[Cost-effectiveness analysis of 2 strategies of Helicobacter pylori eradication: results of a prospective and randomized study in primary care]. / Análisis coste-efectividad de dos estrategias de erradicación de Helicobacter pylori: resultados de un estudio prospectivo y aleatorizado en atención primaria.

BACKGROUND: To analyze cost-effectiveness of two different strategies to treat H. pylori infection in peptic ulcer in the primary care setting. PATIENTS AND METHODS: Consecutive patients with endoscopic diagnosis of peptic ulcer were randomized to one of two strategies: a) treatment during 7 days with omeprazole, tetracycline, metronidazole and bismuth subcitrate ("quadruple" therapy) and if failure second-line treatment with omeprazole, amoxycillin and clarithromycin during 7 days (OCA7), and b) initial treatment with OCA7 and if failure treatment with "quadruple therapy". End point was eradication 8 weeks after last treatment dose. Direct and indirect costs were estimated (euros, 1997) and a cost-effectiveness analysis using a decision-tree model was undertaken after real clinical data. 95% confidence intervals are given. RESULTS: After screening 255 patients, 97 were finally included. 48 patients were given strategy a and 49 strategy b. Eradication was obtained (intention-to-treat) in 72.9% (CI 95%: 58.2-84.7) in group a versus 91.8% (CI 95%: 80.4-97.7) (p < 0.05) in group b. Mean cost per case treated was lower in group a (237 versus 268 euros) but cost per case eradicated was lower in group b (320 versus 296 euros). The cost was primarily determined by efficacy. CONCLUSIONS: Treatment with OCA7 followed by rescue with "quadruple" therapy if failure is more efficient in our area that the inverse strategy. Efficiency is mostly determined by efficacy.

Evaluación económica de la vacunación rutinaria a niños de 15 meses de edad frente al virus de la varicela-zoster / Economic evaluation of routine vaccination of 15 month old children against chicken-pox-zoster

Fundamento. Se realiza una evaluación económica, coste-efectividad, comparando un programa hipotético de vacunación rutinaria y masiva frente al virus de la varicela-zoster en niños de 15 meses de edad de la Comunidad Foral de Navarra, frente a la actual estrategia de vacunación reducida a población de alto riesgo. Material y métodos. Se utilizan árboles de decisiones para calcular los costes de los cuidados sanitarios de los casos de infección y de los efectos del programa de vacunación apoyado en los modelos de Markov. La eficacia de la vacuna es del 90-95 por ciento y el escenario para la vacunación produce una inmunogenecidad de al menos diez años, con coberturas del 90 por ciento. Se han tenido en cuenta, tanto los costes directos de los cuidados sanitarios como los costes indirectos en pesetas constantes de 1995, debidos a la pérdida productiva a cargo de algún familiar y el punto de vista adoptado para la valoración del estudio ha sido el social. Resultados. El índice coste-efectividad refleja el coste o ahorro adicional por caso evitado de infección que supone vacunar rutinariamente a los niños respecto a vacular sólo a aquellas personas pertenecientes a las poblaciones de alto riesgo. El coste por caso evitado se sitúa entre las 3500 y las 4000 ptas. Por cada peseta invertida en el programa de vacunación se producirá un reembolso de 0'45 ptas. Conclusiones. El programa de vacunación rutinaria provoca un coste incremental. Sólo en el supuesto de reducir el precio de la vacuna en más de un 50 por ciento, podría el índice coste-efectividad ofrecer un beneficio social neto. (AU)

[Economic evaluation of routine vaccination of 15 month old children against chicken-pox-zoster]. / Evaluación económica de la vacunación rutinaria a niños de 15 meses de edad frente al virus de la varicela-zoster.

