pittsburgh, PA, United States
| | - Dagna Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Eli Zenkov
- Pittsburgh Supercomputing Center (PSC), Carnegie Mellon University, Pittsburgh, PA, United States
| | - Marie Ferguson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Gatien de Broucker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Sachiko Ozawa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Samantha Clark
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Bruce Y Lee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
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23
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Constenla D, Carvalho A, Alvis Guzmán N. Economic Impact of Meningococcal Outbreaks in Brazil and Colombia. Open Forum Infect Dis 2015; 2:ofv167. [PMID: 26688825 PMCID: PMC4682177 DOI: 10.1093/ofid/ofv167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/03/2015] [Indexed: 11/21/2022] Open
Abstract
Costs of meningococcal outbreaks comprising costs incurred during the disease response phase and the disease surveillance phase are substantial. The increasing occurrence of meningococcal cases in outbreak situations and the associated control costs should appropriately be considered in economic evaluations of vaccination programs in countries affected by these outbreaks. More studies documenting outbreak-control strategies in terms of costs and resource use are needed. Background. The impact of meningitis outbreaks is substantial. We aim to calculate the costs of meningococcal outbreaks in Brazil and Colombia from the healthcare system perspective. Methods. A review of the literature was performed on costs associated with meningococcal outbreak in Latin America. Structured interviews capturing information about the use of resources, expenses allocated to treatment of infection, immunization campaigns, and response activities during the outbreak and disease surveillance pre- and postoutbreak were directed at local health authorities in Brazil and Colombia to foster a greater understanding of the economic impact of meningococcal outbreaks. All costs were expressed in 2014 US values. Results. The Vila Brandina outbreak in Brazil reported 3 cases that were associated with a total investigation and outbreak management cost of $34 425 ($11 475 per notified case), representing 2.7 more than the annual gross domestic product per capita in Brazil. In contrast, the outbreak in Cartagena de Indias in Colombia reported 6 cases at a cost of the disease response phase of $735 or 9.5% of the annual gross domestic product per capita ($123 per notified case). For the disease surveillance phase, the costs ranged from $3935 (in Cartagena de Indias) to $6667 (in Vila Brandina). Serogroups B and C were responsible for the majority of meningococcal outbreaks reported in Brazil and Colombia. Conclusions. Findings of this study underscore the importance of meningococcal disease in the region. Future research should focus on a more detailed investigation of costs of meningococcal outbreaks covering all phases of an outbreak.
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Affiliation(s)
- D Constenla
- Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - A Carvalho
- Sabin Vaccine Institute , Washington, District of Columbia
| | - N Alvis Guzmán
- Centro de Investigación y Docencia , Fundación Hospital Infantil Napoleón Franco Pareja, Grupo de Investigación en Economía de la Salud, Universidad de Cartagena , Colombia
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24
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Constenla D, Garcia C, Lefcourt N. Assessing the Economics of Dengue: Results from a Systematic Review of the Literature and Expert Survey. Pharmacoeconomics 2015; 33:1107-1135. [PMID: 26048354 DOI: 10.1007/s40273-015-0294-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The economics of dengue is complex and multifaceted. OBJECTIVES We performed a systematic review of the literature to provide a critical overview of the issues related to dengue economics research and to form a background with which to address the question of cost. METHODS Three literature databases were searched [PubMed, Embase and Latin American and Caribbean Health Sciences Literature (LILACS)], covering a period from 1980 to 2013, to identify papers meeting preset inclusion criteria. Studies were reviewed for methodological quality on the basis of a quality checklist developed for this purpose. An expert survey was designed to identify priority areas in dengue economics research and to identify gaps between the methodology and actual practice. Survey responses were combined with the literature review findings to determine stakeholder priorities in dengue economics research. RESULTS The review identified over 700 papers. Forty-two of these papers met the selection criteria. The studies that were reviewed presented results from 32 dengue-endemic countries, underscoring the importance of dengue as a global public health problem. Cost analyses were the most common, with 21 papers, followed by nine cost-effectiveness analyses and seven cost-of-illness studies, indicating a relatively strong mix of methodologies. Dengue annual overall costs (in 2010 values) ranged from US$13.5 million (in Nicaragua) to $56 million (in Malaysia), showing cost variations across countries. Little consistency exists in the way costs were estimated and dengue interventions evaluated, making generalizations around costs difficult. CONCLUSIONS The current evidence suggests that dengue costs are substantial because of the cost of hospital care and lost earnings. Further research in this area will broaden our understanding of the true economic impact of dengue.
