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.

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.

Seroprevalence of anti-polio antibodies in a population 7 months to 39 years of age in Uruguay: Implications for future polio vaccination strategies.

This study evaluated the seroprevalence of poliovirus types 1, 2 and 3 antibodies and vaccination coverage in 780 subjects aged between 7 months and 39 years in Montevideo, Uruguay, where oral polio vaccine (OPV) is used. Antibody titers were measured and seroprotection rates and geometric mean titers (GMTs) were compared among four age groups. Vaccination histories were recorded from documents and interviews. Seroprotection rates ranged from 72% to 95% in children aged 7-23 months, 31-77% in 2-9-year olds, 14-45% in 10-19-year olds and 20-59.5% in 20-39-year olds. Seroprotection decreased significantly with increasing age (p<0.05). Polio vaccination coverage was >90% for the two youngest age groups. These results could help guide public policy decisions regarding polio vaccination, and support the use of inactivated polio vaccine following cessation of OPV.

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.