BACKGROUND: An economic, cost-effectiveness evaluation was carried out that compared a hypothetical program of routine mass vaccination against the chicken-pox-zoster virus in children aged 15 months in the Foral Community of Navarra against the present strategy of vaccination that is restricted to the high risk population. MATERIAL AND METHODS: Decision trees based on Markov models were used to calculate the costs of the health care of cases of infection and the costs of the effects of the vaccination program. The efficacy of the vaccination is 90-95%, and the scenario produces an immunogenicity of at least ten years, with a coverage of 90%. Account was taken of both the direct costs of health care and the indirect costs, with 1995 Pesetas taken as a constant, due to the loss in productivity of a family member, and a social view point was adopted for evaluating the study RESULTS: The index of cost-effectiveness reflects the additional cost or saving for each case of avoided infection brought about by vaccinating the children in comparison with vaccinating only those persons belonging to the high risk population sectors. The cost per avoided case is situated between 3,500 Ptas and 4,000 Ptas. For each Peseta invested in the vaccination program there would be a reimbursement of 0.45 Pesetas. CONCLUSIONS: The routine vaccination program produces an incremental cost. Only in the case of a reduction in the price of the vaccine by more than 50% would the cost-effectiveness index offer a net social profit.

Vaccination against hepatitis B virus in Spain: a cost-effectiveness analysis.

A cost-effectiveness analysis was made to determine the effectiveness of the following strategies of mass immunization with the new recombinant vaccine against the hepatitis B virus in Spain: vaccination of adolescents, newborns, both populations, and vaccination plus passive immunization of newborns of HBsAg positive mothers. Decision trees supported on Markov models with Monte Carlo simulation have been used for the calculation of costs of the disease, and a mathematical model of differential equations was used for the simulation of the potential effectiveness of vaccination. The costs considered were those associated with the vaccination and travel of subjects, diagnosis, and treatment of the disease. The results are presented as additional cost or saving per case of infection prevented. In all assumptions, results showed that the most effective strategy for mass vaccination was the combination of vaccinating all adolescents together with active and passive immunization of children born to HBsAg positive mothers.

Cost effectiveness of hepatitis A virus immunisation in Spain.

The aim of this study was to evaluate, in economic terms, the recently launched hepatitis A vaccine in comparison with the use of nonspecific immune globulin, for the prevention of hepatitis A. A cost-effectiveness analysis was performed, comparing mass and selective strategies for both active and passive immunisation in children, adolescents and the high-risk adult population. Direct costs of diagnosis, treatment and immunisation, and travelling expenses of the individuals, were considered. The alternative of mass vaccination for children and adolescents cost 2679 to 6394 European Currency Units (ECU) [$US 3040 to $US 8312; 1994 values] per case prevented. Selective vaccination of high-risk individuals cost ECU205 per case prevented for young adults (those aged about 20 years) when the annual risk of contracting the disease was 0.7%, while there were net savings for all age groups when there was a 2 to 3% risk. The most sensitive variables affecting the cost of mass-vaccination strategies were incidence of hepatitis A, vaccine coverage and vaccine cost; for the various high-risk groups, these were vaccine cost, incidence of hepatitis A and costs of treating infection. Selective vaccination, depending on the age of high-risk patients [mainly travellers to endemic areas for periods of over 6 months, or those under 'precarious' conditions (e.g. backpackers, even for short periods)], is the most efficient alternative; in fact, the cost-effectiveness ratio has not been calculated, since there were net savings. For occasional travellers (as above, and those travelling for periods of under 6 months in 10 years), passive immunisation is more efficient. Selective vaccination for package-tour, short-stay travellers (infection risk around 0.3%) and strategies for mass vaccination of children and adolescents are not justified from an efficiency point of view.

Cost-effectiveness analysis of hepatitis B vaccination strategies in Catalonia, Spain.

