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Calabrò GE, Rumi F, Ricciardi R, Cicchetti A. The economic and fiscal impact of incremental use of cell-based quadrivalent influenza vaccine for the prevention of seasonal influenza among healthcare workers in Italy. Health Res Policy Syst 2024; 22:36. [PMID: 38519969 PMCID: PMC10960473 DOI: 10.1186/s12961-024-01122-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/17/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Seasonal influenza has a significant impact on public health, generating substantial direct healthcare costs, production losses and fiscal effects. Understanding these consequences is crucial to effective decision-making and the development of preventive strategies. This study aimed to evaluate the economic and the fiscal impact of implementing an incremental strategy for seasonal influenza prevention using the cell-based quadrivalent influenza vaccine (QIVc) among healthcare workers (HCWs) in Italy. METHODS To estimate the economic impact of implementing this strategy, we performed a cost analysis that considered direct healthcare costs, productivity losses and fiscal impact. The analysis considered a 3-year time horizon. A deterministic sensitivity analysis was also conducted. RESULTS Assuming a vaccination coverage rate of 30% among HCWs, the analysis considered a total of 203 018 vaccinated subjects. On analysing the overall differential impact (including direct costs, indirect costs and fiscal impact), implementing QIVc vaccination as a preventative measure against influenza among HCWs in Italy would yield societal resource savings of €23 638.78 in the first year, €47 277.56 in the second year, and €70 916.35 in the third year, resulting in total resource savings of €141 832.69. CONCLUSIONS The study demonstrated that implementing the incremental use of QIVc as part of a preventive strategy for seasonal influenza among HCWs in Italy could yield positive economic outcomes, especially in terms of indirect costs and fiscal impact. The resources saved could be utilized to fund further public health interventions. Policy-makers should consider these findings when making decisions regarding influenza prevention strategies targeting HCWs.
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Affiliation(s)
- Giovanna Elisa Calabrò
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, L.Go F. Vito 1, 00168, Rome, Italy.
- VIHTALI (Value in Health Technology and Academy for Leadership & Innovation), Spin-Off of Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
| | - Filippo Rumi
- Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Roberto Ricciardi
- VIHTALI (Value in Health Technology and Academy for Leadership & Innovation), Spin-Off of Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Americo Cicchetti
- Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, 00168, Rome, Italy
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Michell E, Lam T, Xia T, Nielsen S, Stevens J. The relationship between presurgical opioid type and persistent postoperative opioid use: a retrospective observational linkage study comparing tapentadol and oxycodone. Anaesthesia 2024; 79:203-205. [PMID: 37932877 DOI: 10.1111/anae.16164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 11/08/2023]
Affiliation(s)
- E Michell
- St Vincent's Clinical Campus, Darlinghurst, UNSW Sydney
| | - T Lam
- Eastern Health Clinical School, Monash University, Frankston, VIC, Australia
| | - T Xia
- Eastern Health Clinical School, Monash University, Frankston, VIC, Australia
| | - S Nielsen
- Eastern Health Clinical School, Monash University, Frankston, VIC, Australia
| | - J Stevens
- St Vincent's Clinical School, UNSW Medicine, Darlinghurst, NSW, Australia
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Evans A, Waterhouse BJ. Levodopa use in Australia: an analysis of Pharmaceutical Benefits Scheme 10% data. BMJ Neurol Open 2024; 6:e000484. [PMID: 38268755 PMCID: PMC10806810 DOI: 10.1136/bmjno-2023-000484] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/23/2023] [Indexed: 01/26/2024] Open
Abstract
Background Levodopa remains the mainstay of treatment of Parkinson's disease, however, over time motor fluctuations and levodopa-induced dyskinesia develop, requiring add-on therapies to control emerging symptoms. To date, however, there is no clear consensus in Australia, or elsewhere, at which dose of levodopa that add-on therapies should be considered. Objectives The purpose of this study was to examine the treatment patterns of patients with Parkinson's disease in Australia, with particular focus on levodopa doses at the time of first add-on. Methods This was a retrospective, observational, non-interventional study of patients with Parkinson's disease within the Australian Department of Human Services Pharmaceutical Benefits Scheme (PBS) 10% sample. Data on all reimbursed prescriptions (both general and concession), prescriber type and item code were extracted for patients who were dispensed at least three PBS reimbursed prescriptions for levodopa in the previous 12 months prescription from 1 January 2007 to 31 December 2021. Results 154 850 unique patients were included, of whom 42 330 (27%) commenced add-on therapy during the period. In the 12 months prior to add-on therapy, levodopa doses ranged from 100 mg/day to 1000 mg/day. The majority of patients were prescribed add-on therapy by a neurologist and approximately 40% of patients were prescribed levodopa doses of 600 mg/day or more prior to the first add-on therapy being initiated. Conclusions A large proportion of patients in Australia are managed with levodopa monotherapy doses that are considered high and many of these patients may benefit from the addition of add-on therapy to their regimen.