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Affiliation(s)
- Dagna Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, 21205, USA.
- Dengue Vaccine Initiative (DVI), Baltimore, USA.
| | - Cristina Garcia
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, 21205, USA
| | - Noah Lefcourt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, 21205, USA
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Martelli CMT, Siqueira JB, Parente MPPD, Zara ALDSA, Oliveira CS, Braga C, Pimenta FG, Cortes F, Lopez JG, Bahia LR, Mendes MCO, da Rosa MQM, de Siqueira Filha NT, Constenla D, de Souza WV. Economic Impact of Dengue: Multicenter Study across Four Brazilian Regions. PLoS Negl Trop Dis 2015; 9:e0004042. [PMID: 26402905 PMCID: PMC4581827 DOI: 10.1371/journal.pntd.0004042] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 08/08/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Dengue is an increasing public health concern in Brazil. There is a need for an updated evaluation of the economic impact of dengue within the country. We undertook this multicenter study to evaluate the economic burden of dengue in Brazil. METHODS We estimated the economic burden of dengue in Brazil for the years 2009 to 2013 and for the epidemic season of August 2012- September 2013. We conducted a multicenter cohort study across four endemic regions: Midwest, Goiania; Southeast, Belo Horizonte and Rio de Janeiro; Northeast: Teresina and Recife; and the North, Belem. Ambulatory or hospitalized cases with suspected or laboratory-confirmed dengue treated in both the private and public sectors were recruited. Interviews were scheduled for the convalescent period to ascertain characteristics of the dengue episode, date of first symptoms/signs and recovery, use of medical services, work/school absence, household spending (out-of-pocket expense) and income lost using a questionnaire developed for a previous cost study. We also extracted data from the patients' medical records for hospitalized cases. Overall costs per case and cumulative costs were calculated from the public payer and societal perspectives. National cost estimations took into account cases reported in the official notification system (SINAN) with adjustment for underreporting of cases. We applied a probabilistic sensitivity analysis using Monte Carlo simulations with 90% certainty levels (CL). RESULTS We screened 2,223 cases, of which 2,035 (91.5%) symptomatic dengue cases were included in our study. The estimated cost for dengue for the epidemic season (2012-2013) in the societal perspective was US$ 468 million (90% CL: 349-590) or US$ 1,212 million (90% CL: 904-1,526) after adjusting for under-reporting. Considering the time series of dengue (2009-2013) the estimated cost of dengue varied from US$ 371 million (2009) to US$ 1,228 million (2013). CONCLUSIONS The economic burden associated with dengue in Brazil is substantial with large variations in reported cases and consequently costs reflecting the dynamic of dengue transmission.
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Affiliation(s)
- Celina Maria Turchi Martelli
- Department of Public Health, Aggeu Magalhaes Research Centre, Oswaldo Cruz Foundation, Recife, Brazil
- Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiania, Brazil
| | - Joao Bosco Siqueira
- Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiania, Brazil
| | | | - Ana Laura de Sene Amancio Zara
- Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiania, Brazil
| | | | - Cynthia Braga
- Department of Public Health, Aggeu Magalhaes Research Centre, Oswaldo Cruz Foundation, Recife, Brazil
| | - Fabiano Geraldo Pimenta
- Department of Health Surveillance, Secretaria Municipal Saude Belo Horizonte, Belo Horizonte, Brazil
| | - Fanny Cortes
- Department of Health Science, Universidade de Pernambuco, Recife, Brazil
| | - Juan Guillermo Lopez
- Health Economics and Market Access, Sanofi Pasteur Latin America, Mexico City, Mexico
| | - Luciana Ribeiro Bahia
- Department of Internal Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | - Dagna Constenla
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Wayner Vieira de Souza
- Department of Public Health, Aggeu Magalhaes Research Centre, Oswaldo Cruz Foundation, Recife, Brazil
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Constenla D, Armien B, Arredondo J, Carabali M, Carrasquilla G, Castro R, Durand L, Durán-Arenas L, García ME, Gallegos RV, Gontes ML, López JG, McFarlane C, Montoya R, Sartori AM, Siqueira JB, Martelli CT. Costing Dengue Fever Cases and Outbreaks: Recommendations from a Costing Dengue Working Group in the Americas. Value Health Reg Issues 2015; 8:80-91. [PMID: 29698176 DOI: 10.1016/j.vhri.2015.