Cost minimization analysis of a hexavalent vaccine in Argentina.

BACKGROUND: Argentina currently uses a pentavalent vaccine containing diphtheria, tetanus, pertussis (whole cell), Haemophilus influenza type b and hepatitis B antigens, administered concomitantly with the inactivated polio vaccine (IPV) (DTwP-Hib-HB plus IPV) in its childhood vaccination schedule. However, hexavalent vaccines containing acellular pertussis antigens (DTaP-Hib-HB-IPV) and providing protection against the same diseases are also licensed, but are only available with a private prescription or for high-risk pre-term infants in the public health program. We analyzed the cost of switching from the current schedule to the alternative schedule with the hexavalent vaccine in Argentina, assuming similar levels of effectiveness. METHODS: The study population was infants ≤ 1 year of age born in Argentina from 2015 to 2019. The analysis considered adverse events, programmatic, logistic, and vaccine costs of both schemes from the societal perspective. The societal costs were disaggregated to summarize costs incurred in the public sector and with vaccination pre-term infants in the public sector. Costs were expressed in 2021 US Dollars (US$). RESULTS: Although the cost of vaccines with the alternative scheme would be US$39.8 million (M) more than with the current scheme, these additional costs are in large part offset by fewer adverse event-associated costs and lower programmatic costs such that the overall cost of the alternative scheme would only be an additional US$3.6 M from the societal perspective. The additional cost associated with switching to the alternative scheme in the public sector and with the vaccination of pre-term infants in the public sector would be US$2.1 M and US$84,023, respectively. CONCLUSIONS: The switch to an alternative scheme with the hexavalent vaccine in Argentina would result in marginally higher vaccine costs, which are mostly offset by the lower costs associated with improved logistics, fewer separate vaccines, and a reduction in adverse events.

Switching from trivalent to quadrivalent inactivated influenza vaccines in Uruguay: a cost-effectiveness analysis.

We evaluated the cost-utility of replacing trivalent influenza vaccine (TIV) with quadrivalent influenza vaccine (QIV) in the current target populations in Uruguay. An existing decision-analytic static cost-effectiveness model was adapted for Uruguay. The population was stratified into age groups. Costs and outcomes were estimated for an average influenza season, based on observed rates from 2013 to 2019 inclusive. Introducing QIV instead of TIV in Uruguay would avoid around 740 additional influenza cases, 500 GP consultations, 15 hospitalizations, and three deaths, and save around 300 workdays, for the same vaccination coverage during an average influenza season. Most of the influenza-related consultations and hospitalizations would be avoided among children ≤4 and adults ≥65 years of age. Using QIV rather than TIV would cost an additional ~US$729,000, but this would be partially offset by savings in consultations and hospitalization costs. The incremental cost per quality-adjusted life-year (QALY) gained with QIV would be in the order of US$18,000 for both the payor and societal perspectives, for all age groups, and around US$12,000 for adults ≥65 years of age. The main drivers influencing the incremental cost-effectiveness ratio were the vaccine efficacy against the B strains and the percentage of match each season with the B strain included in TIV. Probabilistic sensitivity analysis showed that switching to QIV would provide a favorable cost-utility ratio for 50% of simulations at a willingness-to-pay per QALY of US$20,000. A switch to QIV is expected to be cost-effective for the current target populations in Uruguay, particularly for older adults.

Valuing the cost of improving Chilean primary vaccination: a cost minimization analysis of a hexavalent vaccine.

BACKGROUND: The phased withdrawal of oral polio vaccine (OPV) and the introduction of inactivated poliovirus vaccine (IPV) is central to the polio 'end-game' strategy. METHODS: We analyzed the cost implications in Chile of a switch from the vaccination scheme consisting of a pentavalent vaccine with whole-cell pertussis component (wP) plus IPV/OPV vaccines to a scheme with a hexavalent vaccine with acellular pertussis component (aP) and IPV (Hexaxim®) from a societal perspective. Cost data were collected from a variety of sources including national estimates and previous vaccine studies. All costs were expressed in 2017 prices (US$ 1.00 = $Ch 666.26). RESULTS: The overall costs associated with the vaccination scheme (4 doses of pentavalent vaccine plus 1 dose IPV and 3 doses OPV) from a societal perspective was estimated to be US$ 12.70 million, of which US$ 8.84 million were associated with the management of adverse events related to wP. In comparison, the cost associated with the 4-dose scheme with a hexavalent vaccine (based upon the PAHO reference price) was US$ 19.76 million. The cost of switching to the hexavalent vaccine would be an additional US$ 6.45 million. Overall, depending on the scenario, the costs of switching to the hexavalent scheme would range from an additional US$ 2.62 million to US$ 6.45 million compared with the current vaccination scheme. CONCLUSIONS: The switch to the hexavalent vaccine schedule in Chile would lead to additional acquisition costs, which would be partially offset by improved logistics, and a reduction in adverse events associated with the current vaccines.

