The cost-effectiveness of food consistency modification with xanthan gum-based Nutilis Clear® in patients with post-stroke dysphagia in Poland.

BACKGROUND: Dysphagia is a well-known stroke complication characterised by difficulty in swallowing. It may affect the majority of stroke patients and increases mortality and morbidity, due to aspiration pneumonia and malnutrition. Food thickening may help patients to feed themselves, and its effectiveness was demonstrated. However, the cost-effectiveness studies are lacking. We evaluate the cost-utility of xanthan gum-based consistency modification therapy (Nutilis Clear®) in adult post-stroke patients from the public payer perspective in Poland. METHODS: Routine clinical practice was used as a comparator, as no alternative specific treatment for dysphagia is available. To verify the robustness of the results against the modelling approach, we built two models: a static (a fixed simple-equations model, 8-week time horizon of dysphagia) and a dynamic one (Markov model, with a possible dysphagia resolution over a 1-year horizon). In both models, the treatment costs, health state utilities, and clinical events (i.e. aspiration, aspiration pneumonia, death) were included. Parameters were estimated jointly for both models, except for the duration of dysphagia and the risk of aspiration pneumonia (specific to the time horizon). We only assumed Nutilis Clear® to prevent aspirations, without affecting dysphagia duration. RESULTS: The average cost of one quality-adjusted life year (i.e. the incremental cost-utility ratios, ICURs) amounted to 21,387 PLN (€1 ≈ 4.5 PLN), and 20,977 PLN in static and dynamic model, respectively; far below the cost-effectiveness threshold in Poland (147,024 PLN). The one-way, scenario, and probabilistic sensitivity analysis confirmed these findings. CONCLUSIONS: Nutilis Clear® is highly cost-effective in Poland from the public payer perspective. Our approach can be used in other countries to study the cost-effectiveness of food thickening in stroke patients.

Cloning and knockout of phytoene desaturase gene in Sphingomonas elodea ATCC 31461 for economic recovery of gellan gum.

A gene encoding phytoene desaturase (crtI) in the carotenoid biosynthetic pathway of Sphingomonas elodea ATCC 31461, an industrial gellan gum-producing strain, was cloned and identified. This gene is predicted to encode a 492-amino acid protein with significant homology to the phytoene desaturase of other carotenogenic organisms. Knockout of crtI gene blocked yellow carotenoid pigment synthesis and resulted in the accumulation of colorless phytoene, confirming that it encodes phytoene desaturase. Further research indicates that the yield of gellan gum production by crtI gene knockout mutants is almost the same as that by the wild-type strain. In addition, a recovery method based on the colorless fermentation broth of the crtI gene knockout mutant was investigated. Compared to the volume of alcohol for the parent strain, much less alcohol (30%) is required in this recovery process; thus, the costs of downstream purification of gellan gum can be substantially reduced.

[Sphingomonas sp.: an important microbial resource for biopolymer synthesis].

The genus Sphingomonas was established in 1990. Sphingomonas spp. synthesize sphingans, structurally related biopolymers such as gellan, welan and diutan. At present, only gellan is applied widely in foods and pharmaceuticals. The economic value of other sphingans has not been well explored, and related research of sphingans still remains limited. In the present review, we address the latest taxonomy developments of Sphingomonas, details about structure, characteristics and biosynthetic pathway of sphingans, current knowledge on the molecular genetics and genetic engineering of sphingans. In addition, we indicate future research needs.

Optimizing emulsan production of A. venetianus RAG-1 using response surface methodology.

Statistical experimental design was used to optimize medium constituents for emulsan production by Acinetobacter venetianus RAG-1 in batch cultivation. The factors affecting emulsan production were screened by a two-level factorial design, and the optimal concentration of medium constituents for emulsan production were determined by the method of steepest path ascent and central composite experimental design. Experimental results showed that the optimal medium constituents were 9.16 g/L ethanol, 8.2 g/L KH(2)PO(4), 23.32 g/L K(2)HPO(4), 5.77 g/L (NH(4))(2)SO(4) and 0.354 g/L MgSO(4)*7H(2)O. Under this optimal composition, the predicted emulsan production was 72.198 mg/L, and experimental value was 73.312 mg/L for 80 h culture in the shake flasks, and the emulsan yield by A. venetianus RAG-1 was enhanced nearly 1.48-fold (from 49.5 to 73.312 mg/L). Based on the results, we identify the optimal medium constituents for emulsan production and could take advantage of strategy for scale up the fermentation of emulsan production.