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Affiliation(s)
- Andrew Evans
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
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Skowronski DM, Setayeshgar S, Zou M, Prystajecky N, Tyson JR, Galanis E, Naus M, Patrick DM, Sbihi H, El Adam S, Henry B, Hoang LMN, Sadarangani M, Jassem AN, Krajden M. Single-dose mRNA Vaccine Effectiveness Against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), Including Alpha and Gamma Variants: A Test-negative Design in Adults 70 Years and Older in British Columbia, Canada. Clin Infect Dis 2022; 74:1158-1165. [PMID: 34244723 PMCID: PMC8406884 DOI: 10.1093/cid/ciab616] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [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: 06/05/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Randomized-controlled trials of messenger RNA (mRNA) vaccine protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) included relatively few elderly participants. We assess single-dose mRNA vaccine effectiveness (VE) in adults ≥ 70 years old in British Columbia, Canada, where second doses were deferred by up to 16 weeks and where a spring 2021 wave uniquely included codominant circulation of Alpha (B.1.1.7) and Gamma (P.1) variants of concern (VOC). METHODS Analyses included community-dwelling adults ≥ 70 years old with specimen collection between 4 April (epidemiological week 14) and 1 May (week 17) 2021. Adjusted VE was estimated by test-negative design. Cases were reverse-transcription polymerase chain reaction (RT-PCR) test-positive for SARS-CoV-2, and controls were test-negative. Vaccine status was defined by receipt of a single-dose ≥ 21 days before specimen collection, but a range of intervals was assessed. Variant-specific VE was estimated against viruses genetically characterized as Alpha, Gamma or non-VOC lineages. RESULTS VE analyses included 16 993 specimens: 1226 (7%) test-positive cases and 15 767 test-negative controls. Of 1131 (92%) genetically characterized viruses, 509 (45%), 314 (28%), and 276 (24%) were Alpha, Gamma, and non-VOC lineages, respectively. At 0-13 days postvaccination, VE was negligible at 14% (95% confidence interval [CI], 0-26) but increased from 43% (95% CI, 30-53) at 14-20 days to 75% (95% CI, 63-83) at 35-41 days postvaccination. VE at ≥ 21 days postvaccination was 65% (95% CI, 58-71) overall: 72% (95% CI, 58-81), 67% (95% CI, 57-75), and 61% (95% CI, 45-72) for non-VOC, Alpha, and Gamma variants, respectively. CONCLUSIONS A single dose of mRNA vaccine reduced the risk of SARS-CoV-2 by about two-thirds in adults ≥ 70 years old, with protection only minimally reduced against Alpha and Gamma variants.
