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1.
Value in Health ; 25(12 Supplement):S306, 2022.
Article in English | EMBASE | ID: covidwho-2181155

ABSTRACT

Objectives: Vaccination is paramount to reduce the health and economic impact of vaccine preventable diseases (VPDs), but are mainly focused on the immunization of children where COVID-19 demonstrated the importance of considering other age groups too. Providing healthcare decision makers with evidence-based assessments and recommendations is crucial but health technology assessments (HTAs) of older adult vaccination might be challenging. Method(s): Drawing upon the review of relevant literature and recent study cases, an expert panel elaborated on a list of HTA challenges and recommendations for older adult vaccination that could be instrumental to foster implementation of lifelong immunization. Result(s): Five challenges were identified for older adult vaccination: i) population characteristics, including immunosenescence, waning rates, comorbidities, changing functional status, and frailty;ii) limited surveillance data, causing a knowledge gap between population characteristics and vaccine effectiveness;iii) uncertainty in health economic value assessments - as a spill-over of the first two challenges;iv) prioritization of sub-groups might not align with health equity principles;and v) vaccination acceptance/hesitancy could prevent attaining optimal vaccination coverage and population benefits. Five concrete recommendations were issued in response to abovementioned challenges: i) introduce specific adult working groups within NITAGs as in the UK and US;ii) develop standardized/transferrable assessment methods adapted for older adults vaccination;iii) filling evidence gaps by the design of inclusive surveillance systems;iv) strengthen transparency of assessments to improve trust within healthcare and the society;and v) establish dedicated budget plans for prevention so that policy decisions - supported by adequate HTAs - can be implemented, inclusive older adults vaccination. Conclusion(s): Global interest in strengthening evidence-based policymaking for vaccination is increasing. It is therefore the right time to rethink how HTA could serve in fostering older adults' vaccination and to convey the message that implementing preventive measures and promoting lifelong immunization programs are instrumental to secure healthcare systems' sustainability. Copyright © 2022

2.
Value in Health ; 25(12 Supplement):S16, 2022.
Article in English | EMBASE | ID: covidwho-2181120

ABSTRACT

Objectives: National strategies for preparedness on future outbreaks of COVID-19 often include the timely preparedness with available vaccines. Fiscal health modelling (FHM) has recently been brought forward as an additional analysis by defining the fiscal impact of a health condition from a governmental perspective. As governments are the main decision-makers on preparedness, this study assesses a FHM framework for a communicable disease. Method(s): Using data of the Dutch COVID-19 pandemic, two approaches for identifying the fiscal impact of COVID-19 were assessed: 1. modelling of future fiscal impact based on publicly available population counts;and 2. assessment of the extrapolated tax and benefit income and gross domestic product (GDP) in a particular time period with the respective realized values. The appropriateness of different modelling approaches was in line with the ISPOR FHM guidelines and extensively validated in an expert meeting. Result(s): Dutch publicly available data was the basis for the analysis performed, showing total counts of 2.36 million infections, 52,678 hospitalisations, 9,805 ICU admissions and 9,493 deaths in a period of 24 months following the start of COVID-19 in 2020. Consequences which can be causally linked to these counts influencing income tax collected and social benefits paid (approach 1) amounted to a fiscal loss of 158 million over 2 years. The total losses in terms of the fiscal income and GDP (approach 2), were estimated at respectively 13,582 million and 96.3 billion over 24 months. Conclusion(s): This study is a full integrated fiscal macro-economic orientation to analyse different aspects of an infectious disease outbreak and its influence on government public accounts. The suitability of the two presented approaches depends on the perspective of the analysis, time horizon of the analysis and availability of data. The consequence-linking approach is more suited to a prospective estimation and the extrapolating approach more to a retrospective one. Copyright © 2022

3.
Value in Health ; 25(12 Supplement):S1, 2022.
Article in English | EMBASE | ID: covidwho-2181119

ABSTRACT

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

5.
Value in Health ; 25(12):S239-S240, 2022.
Article in English | Academic Search Complete | ID: covidwho-2159434
6.
Open Forum Infectious Diseases ; 8(SUPPL 1):S136, 2021.
Article in English | EMBASE | ID: covidwho-1746749