An optimization model for reducing typhoid cases in developing countries without increasing public spending.

This article considers the investment case for using the Vi polysaccharide vaccine in developing countries from two perspectives: reducing typhoid cases and limiting new health care spending. A case study is presented using data from South and Southeast Asia. The purpose of the paper, however, is to draw broad implications that may apply to developing countries in general. Typical consumer demand functions developed from stated preference household surveys in South and Southeast Asia are used to predict probabilities of adults and children purchasing typhoid vaccinations at different prices. These functions are incorporated in a formal mathematical model. Using data from the recent literature for South and Southeast Asia for typhoid incidence, Vi vaccine effectiveness, public cost of illness, and vaccination program cost, three mass vaccination policy alternatives are evaluated: charging adults and children different (optimal) prices, charging uniform prices, and providing free vaccines. Assuming differential pricing is politically feasible, different vaccine prices for children and adults would maximize the number of typhoid cases avoided from a mass vaccination program if the public sector faces a budget constraint on spending for the vaccination program. However, equal prices for children and adults produce very similar results, and they might be more readily accepted by the community. Alternatively, if vaccines are free, the number of cases is not significantly reduced compared to either pricing policy, but a large external financial contribution from government or donors would be required. A Monte Carlo simulation explores the effects of uncertain parameters on vaccination program outcomes.

[Economic aspects of hospitaly treated pneumococcal pneumonia and the results of Pneumo 23 vaccine use in Serbia].

INTRODUCTION: In Serbia, there is a significant number of persons suffering of pneumococcal pneumonia. Persons aged 65 years or older, immunocompromised patients, patients with co-morbidities, such as chronic obstructive lung disease and congestive heart failure, are at the highest risk for developing pneumococcal pneumonia. Most of the patients are treated empirically, although it is often overlooked that Streptococcus pneumoniae can be resistant to the used antibiotics. The treatment costs of such inpatients and outpatients are very high. In Serbia, immunization of persons at risk to develop the diseases caused by Streptococcus pneumoniae is carried out using pneumococcus polysaccharide vaccine according to clinical indications. The exact number of immunized persons and the total number of registered patients are still unknown, but it is certain of being unjustifiably low. OBJECTIVE: The goal of the study was to investigate, during a one-year period, the number and basic characteristics of persons hospitably treated for pneumonia, the type of cause of the infection, applied antibiotic medications, duration and costs of hospital treatment at the Institute for Lung Diseases and Tuberculosis of the Clinical Centre of Serbia in Belgrade. METHOD: We retrospectively analyzed the medical records of patients with pneumonia treated at the Institute for Lung Diseases and Tuberculosis of the Clinical Centre of Serbia in Belgrade during 2006. RESULTS: During the observed one-year period, 290 patients underwent hospital treatment, of whom the cause of the infection was confirmed in 116 (40%). The average duration of hospitalization was 12 days, with treatment cost of 32,031.74 RSD (402.42 EUR) per patient. The treatment cost per patient including general and intensive care was 18,290.01 RSD (229.78 EUR). The distribution cost of Pneumo 23 vaccine in Serbia, without purchase tax, was 746.90 RSD (9.38 EUR). CONCLUSION: Pneumococcal pneumonia is a significant medical and economic problem for the healthcare system of Serbia. The use of antipneumococcal vaccination can be useful in decreasing the overall treatment costs related to pneumococcal infection.

Carriage rate of Haemophilus influenzae among preschool children in Turkey.