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Affiliation(s)
- Danuta M Skowronski
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
| | - Solmaz Setayeshgar
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada
| | - Macy Zou
- BC Centre for Disease Control, Data and Analytics Services, Vancouver, British Columbia, Canada
| | - Natalie Prystajecky
- BC Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada
- University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, British Columbia, Canada
| | - John R Tyson
- BC Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada
- University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, British Columbia, Canada
| | - Eleni Galanis
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
| | - Monika Naus
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
| | - David M Patrick
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
| | - Hind Sbihi
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
- BC Centre for Disease Control, Data and Analytics Services, Vancouver, British Columbia, Canada
| | - Shiraz El Adam
- BC Centre for Disease Control, Communicable Diseases and Immunization Services, Vancouver, British Columbia, Canada
| | - Bonnie Henry
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
- Office of the Provincial Health Officer, Ministry of Health, Victoria, British Columbia, Canada
| | - Linda M N Hoang
- BC Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada
- University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, British Columbia, Canada
| | - Manish Sadarangani
- BC Children’s Hospital Research Institute, Vaccine Evaluation Center, Vancouver, British Columbia, Canada
- University of British Columbia, Department of Pediatrics, Vancouver, British Columbia, Canada
| | - Agatha N Jassem
- BC Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada
- University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, British Columbia, Canada
| | - Mel Krajden
- BC Centre for Disease Control, Public Health Laboratory, Vancouver, British Columbia, Canada
- University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, British Columbia, Canada
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Sadarangani M, Kollmann T, Bjornson G, Heath P, Clarke E, Marchant A, Levy O, Leuridan E, Ulloa-Gutierrez R, Cutland CL, Kampmann B, Chaithongwongwatthana S, Dinleyici E, van Damme P, Munoz FM. The Fifth International Neonatal and Maternal Immunization Symposium (INMIS 2019): Securing Protection for the Next Generation. mSphere 2021; 6:e00862-20. [PMID: 33504658 PMCID: PMC7885317 DOI: 10.1128/msphere.00862-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Despite significant progress in reaching some milestones of the United Nations Sustainable Development Goals, neonatal and early infant morbidity and mortality remain high, and maternal health remains suboptimal in many countries. Novel and improved preventative strategies with the potential to benefit pregnant women and their infants are needed, with maternal and neonatal immunization representing effective approaches. Experts from immunology, vaccinology, infectious diseases, clinicians, industry, public health, and vaccine-related social sciences convened at the 5th International Neonatal and Maternal Immunization Symposium (INMIS) in Vancouver, Canada, from 15 to 17 September 2019. We critically evaluated the lessons learned from recent clinical studies, presented cutting-edge scientific progress in maternal and neonatal immunology and vaccine development, and discussed maternal and neonatal immunization in the broader context of infectious disease epidemiology and public health. Focusing on practical aspects of research and implementation, we also discussed the safety, awareness, and perception of maternal immunization as an existing strategy to address the need to improve maternal and neonatal health worldwide. The symposium provided a comprehensive scientific and practical primer as well as an update for all those with an interest in maternal and neonatal infection, immunity, and vaccination. The summary presented here provides an update of the current status of progress in maternal and neonatal immunization.