ABSTRACT

Background. According to the Centers for Disease Control and Prevention (CDC), during the 2019-20 U.S. influenza season, influenza resulted in almost 180,000 hospitalizations and over 13,000 deaths in adults ≥ 65 years. The current study evaluated the relative vaccine effectiveness (rVE) of adjuvanted trivalent influenza vaccine (aTIV) compared to high-dose trivalent influenza vaccine (TIV-HD), against influenza-related hospitalizations/emergency room (ER) visits, all-cause hospitalizations and hospitalizations/ER visits for cardio-respiratory disease (CRD) among adults ≥65 years for the 2019-20 influenza season. Methods. A retrospective cohort analysis of older adults (≥ 65 years) was conducted using IQVIA's professional fee, prescription claims and hospital charge master data in the U.S. Baseline characteristics included age, gender, payer type, geographic region, Charlson Comorbidity Index (CCI), comorbidities, indicators of frail health status, and pre-index hospitalization rates. To avoid any influenza outcome misclassification with COVID-19 infection, the study period ended March 7, 2020. Adjusted analyses were conducted through inverse probability of treatment weighting (IPTW) to control for selection bias. Poisson regression was used to estimate the adjusted pairwise rVE against influenza-related hospitalizations/ ER visits, all-cause hospitalizations and any hospitalization/ER visit for CRD. An unrelated negative control outcome, urinary tract infection (UTI) hospitalization was included. Results. During the 2019-20 influenza season, following IPTW, 798,987 recipients of aTIV and 1,655,979 recipients of TIV-HD were identified. After IPTW adjustment and Poisson regression, aTIV was statistically comparable to TIV-HD for prevention of influenza-related hospitalizations/ER visits (3.1%;95% CI: -2.8%-8.6%) and all-cause hospitalizations (-0.7%;95% CI: -1.6%-0.3%). Similar comparable outcomes were found for reduction of any hospitalization/ER visit for CRD (0.9%;95% CI: 0.0%-1.7%). No treatment effect was identified for the negative control outcome. Conclusion. aTIV and TIV-HD demonstrated comparable reductions in influenza-related hospitalizations/ER visits, all-cause hospitalizations and hospitalizations/ ER visits for CRD.

7.
Open Forum Infectious Diseases ; 8(SUPPL 1):S758, 2021.
Article in English | EMBASE | ID: covidwho-1746293

ABSTRACT

Background. Non-egg-based influenza vaccine manufacturing reduces egg adaptation and therefore has the potential to increase vaccine effectiveness. This study evaluated whether the cell-based quadrivalent influenza vaccine (QIVc) improved relative vaccine effectiveness (rVE) compared to standard-dose egg-based quadrivalent influenza vaccine (QIVe-SD) in the reduction of influenza-related and respiratory-related hospitalizations/emergency room (ER) visits among subjects 4-64 years old during the 2019/20 influenza season. Methods. A retrospective analysis was conducted among subjects 4-64 years old vaccinated with QIVc or QIVe-SD using administrative claims data in the United States of America (U.S.) (IQVIA PharMetrics® Plus). Inverse probability of treatment weighting (IPTW) was used to adjust for baseline confounders. Post-IPTW, the number of events and rates (per 1,000 vaccinated subject-seasons) of influenza-related hospitalizations/ER visits, respiratory-related hospitalizations/ ER visits and all-cause hospitalizations were assessed. Poisson regression was used to estimate adjusted rVE. To avoid any influenza outcome misclassification with COVID-19 infection, the study period ended March 7,2020. A sub-analysis for a high-risk subgroup was conducted. Urinary tract infection (UTI) hospitalization was assessed as a negative control endpoint. Results. During the 2019/20 influenza season, 1,150,134 QIVc and 3,924,819 QIVe-SD recipients were identified post-IPTW. Overall adjusted analyses (4-64 years old) found that QIVc was associated with a significantly higher rVE compared to QIVe-SD against influenza-related hospitalizations/ER visits (5.3% [95% CI: 0.5%-9.9%]), all-cause hospitalizations (14.5% [95% CI: 13.1%-15.8%]) and any respiratory-related hospitalization/ER visit (8.2% [95% CI: 6.5%-9.8%]). A similar trend was seen for the high-risk subgroup;for instance, rVE for QIVc compared to QIVe-SD against influenza-related hospitalizations/ER visits was 10.5% [95% CI: 2.9%-17.4%]. No effect was identified for the negative control outcome. Conclusion. QIVc was significantly more effective in preventing influenza-related and respiratory-related hospitalizations/ER visits, as well as all-cause hospitalizations, compared to QIVe-SD.