This study was designed to determine the prevalence of healthy Haemophilus influenzae carriers in a random sample of the preschool population in Kayseri, Turkey. The lack of H. influenzae type b (Hib) disease surveillance and epidemiological data on the throat carriage of Turkish children has caused a delay in the introduction of conjugated Hib vaccination into proposed national vaccination programs. Oropharyngeal cultures were collected and cultured on chocolate agar supplemented with 260 microg/ml bacitracin from 683 children between May and June, 2006. One hundred seven (15,6%) of the 683 children studied were found to be as H. influenzae carriers, and 29 (4,2%) isolates were serotype b. Beta-lactamase production was detected in four isolates (3.7%). According to multivariate analysis, the sex of the child and the number of people sharing the same room with the child significantly influenced the odds of carrying H. influenzae. Age, having older siblings, passive smoking, respiratory infection during the last 30 days, number of people in the household, attending kindergarten or a day-care center, and household income were not significant variables. Our results suggest that there is a strong relationship between exposure to large numbers of children and H. influenzae carriage.

Relación costo-efectividad de la vacuna contra Haemophilus influenzae tipo b en niños menores de dos años de edad en Colombia / The cost-effectiveness of Haemophilus influenzae type b vaccine for children under 2 years of age in Colombia

OBJETIVOS: Las vacunas conjugadas contra Haemophilus influenzae tipo b (Hib) son la herramienta más importante para prevenir la mayoría de las enfermedades invasoras producidas por dicho patógeno, pero debido a su costo, aún no se han introducido mundialmente de manera masiva. En el presente estudio se determinó la relación costo-efectividad de una vacuna contra Hib para prevenir la neumonía y la meningitis bacterianas en niños menores de 2 años en Colombia. MÉTODOS: Se estimaron los costos directos e indirectos de la neumonía y la meningitis hospitalaria y siguiendo las recomendaciones de la Organización Mundial de la Salud (OMS), la relación costo-efectividad de los programas de vacunación contra Hib. Se estimaron también las razones de costos por caso evitado de enfermedad invasora por Hib y el costo por año de vida salvado en dos situaciones hipotéticas: con vacunación contra Hib (cobertura vacunal: 90 por ciento) y sin vacunación. RESULTADOS: El costo medio del tratamiento hospitalario de un caso de neumonía fue de 611,5 dólares estadounidenses (US$) (intervalo de confianza del 95 por ciento [IC95 por ciento]: 532,2 - 690,8), el costo medio del tratamiento hospitalario de un caso de meningitis fue de US$ 848,9 (IC95 por ciento: 716,8 - 981,0) y el costo por caso evitado de enfermedad invasora por Hib, de US$ 316,7 (IC95 por ciento: 294,2 - 339,2). La relación costo-efectividad en la hipótesis con vacunación fue de 2,38, frente a 3,81 en la hipótesis sin vacunación. CONCLUSION: La aplicación de un programa adecuado de vacunación contra Hib en Colombia puede prevenir cerca de 25 000 casos de enfermedad invasora por año, lo que representa un ahorro de por lo menos US$ 15 millones anuales. Además, puede evitar cerca de 700 defunciones y salvar anualmente 44 054 años de vida.

OBJECTIVE: Conjugate vaccines are the best public health tools available for preventing most invasive diseases caused by Haemophilus influenzae type b (Hib), but the high cost of the vaccines has so far kept them from being introduced worldwide. The objective of this study was to estimate the cost-effectiveness of introducing Hib conjugate vaccines for the prevention of meningitis and pneumonia among children under 2 years of age in Colombia. METHODS: We estimated the direct and indirect costs of managing in-hospital pneumonia and meningitis cases. In addition, following the recommendations of the World Health Organization, we assessed the cost-effectiveness of Hib vaccination programs. We also estimated the costs for preventing Hib cases, and the cost per year of life saved in two hypothetical situations: (1) with vaccination against Hib (with 90 percent coverage) and (2) without vaccination. RESULTS: The average in-hospital treatment costs were US$ 611.50 (95 percent confidence interval (95 percent CI) = US$ 532.2 to US$ 690.8) per case of pneumonia and US$ 848.9 (95 percent CI = US$ 716.8 to US$ 981.0) per case of meningitis. The average cost per Hib case prevented was US$ 316.7 (95 percent CI = US$ 294.2 to US$ 339.2). In terms of cost-effectiveness, the cost would be US$ 2.38 per year of life saved for vaccination, versus US$ 3.81 per year of life saved without vaccination. CONCLUSION: Having an adequate Hib vaccination program in Colombia could prevent around 25 000 cases of invasive disease per year, representing a cost savings of at least US$ 15 million annually. Furthermore, the program could prevent some 700 deaths per year and save 44 054 years of life per year.