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Affiliation(s)
- Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tobias Kollmann
- Telethon Kids Institute, Perth Children's Hospital, University of Western Perth, Perth, Australia
| | - Gordean Bjornson
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Paul Heath
- St. George's University of London, London, United Kingdom
| | - Ed Clarke
- Vaccines & Immunity Theme, Medical Research Council Unit, The Gambia, London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Banjul, The Gambia
| | - Arnaud Marchant
- Institute for Medical Immunology, Université Libre de Bruxelles, Charleroi, Belgium
| | - Ofer Levy
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT & Harvard, Cambridge, Massachusetts, USA
| | - Elke Leuridan
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Rolando Ulloa-Gutierrez
- Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Centro de Ciencias Médicas C.C.S.S., San José, Costa Rica
| | - Clare L Cutland
- African Leadership in Vaccinology Expertise (ALIVE), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Beate Kampmann
- Vaccines & Immunity Theme, Medical Research Council Unit, The Gambia, London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Banjul, The Gambia
- The Vaccine Centre, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Surasith Chaithongwongwatthana
- Division of Infectious Disease in Gynecology and Obstetrics (InDiGO), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ener Dinleyici
- Eskisehir Osmangazi University, Faculty of Medicine, Eskisehir, Turkey
| | - Pierre van Damme
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Flor M Munoz
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
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Lam T, Hayman J, Berecki-Gisolf J, Sanfilippo P, Lubman DI, Nielsen S. Comparing rates and characteristics of emergency department presentations related to pharmaceutical opioid poisoning in Australia: a study protocol for a retrospective observational study. BMJ Open 2020; 10:e038979. [PMID: 32994254 PMCID: PMC7526272 DOI: 10.1136/bmjopen-2020-038979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION AND AIMS Pharmaceutical opioids are an important contributor to the global 'opioid crisis', and are implicated in 70% of Australia's opioid-related mortality. However, there have been few studies which consider the relative contribution of different pharmaceutical opioids to harm.We aim to compare commonly used pharmaceutical opioids in terms of (1) rates of harm, and (2) demographic and clinical characteristics associated with that harm. METHOD AND ANALYSIS Observational study of emergency department presentations for non-fatal poisoning related to pharmaceutical opioid use. Data from 2009 to 2019 will be extracted from the Victorian Emergency Minimum Dataset which contains data from public hospitals with dedicated emergency departments in Victoria, Australia's second most populous state. A combination of free-text and International Classification of Diseases 10th Revision codes will be used to identify relevant cases, with manual screening of each case to confirm relevance. We will calculate supply-adjusted rates of presentations using Poisson regression for all pharmaceutical opioid cases identified, separately for nine commonly prescribed pharmaceutical opioids (buprenorphine, codeine, fentanyl, methadone, morphine, oxycodone, oxycodone-naloxone, tapentadol, tramadol), and for a multiple opioid category. We will use multinomial logistic regression to compare demographic and clinical characteristics, such as triage category, across opioid types. ETHICS AND DISSEMINATION This work is conducted under approval 21427 from the Monash University Human Research Ethics Committee for ongoing injury surveillance. As per conditions of approval, cells of <5 will not be reported, though zeroes will be preserved. We will present project findings in a peer-reviewed journal article as well as at relevant scientific conferences.
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Affiliation(s)
- Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
| | - Jane Hayman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
- Victorian Injury Surveillance Unit, Monash University Accident Research Centre, Monash University, Clayton, Victoria, Australia
| | - Janneke Berecki-Gisolf
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
- Victorian Injury Surveillance Unit, Monash University Accident Research Centre, Monash University, Clayton, Victoria, Australia
| | - Paul Sanfilippo
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
- Turning Point, Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia
| | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
- Turning Point, Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
- Turning Point, Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia
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Nielsen S, Crossin R, Middleton M, Martin C, Wilson J, Lam T, Scott D, Smith K, Lubman D. Comparing rates and characteristics of ambulance attendances related to extramedical use of pharmaceutical opioids in Australia: a protocol for a retrospective observational study. BMJ Open 2019; 9:e029170. [PMID: 31138584 PMCID: PMC6549600 DOI: 10.1136/bmjopen-2019-029170] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION AND AIMS Extramedical use of, and associated harms with pharmaceutical opioids are common. Analysis of coded ambulance clinical records provides a unique opportunity to examine a national population-level indicator of relative harms. This protocol describes an observational study with three aims: (1) to compare supply adjusted rates of pharmaceutical opioid-related ambulance attendances for buprenorphine, codeine, fentanyl, oxycodone, oxycodone-naloxone, morphine, pethidine, tramadol and tapentadol; (2) to compare presentation characteristics for these commonly used pharmaceutical opioids and (3) to describe the context surrounding ambulance presentations related to oxycodone, a widely used opioid with an established abuse liability, and tapentadol, a more recent 'atypical' opioid on the Australian market, with fewer studies that have directly examined signals of extramedical use. METHOD Trained coders extract data from clinical records for ambulance presentations relating to extramedical use of commonly used pharmaceutical opioids. These data form the basis of a large, national database that captures alcohol-related and drug-related harms. Supply adjusted rates of presentations will be examined using Poisson regression. Multinomial logistic regression will be used to compare severity and other characteristics of attendances relating to different pharmaceutical opioids. Tapentadol-related and oxycodone-related cases will be qualitatively examined to understand the situationally specific contexts of the ambulance attendances outside of the characteristics captured in routinely coded variables. ETHICS AND DISSEMINATION Ethics approval related to analysis of ambulance attendance data was obtained from the Eastern Health Human Research Ethics Committee (E122 08-09), with an amendment specific to the qualitative analysis. Findings will be submitted for peer review in 2019. The understanding of risk profiles in real-world settings is of international public health importance. The analysis and publication of findings from this national dataset of clinical records will provide one of the most nuanced analyses to date of relative harms across nine pharmaceutical opioids over a 6-year period.
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Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- National Drug and Alcohol Research Centre, UNSW Sydney, Randwick, New South Wales, Australia
- Turning Point, Monash University Eastern Health Clinical School, North Richmond, Victoria, Australia
| | - Rose Crossin
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Turning Point, Monash University Eastern Health Clinical School, North Richmond, Victoria, Australia
| | - Melissa Middleton
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Catherine Martin
- Biostatistics Unit, Public Health and Preventative Medicine, Monash University, Melbourne, New South Wales, Australia
| | - James Wilson
- Turning Point, Monash University Eastern Health Clinical School, North Richmond, Victoria, Australia
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Debbie Scott
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Turning Point, Monash University Eastern Health Clinical School, North Richmond, Victoria, Australia
| | - Karen Smith
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
- Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia
| | - Dan Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Turning Point, Monash University Eastern Health Clinical School, North Richmond, Victoria, Australia
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Abstract
INTRODUCTION It has been argued that tapentadol may pharmacologically have lower abuse potential than other pharmaceutical opioids currently available. However, there has been no comprehensive triangulation of data regarding use and harms associated with this formulation. A sustained-release formulation (SRF) of tapentadol (Palexia) was released in Australia in 2011 and listed for public subsidy in 2013. We summarise here the methods of a postmarketing study which will measure postintroduction: (1) population level availability, (2) extramedical use and diversion, (3) attractiveness for extramedical use and (4) associated harms, of tapentadol compared against other pharmaceutical opioids. METHODS AND ANALYSIS We evaluated key sources on pharmaceutical use and harms in Australia. This review indicateddata from four sources that disaggregate pharmaceutical opioid formulations and capture tapentadol SRF could be triangulated. These data sources comprised: (1) national pharmaceutical opioid community sales data from 2011 to 2017, (2) national pharmaceutical opioid poisonings reported to Poison Information Centres (PICs) from 2011 to 2017, (3) number of vendors on online marketplaces listing pharmaceutical opioids for sale and (4) data on pharmaceutical opioid extramedical use, attractiveness and harms from interviews with people who regularly inject drugs in Australia. ETHICS AND DISSEMINATION Ethics approval is not required for use of pharmaceutical sales data. Ethics approval has been obtained for use of national pharmaceutical opioid poisonings reported to PICs (LNR/16/SCHN/44) and for use of online marketplace data and interview data from people who inject drugs (HC12086). Key findings will be published mid-2018 in a peer-reviewed academic journal, and presented at various conferences and professional meetings.