8.
Value in Health ; 25(1):S12, 2022.
Article in English | EMBASE | ID: covidwho-1649053

ABSTRACT

Objectives: The current COVID-19 pandemic caused ∼20,000 deaths and ∼50,000 hospital admissions in the Netherlands. Efforts to manage this communicable disease and its impact on the health-care system without prior development of specific vaccines have put a strain on the fiscal budget. This study aims to indicatively quantify the impact of COVID-19 on the Dutch government’s fiscal position, simultaneously indicating the value of preventive vaccines from a payer perspective. Methods: Dutch COVID-19 specific population data on laboratory-confirmed infections, hospital admissions and mortality, was collected from the domestic start of the COVID-19 pandemic on 27 February 2020 until the first administered vaccine on 6 January 2021. A fiscal health modelling approach was used to estimate the loss in tax revenues. Occurred productivity losses were added as an indicator for the future burden on the social security system. Tax revenue losses were caused by premature mortality, whereas the productivity losses occurred through mortality as well as morbidity. Outcomes were expressed in total monetary impact (€, 2020). Results: The impact of the pandemic in the analysed time-period was estimated to amount to a total of €920.7 million. Tax loss due to premature mortality amounted to €58.8 million with 50% attributed to patients >60 years. Productivity loss due to morbidity summed up to €862 million with 46% due to patients 40-59 years. Conclusions: The fiscal impact of the current pandemic highlights the importance of a broader approach to health-economic analysis. A fiscal health framework, optimally linked to a disease simulation model, is a better instrument to inform decision-making in the context of communicable diseases. The reported fiscal estimates also highlight the benefit of investments in communicable disease prevention such as anticipative development of vaccines. In the decision-making process around pandemic preparedness measures, investment funding and real-options can consequently be informed by a fiscal health framework.

9.
European Journal of Public Health ; 31:1, 2021.
Article in English | Web of Science | ID: covidwho-1610351
10.
Vaccines (Basel) ; 9(4):18, 2021.
Article in English | MEDLINE | ID: covidwho-1208788

ABSTRACT

As of March 2021, COVID-19 has claimed the lives of more than 2.7 million people worldwide. Vaccination has started in most countries around the world. In this study, we estimated the cost-effectiveness of strategies for COVID-19 vaccination for Turkey compared to a baseline in the absence of vaccination and imposed measures by using an enhanced SIRD (Susceptible, Infectious, Recovered, Death) model and various scenarios for the first year after vaccination. The results showed that vaccination is cost-effective from a health care perspective, with an incremental cost-effectiveness ratio (ICER) of 511 USD/QALY and 1045 USD/QALY if vaccine effectiveness on transmission is equal or reduced to only 50% of effectiveness on disease, respectively, at the 90% baseline effectiveness of the vaccine. From a societal perspective, cost savings were estimated for both scenarios. Other results further showed that the minimum required vaccine uptake to be cost-effective would be at least 30%. Sensitivity and scenario analyses, as well as the iso-ICER curves, showed that the results were quite robust and that major changes in cost-effectiveness outcomes cannot be expected. We can conclude that COVID-19 vaccination in Turkey is highly cost-effective or even cost-saving.

11.
Data ; 5(4):11, 2020.
Article in English | Web of Science | ID: covidwho-1013365

ABSTRACT

As a part of mitigation strategies during a COVID-19 pandemic, the WHO currently recommends social distancing measures through school closures (SC) and work closures (WC) to control the infection spread and reduce the illness attack rate. Focusing on the use of administrative and secondary data, this study aimed to estimate the costs and effects of alternative strategies for mitigating the COVID-19 pandemic in Jakarta, Indonesia, by comparing the baseline (no intervention) with SC + WC for 2, 4, and 8 weeks as respective scenarios. A modified Susceptible-Exposed-Infected-Recovered (SEIR) compartmental model accounting for the spread of infection during the latent period was applied by taking into account a 1-year time horizon. To estimate the total pandemic cost of all scenarios, we took into account the cost of healthcare, SC, and productivity loss due to WC and illness. Next to costs, averted deaths were considered as the effect measure. In comparison with the baseline, the result showed that total savings in scenarios of SC + WC for 2, 4, and 8 weeks would be approximately $24 billion, $25 billion, and $34 billion, respectively. In addition, increasing the duration of SC and WC would increase the number of averted deaths. Scenarios of SC + WC for 2, 4, and 8 weeks would result in approximately 159,075, 173,963, and 250,842 averted deaths, respectively. A sensitivity analysis showed that the wage per day, infectious period, basic reproduction number, incubation period, and case fatality rate were found to be the most influential parameters affecting the savings and number of averted deaths. It can be concluded that all the mitigation scenarios were considered to be cost-saving, and increasing the duration of SC and WC would increase both the savings and the number of averted deaths.