Economic evaluation of Haemophilus influenzae type b vaccination in Moscow, Russian Federation.

OBJECTIVE: To estimate the cost-effectiveness of providing Haemophilus influenzae type b (Hib) vaccine to children in Moscow in routine immunization services. METHODS: The incidence of Hib meningitis among children aged <5 years in Moscow was obtained from a prospective surveillance study undertaken during October 1999-September 2001, with treatment cost data collected for all cases. Sequelae in surviving children were assessed in December 2002. The costs of Hib vaccination in Moscow were estimated assuming a vaccine price of US dollar 5 per dose and the same four-dose schedule and 97% coverage as for diphtheria-tetanus-pertussis vaccine. The most uncertain variables were varied in a sensitivity analysis. RESULTS: The annual incidence of Hib meningitis was 5.7 per 100,000 children <5 years. The average treatment cost for an acute Hib meningitis case was US dollar 1296. For a patient with sequelae, the average additional lifetime discounted treatment cost was US dollar 15,820. The total annual cost of Hib vaccination of infants in Moscow was estimated as US dollar 1.5 million per year. In the base case analysis, the cost-effectiveness ratios amount to US dollar 77,503 per Hib meningitis case averted and US dollar 10,842 per discounted disability adjusted life year averted. The break-even vaccine price, where the annual vaccination costs equal annual treatment costs averted, is only US dollar 0.04 per dose in the base case scenario. If discounted indirect costs are included, the break-even vaccine price is US dollar 0.5 per dose. CONCLUSION: In Moscow, the incidence of Hib meningitis is low and the costs of hospitalization and subsequent medical treatment are relatively inexpensive. Given these factors, Hib vaccine at US dollar 5 per dose would not be a cost-effective option in Moscow at the present time.

Xanthan gum: an economical substitute for agar in plant tissue culture media.

Xanthan gum, a microbial desiccation-resistant polysaccharide prepared commercially by aerobic submerged fermentation from Xanthomonas campestris, has been successfully used as a solidifying agent for plant tissue culture media. Its suitability as a substitute to agar was demonstrated for in vitro seed germination, caulogenesis and rhizogenesis of Albizzia lebbeck, androgenesis in anther cultures of Datura innoxia, and somatic embryogenesis in callus cultures of Calliandra tweedii. Culture media used for eliciting these morphogenic responses were gelled with either 1% xanthan gum or 0.9% agar. Xanthan gum, like agar, supported all these responses.

Immunogenicity and safety of four different doses of Haemophilus influenzae type b-tetanus toxoid conjugated vaccine, combined with diphtheria-tetanus-pertussis vaccine (DTP-Hib), in Indonesian infants.

Widespread use of Haemophilus influenzae type b (Hib) conjugated vaccine in industrialized countries has resulted in a dramatic decline in the incidence of invasive Hib diseases, but the vaccine's cost has prevented its inclusion in basic immunization programs in developing countries. To overcome this problem, combination with diphtheria-tetanus-pertussis (DTP) vaccine or reduction in the dose of Hib vaccine has been proposed. To evaluate the immunogenicity and adverse reactions from lower doses of Hib-polyribosylphosphate (PRP) conjugated with tetanus toxoid (PRP-T), a double-blind study was conducted in Jakarta, Indonesia, and its suburbs. A total of 1048 infants 6 weeks to 6 months of age received three doses of DTP vaccine combined with the usual 10 microg dose or with a reduced dose of 5, 2.5 or 1.25 microg of PRP-T at two-monthly intervals. Antibodies were measured prior to the first dose and 4-6 weeks following the third dose. Adverse reactions were similar among all four groups. The only significant difference was a higher rate of irritability (p<0.02) and of temperature elevation >38 degrees C (p<0.009) after doses 1 and 2 in the lowest dose group (1.25 microg PRP-T) compared to the other groups. All participants tested had a 4-fold increase in antibodies against all DTP antigens. In addition, after a fourth booster dose of Hib, 99.6% of infants produced >or=0.15 microg/ml of antibody to Hib-PRP, and 96.4% showed levels >or=1.0 microg/ml after primary immunization, level that correlate with short- and long-term immunity, respectively. Antibody titers to the PRP antigen showed no significant differences among dosage groups with the exception of the 5.0 microg group, which had a significantly higher GMC than the 1.25 microg group (p<0.012). This study demonstrates that primary vaccination with half, one-fourth, or one-eighth of the usual dose of PRP-T, combined with DTP vaccine, produces protective immune responses, and has side effects that are comparable to DTP vaccination alone. In these lower dosages, PRP-T conjugate vaccine can lower vaccine costs to a level that is affordable for infant immunization programs in developing countries.