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 05/05/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The overall aim of this article was to present a step-by-step guideline for determining the costs associated with dengue in dengue-endemic countries of the Latin American and the Caribbean region and to illustrate how each of these steps can be applied in dengue costing studies. METHODS An expert panel was convened to develop standards for costing dengue so that over the next decade, decision makers will have access to improved information on the true cost of dengue in endemic countries of the Latin American and the Caribbean region. We described the outcome of the expert panel meeting, which resulted in the provision of a step-by-step dengue costing guideline that aims to provide direction to planners and program managers on how to estimate dengue economic burden studies, and provide a discussion forum of the methods used to cost dengue fever cases and outbreaks in a manner that should be accessible to persons with some familiarity with a cost study. RESULTS The guideline includes nine sequential steps: 1) definition of the scope of the study; 2) identification of the target population; 3) description of the study perspective; 4) definition of the time horizon; 5) calculation of the sample size; 6) definition of the unit of analysis; 7) identification of the cost items; 8) measurement and valuation of the cost items; and 9) handling of uncertainty. The trade-off between accurate, patient-level cost estimates and data availability constraints is discussed. CONCLUSIONS The current guideline is the result of constructive collaboration among a multidisciplinary research team to better ascertain the true economic burden of dengue across countries of the region.
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Affiliation(s)
- Dagna Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health (JHSPH), Baltimore, MD, USA; International Vaccines Institute, Dengue Vaccine Initiative (DVI), Seoul, Korea.
| | - Blas Armien
- Gorgas Memorial Institute for Health Studies (GMI), Panama City, Panama
| | - Juan Arredondo
- Secretary of Health, Vector Borne Diseases Control Division, Mexico City, Mexico
| | - Mabel Carabali
- International Vaccines Institute, Dengue Vaccine Initiative (DVI), Seoul, Korea
| | | | | | | | | | | | | | | | | | | | - Romeo Montoya
- Pan-American Health Organization, (PAHO), El Salvador City, El Salvador
| | - Ana Maria Sartori
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | | | - Celina Turchi Martelli
- Federal Univeristy of Goiás, Goiás, Brazil; Federal University of Pernambuco, Recife, Brazil
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Constenla D. Assessing the economic benefits of vaccines based on the health investment life course framework: A review of a broader approach to evaluate malaria vaccination. Vaccine 2015; 33:1527-40. [DOI: 10.1016/j.vaccine.2015.01.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 12/23/2014] [Accepted: 01/20/2015] [Indexed: 11/28/2022]
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Thiry G, Hombach J, Constenla D, Carvalho A, Durbin A. New chapter unfolding in the fight against dengue with an unwritten ending. Trans R Soc Trop Med Hyg 2014; 108:597-8. [DOI: 10.1093/trstmh/tru149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pinzón-Redondo H, Coronell-Rodriguez W, Díaz-Martinez I, Guzmán-Corena Á, Constenla D, Alvis-Guzmán N. Estimating costs associated with a community outbreak of meningococcal disease in a colombian Caribbean city. J Health Popul Nutr 2014; 32:539-548. [PMID: 25395916 PMCID: PMC4221459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Meningococcal disease is a serious and potentially life-threatening infection that is caused by the bacterium Neisseria meningitidis (N. meningitidis), and it can cause meningitis, meningococcaemia outbreaks and epidemics. The disease is fatal in 9-12% of cases and with a death rate of up to 40% among patients with meningococcaemia. The objective of this study was to estimate the costs of a meningococcal outbreak that occurred in a Caribbean city of Colombia. We contacted experts involved in the outbreak and asked them specific questions about the diagnosis and treatment for meningococcal cases during the outbreak. Estimates of costs of the outbreak were also based on extensive review of medical records available during the outbreak. The costs associated with the outbreak were divided into the cost of the disease response phase and the cost of the disease surveillance phase. The costs associated with the outbreak control and surveillance were expressed in US$ (2011) as cost per 1,000 inhabitants. The average age of patients was 4.6 years (SD 3.5); 50% of the cases died; 50% of the cases were reported to have meningitis (3/6); 33% were diagnosed with meningococcaemia and myocarditis (2/6); 50% of the cases had bacteraemia (3/6); 66% of the cases had a culture specimen positive for Neisseria meningitidis; 5 of the 6 cases had RT-PCR positive for N. meningitidis. All N. meningitidis were serogroup B; 50 doses of ceftriaxone were administered as prophylaxis. Vaccine was not available at the time. The costs associated with control of the outbreak were estimated at US$ 0.8 per 1,000 inhabitants, disease surveillance at US$ 4.1 per 1,000 inhabitants, and healthcare costs at US$ 5.1 per 1,000 inhabitants. The costs associated with meningococcal outbreaks are substantial, and the outbreaks should be prevented. The mass chemoprophylaxis implemented helped control the outbreak.