Hepatitis B virus (HBV) infection is an important public health problem all over the world. Vaccination is one way to prevent it, and several strategies can be used depending on endemicity, the main pattern of HBV transmission and the demographic structure of the population. In this study, an economic comparison of 3 vaccination strategies (mass adolescent vaccination, mass infant vaccination and mass combined vaccination) was performed in Catalonia, Spain. Screening pregnant women for HBV infection in combination with these strategies was also evaluated. Epidemiological models to analyse patterns of HBV infection with and without vaccination and to calculate HBV-associated costs were designed. Comparison between strategies was done using cost-effectiveness analysis from the perspective of the healthcare system. Epidemiological model results indicate that implementation of HBV vaccination could prevent as many as 104,778 new acute infections, and avoid up to 5239 chronic infections, 2096 cases of cirrhosis and 419 cases of hepatocarcinoma over a 20-year period in Catalonia. Cost-effectiveness analysis shows that mass adolescent vaccination is the most efficient strategy, with lower costs per avoided case than the other 2 strategies. When any of these strategies is complemented by screening for HBV in pregnant women, the number of avoided cases is always higher and the cost per avoided case decreases or remains unchanged.

[Economic evaluation of prophylaxis with recombinant granulopoiesis stimulating factor]. / Evaluación económica de la profilaxis con el factor estimulador de la granulopoyesis recombinante.

BACKGROUND: The aim of the study was to economically evaluate the prophylactic use of the recombinant factor of the stimulation of granulocyte colonies (rG-CSF) for the prevention of episodes of febrile neutropenia (EFN) following antineoplasic chemotherapy. METHODS: The methods of economic evaluation used were those of cost analysis and cost-effectivity analysis. The probability of occurence of EFN was estimated by the application of the Delphi method and the costs were calculated. RESULTS: The costs of EFN for the patients with solid tumors is situated between 236,000-377,000 pesetas according to hospitalary centers. For patients with acute leukemia the value was estimated as between 391,000-667,000 pesetas. The results of the cost analysis indicate that the net cost per patient prophylactically treated is between 4,000-64,000 pesetas. The results of the cost-effectivity analysis indicate that the cost per case of no incidence of EFN is between 20,000-320,000 pesetas. CONCLUSIONS: Episodes of febrile neutropenia carry expansive hospital and antibiotic clinical treatment. The prophylactic use of new medication for patients between the first and second cycle of chemotherapy, in agreement with the estimates calculated, does not save health care costs but may improve the quality of life in these patients and permit the continuation of a therapeutic schedule without interruption which may improve the life expectancy of the patient.

[A cost-effectiveness analysis of vaccination against the hepatitis B virus]. / Análisis de coste-efectividad de la vacunación frente al virus de la hepatitis B.

BACKGROUND: The incidence of hepatitis B is on the increase despite immunization of people susceptible to risk populations. After the introduction of a recombinant vaccine in 1986, it has become possible to evaluate different alternatives of immunization, from the point of view of efficacy, with the aim of controlling the disease. METHODS: A cost-effectiveness analysis was performed with the use of decision trees and calculation of the cost per avoided case of infection in the different strategies evaluated, vaccination to risk groups, pubescent youth, newborns, and communicated accidental exposure. An evaluation of the different alternatives was carried out in a simple model associated to a passive and active immunization program of newborns of mothers who are carriers of HbsAg and finally, the possibility of revaccination is added. RESULTS: Costs and future profits are presented in pesetas for 1990 and rates of social discounts of 4% and 7% are applied actualizing the same. For the prevalence estimated in the bibliography consulted, the cost per avoided case oscillated between 115,000 and 310,000 ptas in the most numerous risk groups (those living with carriers and ADVP) with lower covering; in massive immunization of pubescent youth the costs are from 30,000 to 130,000 ptas; the costs for newborns is of about 400,000 ptas; and accidental exposure rises to 500,000 ptas per avoided case. CONCLUSIONS: In vaccination versus the hepatitis B virus systematic vaccination of adolescents is proposed as most efficient and with the aim of disease control a program of passive and active immunization of newborns of carrier mothers should be included.