12.
Value in Health ; 23:S721, 2020.
Article in English | EMBASE | ID: covidwho-988661

ABSTRACT

Objectives: Older adults are often evaluated as one homogeneous group. As currently illustrated with the COVID-19 pandemic, older adults are however heterogeneous in risk factors for infection and disease, including, for example, frailty, immunity, and clustering. This research aims to assess the use and the importance of including such heterogeneity in older adults in health economic evaluations of preventive interventions, such as vaccinations. Methods: Multiple scoping reviews were conducted to identify the internal (e.g. immunosenescence, comorbidity, and lifestyle) and external (e.g. social interaction, and location such as nursing homes) risk factors in older adults for acquiring infectious diseases and their related consequences. Both, inclusion and presence of risk factors were assessed, derived from economic evaluations and observational studies. We determined which older adults are more vulnerable to respiratory infections (and related disease), such as influenza, pneumococcal and respiratory syncytial virus (RSV) infections. We evaluated the critical heterogenic characteristics that should be considered in the assessment. Results: Scientific literature typically underreports the broad ranges of heterogeneity in older adults that impact on the risk of acquiring infectious diseases and related disease in the economic assessments of preventative strategies. Only a few publications are available that incorporate crucial internal and/or external factors, such as frailty and location. The impacts of the heterogeneity in these risk factors are not precisely measured beyond age. Yet, immunosenescence, levels of frailty, and comorbidities, such as diabetes and obesity are considered crucial internal heterogeneity factors. The interplay between location/clustering and exact timing (seasonality in epidemics) should be considered core external triggers in heterogeneity, potentially impacting the cost-effectiveness. Conclusions: Risk factors involving heterogeneity in older adults are only sparsely incorporated in health economic evaluations of preventative interventions. Economic evaluations would benefit greatly from the inclusion of these risk factors;this would provide more precise, realistic, and robust analyses.

13.
Value in Health ; 23:S645, 2020.
Article in English | EMBASE | ID: covidwho-988646

ABSTRACT

Innovative treatments, such as gene- or immunotherapy, provide promising solutions warranting accelerated approval. Yet, in general accelerated approvals may pose safety challenges. Among the processes for access and affordability of such treatments information on safety may be less than we are used to in non-accelerated procedures. Here, we investigate to what extent existing procedures satisfy the needs of safety assessment in the healthcare system and how potential existing safety gaps can be addressed. A pragmatic review was carried out to identify relevant literature, using PubMed as a search platform to explore MEDLINE and snowballing as an additional method for further search. There is a trend that solutions for accelerated access for innovative treatments are implemented in models of regulatory approvals, yet with limited data. Besides efficacy data, providing adequate safety data is key to transferring conditional- to final marketing authorization. However, this remains a challenge because of the restricted availability and transferability of such data. An example to overcome such issues is the International Coalition of Medicines Regulatory Authorities (ICMRA) who provide equitable access to global clinical trials data regarding COVID-19. Similarly, HTA bodies and manufacturers are overcoming clinical data issues in the Sharing European Early Dialogs (SEED). Many countries re-invent multi-criteria decision analysis (MCDA) as alternative to focus on (cost-) effectiveness only, yet eligibility, clear criteria, choosing the right model, and outcomes interpretation remain challenges. With managed-entry agreements (MEAs), access barriers between manufacturers and health authorities can be are overcome in conditional access situations. Although a growing trend of outcomes-based MEAs is noticed, financial-oriented MEAs remain dominant, and those MEAs that are outcomes-based focus on effectiveness rather than safety. Safety may be an aspect undervalued in accelerated access procedures. We notice and suggest increasing use of MCDA and MEAs also focussing on safety in real-life conditional access situations.

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