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Affiliation(s)
- Hernando Pinzón-Redondo
- Centro de Investigación y Docencia, Hospital Infantil Napoleón Franco Pareja, Cartagena-Colombia
- Facultad de Medicina, Universidad de Cartagena, Cartagena-Colombia
| | | | - Inés Díaz-Martinez
- Centro de Investigación y Docencia, Hospital Infantil Napoleón Franco Pareja, Cartagena-Colombia
| | - Ángel Guzmán-Corena
- Centro de Investigación y Docencia, Hospital Infantil Napoleón Franco Pareja, Cartagena-Colombia
| | - Dagna Constenla
- International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nelson Alvis-Guzmán
- Centro de Investigación y Docencia, Hospital Infantil Napoleón Franco Pareja, Cartagena-Colombia
- Grupo de Investigación en Economía de la Salud, Universidad de Cartagena, Cartagena-Colombia
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Bärnighausen T, Berkley S, Bhutta ZA, Bishai DM, Black MM, Bloom DE, Constenla D, Driessen J, Edmunds J, Evans D, Griffiths U, Hansen P, Hashmani FN, Hutubessy R, Jamison DT, Jha P, Jit M, Johnson H, Laxminarayan R, Lee BY, Mhatre S, Mills A, Nordström A, Ozawa S, Prosser L, Silver K, Benn CS, Standaert B, Walker D. Reassessing the value of vaccines. The Lancet Global Health 2014; 2:e251-2. [DOI: 10.1016/s2214-109x(13)70170-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sicuri E, Vieta A, Lindner L, Constenla D, Sauboin C. The economic costs of malaria in children in three sub-Saharan countries: Ghana, Tanzania and Kenya. Malar J 2013; 12:307. [PMID: 24004482 PMCID: PMC3844618 DOI: 10.1186/1475-2875-12-307] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 08/21/2013] [Indexed: 11/25/2022] Open
Abstract
Background Malaria causes significant mortality and morbidity in sub-Saharan Africa (SSA), especially among children less than five years of age (U5 children). Although the economic burden of malaria in this region has been assessed previously, the extent and variation of this burden remains unclear. This study aimed to estimate the economic costs of malaria in U5 children in three countries (Ghana, Tanzania and Kenya). Methods Health system and household costs previously estimated were integrated with costs associated with co-morbidities, complications and productivity losses due to death. Several models were developed to estimate the expected treatment cost per episode per child, across different age groups, by level of severity and with or without controlling for treatment-seeking behaviour. Total annual costs (2009) were calculated by multiplying the treatment cost per episode according to severity by the number of episodes. Annual health system prevention costs were added to this estimate. Results Household and health system costs per malaria episode ranged from approximately US$ 5 for non-complicated malaria in Tanzania to US$ 288 for cerebral malaria with neurological sequelae in Kenya. On average, up to 55% of these costs in Ghana and Tanzania and 70% in Kenya were assumed by the household, and of these costs 46% in Ghana and 85% in Tanzania and Kenya were indirect costs. Expected values of potential future earnings (in thousands) lost due to premature death of children aged 0–1 and 1–4 years were US$ 11.8 and US$ 13.8 in Ghana, US$ 6.9 and US$ 8.1 in Tanzania, and US$ 7.6 and US$ 8.9 in Kenya, respectively. The expected treatment costs per episode per child ranged from a minimum of US$ 1.29 for children aged 2–11 months in Tanzania to a maximum of US$ 22.9 for children aged 0–24 months in Kenya. The total annual costs (in millions) were estimated at US$ 37.8, US$ 131.9 and US$ 109.0 nationwide in Ghana, Tanzania and Kenya and included average treatment costs per case of US$ 11.99, US$ 6.79 and US$ 20.54, respectively. Conclusion This study provides important insight into the economic burden of malaria in SSA that may assist policy makers when designing future malaria control interventions.