Reestructura del primer nivel de atención mercado de trabajo del sector salud, trabajo conjunto entre el Ministerio de Salud Pública y el Sindicato Médico del Uruguay / Restructure of the first level of attention labor market of the health sector, joint work between the Ministry of Public Health and the Medical Union of Uruguay

INTRODUCCION: Las bases sobre las que se apoyó ese trabajo fueron los postulados que surgen de las declaraciones finales de los eventos realizados por el SMU entre finales de los 90 y comienzos de 2000, denominados Solís I y II. OBJETIVOS: El objetivo del presente estudio es el de diseñar modelos alternativos de organización y funcionamiento de los recursos humanos en el primer nivel de atención, con la finalidad de contribuir con el proceso de transformación del modelo asistencial orientado a mejorar la calidad de vida de la población, en el marco de los principios que inspiran la reforma sanitaria. MATERIALES Y MÉTODOS: Se delinea entonces una imagen-objetivo de organización y funcionamiento y se establece el número de equipos básicos de salud que se requieren para atender las necesidades de la población, a partir del cambio de las condiciones laborales y retributivas. RESULTADOS: Asimismo, se describe un conjunto de opciones o criterios generales para el análisis y diseño de un proceso de transición que parta de la situación actual y oriente el cambio hacia la imagen-objetivo previamente definida. El equipo básico propuesto está integrado por medicina general, pediatría, ginecoobstetricia y enfermería. Los aspectos centrales de la propuesta de cambio de las condiciones de trabajo son la ampliación de la carga horaria con el objetivo demejorar la calidad asistencial concentrando empleo; incorporación a la jornada laboral actividades que no pertenecen a la atención directa como investigación, formación, coordinación; y disminución del número de usuarios atendidos por hora. CONCLUSIÓN: En términos retributivos, se propone una contrapartida monetaria en consonancia con los cambios planteados y un cambio en el sistema de remuneración hacia el pago por capitación a todo el equipo básico de salud.

Servicios de salud en el Uruguay / Health service in Uruguay

Este artículo describe las principales características de los servicios de atención a la salud del Uruguay. Se hace un breve análisis del contexto socio-histórico en el cual se constituye el Uruguay moderno y la conformación original de la atención sanitaria. Se describen las principales características demográficas y epidemiológicas y su tendencia a lo largo del siglo XX. Se describen los subsectores público y privado, responsables de la atención de la salud de la población. Cada uno de ellos, con gasto muy diferente y por lo tanto, con recursos muy diferentes, logran resultados obviamente distintos. Se analizan las principales tendencias en el subsector privado. Se concluye con un decálogo de "patologías" del sistema y se sugieren las líneas que debieron recorrerse para el logro de la universalidad y equidad

Servicios de salud en el Uruguay / Health service in Uruguay

Este artículo describe las principales características de los servicios de atención a la salud del Uruguay. Se hace un breve análisis del contexto socio-histórico en el cual se constituye el Uruguay moderno y la conformación original de la atención sanitaria. Se describen las principales características demográficas y epidemiológicas y su tendencia a lo largo del siglo XX. Se describen los subsectores público y privado, responsables de la atención de la salud de la población. Cada uno de ellos, con gasto muy diferente y por lo tanto, con recursos muy diferentes, logran resultados obviamente distintos. Se analizan las principales tendencias en el subsector privado. Se concluye con un decálogo de "patologías" del sistema y se sugieren las líneas que debieron recorrerse para el logro de la universalidad y equidad (AU)