Belgian guidelines for budget impact analyses.

OBJECTIVES: To develop methodological guidelines for budget impact analysis submitted to the Belgian health authorities as part of a reimbursement request. METHODS: A review of the literature was performed and provided the basis for preliminary budget impact guidelines. These guidelines were improved after discussion with health economists from the Belgian Health Care Knowledge Centre (KCE) and different Belgian stakeholders from both government and industry. Preliminary guidelines were also discussed in a workshop with health economists from The German Institute for Quality and Efficiency in Healthcare. Finally, the guidelines were also externally validated by three external experts. RESULTS: The guidelines give explicit guidance for the following components of a budget impact analysis: perspective of the evaluation, target population, comparator, costs, time horizon, modeling, handling uncertainty and discount rate. Special attention is given to handling varying target population sizes over time, applying a time horizon up to the steady state instead of short-term predictions, and similarities and differences between budget impact analysis and economic evaluations. CONCLUSION: The guidelines provide a framework for both researchers and assessors to set up budget impact analyses that are transparent, relevant, of high quality and apply a consistent methodology. This might improve the extent to which such evaluations can reliably and consistently be used in the reimbursement decision making process.

[Varicella-zoster virus seroprevalence in nursery and day-care workers in Lyon (France)]. / Séroprévalence de l'immunité au virus de la varicelle et du zona chez le personnel de crèche et de halte-garderie à Lyon (France).

OBJECTIVE: Varicella is a potential occupational hazard for susceptible individuals working in pediatric institutions because infected adults run a greater risk of severe or even fatal varicella and because the disease is so common in children and so contagious. The seroprevalence of varicella-zoster virus (VZV) was examined in a sample of day-care workers in Lyon (France) to determine whether a targeted vaccination policy was needed. METHODS: Two hundred forty-one sera were sampled and analysed with an Elisa test between March and May 2001. Histories of past VZV infection were collected via questionnaires documented either before or after consultation of medical records or other sources of information. RESULTS: The overall VZV seroprevalence was 99.6%. The positive predictive values of past varicella histories (documented or not) were>99% showing that a history of previous varicella in day-care workers was reliable. However, only 68 to 71% of these with serologically confirmed varicella reported a prior history of varicella. All subjects reporting a non-positive history of varicella were seropositive. CONCLUSIONS: Virtually all day-care workers enrolled in this study presented serological evidence of VZV so that sub-populations at risk for varicella infection for which VZV vaccination may be effective could not be identified. However, the VZV seroprevalence of the workers in pediatric institutions being presumably higher than that of the general adult population (94-96.3%), vaccination of susceptible young recruits before any exposure to the VZV, or even vaccination of students willing to work in a pediatric institution, may be positive.

Recommendations for the use of the 23-valent polysaccharide pneumococcal vaccine in adults: a Belgian consensus report.

A multidisciplinary expert panel, appointed by the High Council for Public Health, evaluated the scientific evidence on which the recommendations for the appropriate use of the pneumococcal vaccine was based and reviewed the studies that became available since previous reports. The conclusions of the working group, presented in this manuscript, resulted in an update of the Belgian recommendations for pneumococcal vaccination.

Economic evaluations of pneumococcal vaccination strategies in adults. A summary of the results.

With the view to re-evaluate the current evidence about the efficiency of adult pneumococcal vaccination, we searched the Medline database to collect recent full economic evaluations on this topic. We included a literature review based on studies published up to June 2001 and 5 other studies published between July 2001 and April 2004. Based on these articles' results, pneumococcal vaccination of the elderly aged between 65 and 75 years is found to be relatively cost-effective for the health care payer. There is also evidence that vaccination of HIV+ patients and of young military personnel may be justifiable on the basis of economic evaluation including direct medical costs only. Conclusions about universal vaccination of younger adults (< 65 years) and of high-risk groups could not be drawn because of controversial results. An accurate assessment of the efficiency of adult pneumococcal vaccination is however hard to achieve given the difficulties in collecting valid input data (e.g. for the incidence and mortality of the disease) and given the remaining uncertainties about the vaccine efficacy for non-invasive disease. Finally, by lack of data, none of the studies estimated the impact of vaccination on antimicrobial resistance.