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Affiliation(s)
- Elisa Sicuri
- Health Economics, GlaxoSmithKline Vaccines, Wavre, Belgium.
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Constenla D, Lefcourt N, Garcia C. Expert consensus-building for developing guidelines: lessons learned from a dengue economics workshop. Rev Panam Salud Publica 2013; 34:198-203. [PMID: 24233113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 06/17/2013] [Indexed: 06/02/2023] Open
Abstract
A workshop with 20 experts of diverse backgrounds from five countries in the Americas was convened for two-and-a-half days in March 2012 to discuss and develop a standardized methodology for assessing the economic cost of dengue. This article discusses a number of factors that contributed to the workshop's success, including: engaging the experts at various stages of the process; convening a multidisciplinary group to reduce expert bias and provide a more comprehensive and integrated approach; facilitating guided small- and large-group discussions; developing effective cross-cultural collectivism, trust, communication, and empathy across the expert panel; establishing clear lines of responsibilities within each group of experts; breaking down the complex issues into smaller and simpler ideas; providing ample background materials in multiple languages prior to the workshop. Challenges and areas for improvement are also covered.
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Affiliation(s)
- Dagna Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Constenla D, Sinha A, Valencia JE, Gomez E, de la Hoz F, Valenzuela MT, Quadros CAD. Identifying unit costs for use in regional economic evaluation: an illustrative analysis of childhood pneumococcal conjugate vaccine in Latin America and the Caribbean. Rev Panam Salud Publica 2009; 26:458-68. [DOI: 10.1590/s1020-49892009001100011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 04/26/2009] [Indexed: 11/22/2022] Open
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Constenla D, Velázquez FR, Rheingans RD, Antil L, Cervantes Y. Economic impact of a rotavirus vaccination program in Mexico. Rev Panam Salud Publica 2009; 25:481-90. [DOI: 10.1590/s1020-49892009000600003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Valenzuela MT, O'Loughlin R, De La Hoz F, Gomez E, Constenla D, Sinha A, Valencia JE, Flannery B, De Quadros CA. The burden of pneumococcal disease among Latin American and Caribbean children: review of the evidence. Rev Panam Salud Publica 2009; 25:270-9. [DOI: 10.1590/s1020-49892009000300011] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Sinha A, Constenla D, Valencia JE, O'Loughlin R, Gomez E, de la Hoz F, Valenzuela MT, Quadros CAD. Cost-effectiveness of pneumococcal conjugate vaccination in Latin America and the Caribbean: a regional analysis. Rev Panam Salud Publica 2008; 24:304-13. [DOI: 10.1590/s1020-49892008001100002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Constenla D, Ortega-Barría E, Rheingans RD, Antil L, Sáez-Llorens X. [Economic impact of rotavirus vaccination in Panama]. An Pediatr (Barc) 2008; 68:128-35. [PMID: 18341878 DOI: 10.1157/13116227] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Rotavirus (RV) gastroenteritis (GE) causes a significant health and economic burden in Panama. The main objective of this study is to estimate the healthcare costs and the cost-effectiveness of vaccination in Panama from the societal perspective. METHODS An economic model was constructed, using published epidemiological data, country-specific cost estimates, and vaccine efficacy data. The main outcome measures were disease burden, economic burden and the incremental cost-effectiveness ratio (US$/DALY and US$/life saved) of vaccination. RESULTS In Panama, among children during the first five years of life, it is estimated that due to RV GE, 283 per 1,000 have a clinic visit, 24 per 1,000 are hospitalized, and 0.53 per 1,000 die. For every 1,000 children born, RV infection results in US$16,463 in total costs during their first five years of life. An estimated US$862,388 may be spent annually on treatment of outpatient and hospitalized cases in Panama. Vaccination would prevent 65% of the associated deaths, 68% of hospitalizations, 69% of outpatient visits and 65% of associated DALY (Disability Adjusted Life Years). From the societal perspective, RV vaccination produces a cost-effectiveness ratio of US$487 per DALY when the price of the vaccine is US$7.50 per dose. CONCLUSIONS Vaccination can effectively reduce the disease burden and healthcare costs of RV GE in Panama.