[The cost-effectiveness of Haemophilus influenzae type b vaccine for children under 2 years of age in Colombia]. / Relación costo-efectividad de la vacuna contra Haemophilus influenzae tipo b en niños menores de dos años de edad en Colombia.

OBJECTIVE: Conjugate vaccines are the best public health tools available for preventing most invasive diseases caused by Haemophilus influenzae type b (Hib), but the high cost of the vaccines has so far kept them from being introduced worldwide. The objective of this study was to estimate the cost-effectiveness of introducing Hib conjugate vaccines for the prevention of meningitis and pneumonia among children under 2 years of age in Colombia. METHODS: We estimated the direct and indirect costs of managing in-hospital pneumonia and meningitis cases. In addition, following the recommendations of the World Health Organization, we assessed the cost-effectiveness of Hib vaccination programs. We also estimated the costs for preventing Hib cases, and the cost per year of life saved in two hypothetical situations: (1) with vaccination against Hib (with 90% coverage) and (2) without vaccination. RESULTS: The average in-hospital treatment costs were 611.50 US$ (95% confidence interval (95% CI) = 532.2 to 690.8 US$) per case of pneumonia and 848.9 US$ (95% CI = 716.8 to 981.0 US$) per case of meningitis. The average cost per Hib case prevented was 316.7 US$ (95% CI = 294.2 to 339.2 US$). In terms of cost-effectiveness, the cost would be 2.38 US$ per year of life saved for vaccination, versus 3.81 US$ per year of life saved without vaccination. CONCLUSION: Having an adequate Hib vaccination program in Colombia could prevent around 25,000 cases of invasive disease per year, representing a cost savings of at least 15 million US$ annually. Furthermore, the program could prevent some 700 deaths per year and save 44,054 years of life per year.

Vaccines based on the cell surface carbohydrates of pathogenic bacteria

Vacinas glicoconjugadas, cujo carboidrato da superfície de um microrganismo está covalentemente ligado a uma proteína carreadora, vêm sendo consideradas como efetivas para gerar respostas imunes que previnem um grande número de doenças. A tecnologia é genérica e aplicável a vários patógenos, se os anticorpos contra os carboidratos de superfície forem capazes de proteger contra a infecção. Três vacinas contra Haemophilus influenzae tipo b, Neissseria meningitidis Grupo C e sete sorotipos de Streptococcus pneumoniae já foram licenciadas e muitas outras estão em desenvolvimento. Este artigo discute o racional para o desenvolvimento e uso de vacinas glicoconjugadas; os mecanismos pelos quais elas induzem respostas imune dependentes de célula T e suas implicações para o seu desenvolvimento; o papel dos métodos físico-químicos na caracterização e no controle de qualidade dessas vacinas; e os produtos novos que estão em desenvolvimento.

Vaccines based on the cell surface carbohydrates of pathogenic bacteria.