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Affiliation(s)
- Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Rose Cairns
- NSW Poisons Information Centre, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Buckley
- NSW Poisons Information Centre, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Global Health, School of Public Health, University of Washington, Seattle, Washington, USA
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Lehmann D, Kirarock W, van den Biggelaar AHJ, Passey M, Jacoby P, Saleu G, Masiria G, Nivio B, Greenhill A, Orami T, Francis J, Ford R, Kirkham LA, Solomon V, Richmond PC, Pomat WS. Rationale and methods of a randomized controlled trial of immunogenicity, safety and impact on carriage of pneumococcal conjugate and polysaccharide vaccines in infants in Papua New Guinea. Pneumonia (Nathan) 2017; 9:20. [PMID: 29299402 PMCID: PMC5742486 DOI: 10.1186/s41479-017-0044-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/16/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Children in third-world settings including Papua New Guinea (PNG) experience early onset of carriage with a broad range of pneumococcal serotypes, resulting in a high incidence of severe pneumococcal disease and deaths in the first 2 years of life. Vaccination trials in high endemicity settings are needed to provide evidence and guidance on optimal strategies to protect children in these settings against pneumococcal infections. METHODS This report describes the rationale, objectives, methods, study population, follow-up and specimen collection for a vaccination trial conducted in an endemic and logistically challenging setting in PNG. The trial aimed to determine whether currently available pneumococcal conjugate vaccines (PCV) are suitable for use under PNG's accelerated immunization schedule, and that a schedule including pneumococcal polysaccharide vaccine (PPV) in later infancy is safe and immunogenic in this high-risk population. RESULTS This open randomized-controlled trial was conducted between November 2011 and March 2016, enrolling 262 children aged 1 month between November 2011 and April 2014. The participants were randomly allocated (1:1) to receive 10-valent PCV (10vPCV) or 13-valent PCV (13vPCV) in a 1-2-3-month schedule, with further randomization to receive PPV or no PPV at age 9 months, followed by a 1/5th PPV challenge at age 23 months. A total of 1229 blood samples were collected to measure humoral and cellular immune responses and 1238 nasopharyngeal swabs to assess upper respiratory tract colonization and carriage load. Serious adverse events were monitored throughout the study. Of the 262 children enrolled, 87% received 3 doses of PCV, 79% were randomized to receive PPV or no PPV at age 9 months, and 67% completed the study at 24 months of age with appropriate immunization and challenge. CONCLUSION Laboratory testing of the many samples collected during this trial will determine the impact of the different vaccine schedules and formulations on nasopharyngeal carriage, antibody production and function, and immune memory. The final data will inform policy on pneumococcal vaccine schedules in countries with children at high risk of pneumococcal disease by providing direct comparison of an accelerated schedule of 10vPCV and 13vPCV and the potential advantages of PPV following PCV immunization. TRIAL REGISTRATION ClinicalTrials.gov CTN NCT01619462, retrospectively registered on May 28, 2012.
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Affiliation(s)
- Deborah Lehmann
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008 Australia
| | - Wendy Kirarock
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | | | - Megan Passey
- The University of Sydney, University Centre for Rural Health, School of Public Health, 61 Uralba Street, Lismore, NSW 2480 Australia
| | - Peter Jacoby
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008 Australia
| | - Gerard Saleu
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | - Geraldine Masiria
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | - Birunu Nivio
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | - Andrew Greenhill
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008 Australia
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
- School of Applied and Biomedical Sciences, Federation University, Northways Road, Churchill, VIC 3842 Australia
| | - Tilda Orami
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | - Jacinta Francis
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | - Rebecca Ford
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | - Lea-Ann Kirkham
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008 Australia
- School of Paediatrics and Child Health, University of Western Australia, Roberts Road, Subiaco, WA 6008 Australia
| | - Vela Solomon
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | - Peter C. Richmond
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008 Australia
- School of Paediatrics and Child Health, University of Western Australia, Roberts Road, Subiaco, WA 6008 Australia
| | - William S. Pomat
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008 Australia
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
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