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Affiliation(s)
- D Constenla
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA.
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Abstract
OBJECTIVES To estimate the costs of pneumococcal disease in Brazil, Chile and Uruguay, to describe how these costs vary between different patient groups, and to discuss factors that affect these cost variations. METHODS The cost of pneumococcal disease was estimated from the health care perspective. For each country, baseline cost estimates were primarily developed using health resources information from patient-level data and facility-specific cost data. A regression model was constructed separately for four types of pneumococcal diseases. The skewness-kurtosis test and the Cook-Weisberg test were performed to test the normality of the residuals and the heteroscedasticity, respectively. RESULTS The treatment of pneumococcal meningitis generated up to US$ 5 435 per child. The treatment costs of pneumococcal pneumonia were lower, ranging from US$ 372 per child to US$ 3 483 per child. Treatment of acute otitis media cost between US$ 20 per child and US$ 217 per child. The main source of treatment costs variations was level of service provided and country in which costs were incurred. However, the tendency of costs to change with these variables was not statistically significant at the 5% level for most pneumococcal disease models. CONCLUSIONS Pneumococcal disease resulted in significant economic burden to selected health care systems in Latin America. The patterns of treatment cost of pneumococcal disease showed a great deal of variation.
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Affiliation(s)
- Dagna Constenla
- Health Service Research Unit, Department of Public Health & Policy, School of Hygiene and Tropical Medicine, London, England.
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Constenla D, Pérez-Schael I, Rheingans RD, Antil L, Salas H, Yarzábal JP. [Assessment of the economic impact of the antiretroviral vaccine in Venezuela]. Rev Panam Salud Publica 2007; 20:213-22. [PMID: 17316479 DOI: 10.1590/s1020-49892006000900001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the cost of medical care for rotavirus gastroenteritis and the cost-effectiveness of the antiretroviral vaccine in Venezuelan children under five. METHODS We used an economic model that comprises epidemiologic information, vaccine efficacy, and the cost of medical care in connection with rotavirus gastroenteritis, viewed from a social perspective. In order to determine the effectiveness of the vaccine, we estimated the number of hospitalized cases, of medical visits, and of deaths averted after vaccination. The cost-effectiveness of the vaccine was determined on the basis of the number of disability-adjusted life years (DALYs) and cases averted. RESULTS In Venezuela, health services spend approximately 4.2 million US$ yearly on covering the costs of medical care for rotavirus-related disease. In a vaccinated cohort, an antiretroviral vaccination program would prevent around 52% (186) of the deaths, 54% (7,232) of the hospitalizations, and 50% (55,168) of the ambulatory visits that take place during the first five years of life. For an estimated cost of approximately 24 US$ per individual vaccination schedule, the cost-effectiveness ratio obtained is 1,352 US$ per DALY. CONCLUSIONS The results of this study suggest that antiretroviral vaccination is a cost-effective strategy for preventing rotavirus gastroenteritis in Venezuela, since it can prevent deaths and DALYs in the population under five years of age.
