SELF-PERCEIVED HEALTH STATUS AND ILLNESSES AMONG INTERNALLY DISPLACED PEOPLE IN GEORGIA.

Georgia had several waves of internally displaced people (IDPs) as a result of military conflicts on the territories of Abkhazia and Samachablo starting from 1990's with the latest large wave in 2008. Most of the IDPs live in compact settlements, such as old administrative buildings or specially constructed camps. In both cases, living conditions and social-economic status of IDPs are below Georgia's national average. There is extremely limited data on the health status of the IDPs in Georgia. Health Research Union (HRU) with support from ELRHA/R2HC program conducted a survey to study health service utilization and expenditures among IDPs, and measure the effect of targeted intervention versus untargeted, integrated approach to health financing. The aim of the current study was to analyze the self-reported health status among IDPs on the basis of the data collected through this survey. The survey was carried out among IDPs currently living in Georgia mainly residing in compact settlements. Sampling from the target population was performed by a multi-stage cluster sampling approach. In total 1.319 households with 4,359 household members were recruited and interviewed for the survey. Male accounted for almost 55% of all household members in the survey. Slightly less than half of respondents were married; children under the age of 15 constituted 23% of all IDPs surveyed. In total, 40% of all respondents (1729 persons) report being chronically ill and identify a wide range of conditions. Of them 532 report having 2 or more chronic diseases. About a third of occurrences (29%) of chronic diseases is attributed to cardiovascular diseases. Musculoskeletal and gastrointestinal diseases (each) constitute 13% of all occurrences of chronic diseases. During last 24 months 129 household members gave birth. The prevalence of chronic diseases among adult population increases as the age advances with the highest rate among those aged above 65 with 84% reporting having at least one chronic disease. Self-perceived overall health status was characterized as excellent, very good and good by 53%, as fair by 32% and as poor and very poor by 16% of the respondents. The conducted research was the first wide-scale study of the health status among internally displaced people in Georgia. These data may contribute to better understand the problems in this vulnerable population and evaluate impact of the implementation of the different models of the health care including targeted health insurance for IDPs.

Cost-effectiveness of pneumococcal conjugate vaccination in Georgia.

OBJECTIVE: Financial support from the Global Alliance for Vaccines and Immunization (GAVI) to introduce the 10-valent pneumococcal conjugate vaccine (PCV10) into the routine childhood immunization schedule in Georgia is ending in 2015. As a result, the Interagency Coordination Committee (ICC) decided to carry out a cost-effectiveness analysis to gather additional evidence to advocate for an appropriate evidence-based decision after GAVI support is over. The study also aimed to strengthen national capacity to conduct cost-effectiveness studies, and to introduce economic evaluations into Georgia's decision-making process. METHODOLOGY: A multidisciplinary team of national experts led by a member of the ICC carried out the analysis that compared two scenarios: introducing PCV10 vs no vaccination. The TRIVAC model was used to evaluate 10 cohorts of children over the period 2014-2023. National data was used to inform demographics, disease burden, vaccine coverage, health service utilization, and costs. Evidence from clinical trials and the scientific literature was used to estimate the impact of the vaccine. A 3+0 schedule and a vaccine price increasing to US$ 3.50 per dose was assumed for the base-case scenario. Alternative univariate and multivariate scenarios were evaluated. RESULTS: Over the 10-year period, PCV10 was estimated to prevent 7170 (8288 undiscounted) outpatient visits due to all-cause acute otitis media, 5325 (6154 undiscounted) admissions due to all-cause pneumonia, 87 (100 undiscounted) admissions due to pneumococcal meningitis, and 508 (588 undiscounted) admissions due to pneumococcal non-pneumonia and non-meningitis (NPNM). In addition, the vaccine was estimated to prevent 41 (48 undiscounted) deaths. This is equivalent to approximately 5 deaths and 700 admissions prevented each year in Georgia. Over the 10-year period, PCV10 would cost the government approximately US$ 4.4 million ($440,000 per year). However, about half of this would be offset by the treatment costs prevented. The discounted cost-effectiveness ratio was estimated to be US$ 1599 per DALY averted with scenarios ranging from US$ 286 to US$ 7787. DISCUSSION: This study led to better multi-sectoral collaboration and improved national capacity to perform economic evaluations. Routine infant vaccination against Streptococcus pneumoniae would be highly cost-effective in Georgia. The decision to introduce PCV10 was already made some time before the study was initiated but it provided important economic evidence in support of that decision. There are several uncertainties around many of the parameters used, but a multivariate scenario analysis with several conservative assumptions (including no herd effect in older individuals) shows that this recommendation is robust. This study supports the decision to introduce PCV10 in Georgia.