The Value of Vaccination: Capturing the Impact of Vaccination on Health Equity in Health Economic Analysis

Objectives: The COVID-19 pandemic dramatically highlighted health inequities and the differential impact that vaccination can have on health, depending on social advantage. In a non-pandemic setting, vaccination can improve equity, but this broader value of vaccination is not currently considered in health economic analysis despite equity being a policy priority in many countries. Method(s): A panel of health economists and policy experts convened to discuss how to capture the equity dimension of the value of vaccination. This was conceptualized using a distributional cost-effectiveness analysis framework with four steps leading to differential health impact: (i) differences in vaccine preventable disease incidence;(ii) differences in the vaccination uptake;(iii) differences in health effects;and (iv) differences in health opportunity costs. The concept was illustrated by a retrospective modelling exercise of 4-component meningococcal serogroup B (4CMenB) infant vaccination against serogroup B invasive meningococcal disease (MenB) in England, for which an existing model was adapted. Five social groups were analysed based on Index of Multiple Deprivation Quintiles (IMDQ). Result(s): 4CMenB infant vaccination disproportionately prevented MenB cases among more deprived groups: of all prevented cases, 40.3% were among the most deprived IMDQ (accounting for 25.9% of the target population <5 years of age) and 78.1% among the three most deprived IMDQs. Vaccination had a positive, though small, net equity benefit, and the direction of equity impact was robust to sensitivity analyses varying the distribution of uptake, MenB carriage prevalence, and assumptions related to life expectancy and utility stratified by IMDQ. Conclusion(s): Within a national immunisation programme, 4CMenB vaccination improves health equity by preventing disproportionately more cases in more socially disadvantaged groups. The health equity impacts of vaccination can be captured in health economic evaluation although there is a need to improve the evidence base and develop more user-friendly equity impact measures. Copyright © 2022

Early initiation of hemoadsorption reduces the need for organ support in critically ill COVID-19 patients on ECMO: A post-hoc analysis from the CytoSorb Therapy in COVID-19 (CTC) Registry

Objectives: Preliminary results of the CTC Registry on the first 52 patients showed survival of 69% at 90 days [1]. The current exploratory analysis aimed to examine whether the time of initiation of hemoadsorption (i.e.: early vs late) had any effect organ support requirements and survival. Method(s): We included all 100 patients recruited in the CTC Registry in 5 U.S. intensive care units (ICU). The median time from ICU admission to the start of hemoadsorption was 86.7 h. We created two post hoc groups: <=86.7 h (group-early, GE) and >86.7 h (group-late, GL) and compared outcomes with special focus on the need of mechanical ventilation (MV), vasopressor, renal replacement therapy (CRRT) and extracorporeal membrane oxygenation (ECMO). Result(s): There was no difference between groups in baseline characteristics. 90-day survival was 78% in GE and 62% in GL (p=0.08). Patients in the GL vs GE spent longer time on ECMO (p=0.021), mechanical ventilation (p=0.02) and needed significantly longer ICU-stay (p=0.002), (Fig. 1). There was also a trend for longer vasopressor support (8 [4-21] vs 4 [1-17] days, p=0.13). There was no significant difference between the groups regarding the need of CRRT. Conclusion(s): The current analysis shows that early initiation of hemoadsorption with ECMO in critically ill COVID-19 patients is associated with shorter duration of organ support measures and shorter ICU stays.

Relationship of lung oxygenation to timing of hemoadsorption therapy initiation in COVID-19 patients requiring extracorporeal mechanical oxygenation (ECMO): an observational analysis from the CytoSorb therapy in COVID-19 (CTC) Registry

Introduction: The multicenter CTC Registry study collected patientlevel data in COVID-19 patients receiving CytoSorb therapy under FDA Emergency Use Authorization. An earlier report on the first 52 CTC patients on ECMO treated with CytoSorb showed 69% overall survival [1]. The current analysis focuses on changes in pulmonary function relative to the time of CytoSorb therapy. Methods: A total of 56 patients from 5 U.S. centers were included. Data on demographics, mechanical ventilation (MV), ECMO, and arterial blood gases during CytoSorb therapy were analyzed. Linear regression was used to evaluate the relationship between the timing of initiation of CytoSorb therapy to lung oxygenation according to changes in PaO2/FiO2 ratio. Results: In the current analysis, 71% (40/56) overall survival was observed. For these survivors, time to CytoSorb start after ICU admission, MV start, and ECMO start was 138 ± 171.3 h, 83 ± 111.0 h, and 55 ± 156.5 h, respectively, with mean duration of CytoSorb therapy of 83 ± 29.1 h. At the first 24 h following CytoSorb therapy, oxygenation was improved evidenced by decreased MV FiO2 and ECMO FdO2 requirements and an increased PaO2/FiO2 ratio (90.2 ± 58.13 mmHg to 166.3 ± 98.67 mmHg, p < 0.001, N = 21). Linear regression analysis suggested that earlier initiation of CytoSorb therapy following ICU admission may be correlated to greater improvements in PaO2/FiO2 ratio (r = -0.37, p = 0.103), however, this trend did not achieve statistical significance. Conclusions: High survival rates have been observed with adjunct CytoSorb therapy in critically ill COVID-19 patients on ECMO. The current analysis suggests that early initiation of hemoadsorption following ICU admission may contribute to earlier improvements in native lung oxygenation.