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Affiliation(s)
- Dagna Constenla
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Rheingans RD, Constenla D, Antil L, Innis BL, Breuer T. Economic and health burden of rotavirus gastroenteritis for the 2003 birth cohort in eight Latin American and Caribbean countries. Rev Panam Salud Publica 2007; 21:192-204. [PMID: 17612463 DOI: 10.1590/s1020-49892007000300002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate the health and economic burden of rotavirus gastroenteritis in hospital and outpatient settings in eight Latin American and Caribbean countries (Argentina, Brazil, Chile, Dominican Republic, Honduras, Mexico, Panama, and Venezuela). METHODS An economic model was constructed using epidemiological data from published articles, national health administration studies, and country-specific cost estimates. For each of the eight countries, the model estimated the rotavirus outcomes for the 2003 birth cohort during the first five years of life. The main outcome measures included health care costs, transportation costs, lost wages, and disease burden expressed in disability-adjusted life years. Estimates were expressed in 2003 US dollars. All future costs and disability-adjusted life year estimates were discounted at a rate of 3%. Sensitivity analyses evaluated the impact of specific variables on the medical cost of treating rotavirus. RESULTS For every 1,000 children born during 2003 in the eight Latin American and Caribbean countries studied here, we estimated that rotavirus gastroenteritis would result in an average of 246 outpatient visits, 24 hospitalizations, 0.6 deaths, and 7,971 US dollars in direct medical costs during their first five years of life. The incidence of rotavirus-associated outpatient visits and the cost of outpatient visits were predicted to have the largest impact on the total medical cost per child. CONCLUSIONS Rotavirus gastroenteritis is likely to result in substantial disease and economic burden to health systems in Latin American and Caribbean countries, and the foreseeable burden should be an important consideration in evaluating the cost-effectiveness of vaccination.
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Affiliation(s)
- Richard D Rheingans
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
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Rheingans RD, Constenla D, Antil L, Innis BL, Breuer T. Potential cost-effectiveness of vaccination for rotavirus gastroenteritis in eight Latin American and Caribbean countries. Rev Panam Salud Publica 2007; 21:205-16. [PMID: 17612464 DOI: 10.1590/s1020-49892007000300003] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To estimate the costs, benefits and cost-effectiveness of vaccination for rotavirus gastroenteritis in eight Latin American and Caribbean countries: Argentina, Brazil, Chile, the Dominican Republic, Honduras, Mexico, Panama, and Venezuela. METHODS An economic model was constructed to estimate the cost-effectiveness of vaccination from the health care system perspective, using national administrative and published epidemiological evidence, country-specific cost estimates, and vaccine efficacy data. The model was applied to the first five years of life for the 2003 birth cohort in each country. The main health outcome was the disability-adjusted life year (DALY), and the main summary measure was the incremental cost per DALY averted. A 3% discount rate was used for all predicted costs and benefits. Sensitivity analyses evaluated the impact of uncertainty regarding key variables on cost-effectiveness estimates. RESULTS According to the estimates obtained with the economic model, vaccination would prevent more than 65% of the medical visits, deaths, and treatment costs associated with rotavirus gastroenteritis in the eight countries analyzed here. At a cost of US$ 24 per course (for a two-dose vaccine), the incremental cost-effectiveness ratio ranged from 269 US dollars/DALY in Honduras to 10,656 US dollars/DALY in Chile. Cost-effectiveness ratios were sensitive to assumptions about vaccine price, mortality, and vaccine efficacy. CONCLUSIONS Vaccination would effectively reduce the disease burden and health care costs of rotavirus gastroenteritis in the Latin American and Caribbean countries analyzed here. From the health care system perspective, universal vaccination of infants is predicted to be cost-effective, based on current standards.
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Affiliation(s)
- Richard D Rheingans
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
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Abstract
BACKGROUND Cost effectiveness studies are essential to assess the real value of interventions with preventive or therapeutic objectives. AIM To assess the theoretical cost-effectiveness of a vaccine against rotavirus in Chilean children of less than five years of age. MATERIAL AND METHODS An economic model was developed based on information on disease incidence, health care costs associated with treatment and the effectiveness and costs of vaccination. Net disease and vaccination costs were estimated from the health system perspective and were compared with life years and disability-adjusted life-years (DALYs) gained using a 3% discount rate. Local administrative and accounting hospital data and vaccine efficacy data were used to estimate healthcare costs and cost-effectiveness of vaccination. RESULTS A rotavirus vaccination program would prevent 10 deaths due to rotavirus gastroenteritis, 6,245 related hospitalizations and 41,962 outpatient visits during the first five years of life, per vaccinated cohort. For every 1,000 children born, the healthcare service spends US$15,077 on treatment of gastroenteritis. From the healthcare perspective, vaccination would yield a cost-effectiveness ratio of US$11,261 per DALY when the price of the vaccine is US$24 per course. CONCLUSIONS Rotavirus vaccine can effectively reduce the disease burden and healthcare costs of rotavirus gastroenteritis and can be a cost-effective investment compared to other options.
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Affiliation(s)
- Dagna Constenla
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Savage P, Constenla D, Fisher C, Shepherd JH, Barton DP, Blake P, Gore ME. Granulosa cell tumours of the ovary: demographics, survival and the management of advanced disease. Clin Oncol (R Coll Radiol) 1998; 10:242-5. [PMID: 9764376 DOI: 10.1016/s0936-6555(98)80008-3] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Ovarian granulosa cell tumours (OGCT) are rare, accounting for only 3%-5% of primary ovarian tumours. As a result of oestrogen production OGCTs tend to present with early stage disease, which has a good prognosis. For patients with advanced disease, surgery and radiotherapy have been the major modalities of treatment. More recently, platinum-based chemotherapy has been shown to have important activity in advanced disease. In this retrospective study, we have reviewed the results of 62 patients who were treated for adult OGCT at the Royal Marsden Hospital between 1969 and 1995, with particular emphasis on the management of advanced disease. The median age at primary diagnosis was 53 years (range 13-77). Sixty-one per cent of these patients had Stage I disease, 21% Stage II disease, 16% Stage III and 2% Stage IV. Stage I patients had a good prognosis with 5- and 10-year overall survival rates of 95% and 90%. Eleven Stage I patients received adjuvant pelvic radiotherapy, with no apparent benefit to recurrent rate or overall survival. Disease progression occurred in 40% of Stage I patients at a median interval of 76 months (range 12-240), and in 62% of the Stage II patients, at a median interval of 31 months (range 2-57). The median interval from progression of Stage I/II disease to death was 22 months (range 3-144). For patients with inoperable disease, radiotherapy produced a number of long-term remissions with an overall response rate of 50%. Platinum-based chemotherapy also appears active, with responses documented in four out of five patients treated with the PVB regimen (cisplatin, vinblastine, bleomycin) as first line therapy. There were no responses documented to non-platinum chemotherapy or to hormonal manipulation. The results from this study confirm the activity of platinum-containing chemotherapy regimens in OGCT and support the need for further trials to optimize the management of this rare tumour.
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Affiliation(s)
- P Savage
- Royal Marsden Hospital, London, UK
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Savage P, Constenla D, Fisher C, Thomas JM, Gore ME. The natural history and management of Merkel cell carcinoma of the skin: a review of 22 patients treated at the Royal Marsden Hospital. Clin Oncol (R Coll Radiol) 1997; 9:164-7. [PMID: 9269548 DOI: 10.1016/s0936-6555(97)80073-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Merkel cell carcinoma is a rare skin malignancy, which primarily affects the elderly. Currently, there is only limited data on the natural history of this condition and no consensus on its optimum management. We have reviewed the natural history and management of 22 patients with Merkel cell carcinoma, who were treated at the Royal Marsden Hospital between 1985 and 1994. The median age at diagnosis was 75 years (range 55-96), with the head and neck region being the most common site of disease (nine patients: 41%). Seventeen patients (77%) presented with skin disease, three (14%) with regional lymphadenopathy and two (9%) with metastatic disease. Of the Stage I patients, 41% developed local recurrence postoperatively at a median time to relapse of 12 months. Those with head and neck disease had the highest risk of local recurrence, which occurred in 62.5% of this group. Stage I patients also had a high risk of disease progression, with 53% developing regional lymphadenopathy or visceral metastases. The median survival for all disease stages was 47 months. The treatment of unresectable primary or recurrent disease with radiotherapy led to valuable long term control in four of nine patients treated. Six courses of chemotherapy were administered; one brief complete response was observed, occurring in a patient treated with cyclophosphamide, vincristine and doxorubicin. The data in this study confirms the predilection for the elderly and the aggressive nature of Merkel cell carcinoma, with only four of 17 Stage I patients remaining disease free. To clarify the role of adjuvant postoperative radiotherapy and to establish the appropriate use of chemotherapy in metastatic spread of this rare malignancy will require further studies with multicentre cooperation.
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Affiliation(s)
- P Savage
- Skin and Melanoma Unit, Royal Marsden Hospital, London, UK
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