Glycoconjugate vaccines, in which a cell surface carbohydrate from a micro-organism is covalently attached to an appropriate carrier protein are proving to be the most effective means to generate protective immune responses to prevent a wide range of diseases. The technology appears to be generic and applicable to a wide range of pathogens, as long as antibodies against surface carbohydrates help protect against infection. Three such vaccines, against Haemophilus influenzae type b, Neisseria meningitidis Group C and seven serotypes of Streptococcus pneumoniae, have already been licensed and many others are in development. This article discusses the rationale for the development and use of glycoconjugate vaccines, the mechanisms by which they elicit T cell-dependent immune responses and the implications of this for vaccine development, the role of physicochemical methods in the characterisation and quality control of these vaccines, and the novel products which are under development.

[Epidemiology of Haemophilus influenzae meningitis in Tunisia]. / Epidémiologie des méningites à Haemophilus influenzae en Tunisie.

The incidence of Haemophilus influenzae b meningitis (Hib) in children < 5 years in Tunisia was studied through a surveillance system set up in June 2000 and followed for 14 months. Population-based surveillance began in 3 governorates and sentinel surveillance in 2. Children < 5 years suspected of meningitis had lumbar puncture, macroscopic exam, blood count, chemical analysis and culture carried out. In the 14 months, 80 cases of meningitis were recorded. From the population-based surveillance most cases were children < 1 year (73.6%) and boys (64%). H. influenzae was isolated in 38% of cases, pneumococci in 13% and meningococci in 7%. The incidence of confirmed Hib was 14.4/100 000 children. The estimated cost of identifying and treating Hib meningitis and its complications was greater than the cost of vaccine introduction. Based this study, the Ministry of Health has decided to introduce Hib vaccination.

Economic evaluation of a combined DTPa, hepatitis B, polio, Hib vaccine. Potential impact of the introduction of Infanrix-Hexa in the French childhood immunisation schedule.

A new hexavalent combination vaccine, Infanrix-HEXA, including a recombinant hepatitis B vaccine in addition to the vaccines for diphtheria, tetanus, pertussis, poliomyelitis, and Haemophilus influenzae type B, has recently become available in France. The objectives of this study were to: (1) estimate the break-even price of Infanrix-Hexa for the National Sickness Fund; (2) evaluate its potential impact on vaccine coverage for hepatitis B and the corresponding budget impact. The public price of Infanrix-HEXA associated with a break-even point would be 53.77 euro. Our analyses suggested that other estimates based on a societal perspective including opportunity and indirect costs remained close to this value. The annual additional reimbursed cost of protecting an infant against the risk of hepatitis B would be 28.20 euro per child, or about 21 million euro for an annual cohort of 760,000 births (total cost, 35 million euro). The number of infants protected against hepatitis B could increase from 230,000 in the current situation to about 600,000.

Are economic evaluations of vaccines useful to decision-makers? Case study of Haemophilus influenzae type b vaccines.

BACKGROUND: In concert with efforts to increase global provision, economic evaluations of newer and relatively costly vaccines have proliferated in the medical literature. The extent to which existing vaccine evaluations are useful to decision makers is not clear. We conducted a systematic review of published economic evaluations of conjugate Haemophilus influenzae type b (Hib) vaccine, anticipating that their usefulness to past and present decision makers would be limited by the quality of the analyses and by the extent to which the results were transferable to other settings. METHODS: We systematically identified economic evaluations of conjugate Hib vaccine. We appraised their quality according to a customized checklist and assessed the extent of and reasons for variability of the results. RESULTS: Quality assessment of the available economic evaluations disclosed a number of shortcomings, including the failure across all models to derive systematic estimates of vaccine efficacy as well as a lack of transparency in the costing of Hib disease treatment. Wide variations in results appeared to be caused primarily by epidemiologic and health system differences between settings and secondarily to methodologic differences between models. The generalizability of model results appeared low. CONCLUSIONS: There is scope for improving the overall quality of economic evaluations of Hib vaccination. Relevance to decision makers may also be increased by addressing local budget constraints and vaccine price. There is a need to better understand the decision process, particularly at the national level, to ensure the role of future economic evaluations as important decision tools in the implementation of new vaccines.

Haemophilus influenzae type b infection in children in Pacific countries.

The Haemophilus influenzae type b (Hib) disease burden among children under five years in four Pacific island countries (PIC was estimated. The incidence of confirmed Hib meningitis was calculated using numbers of culture confirmed isolates. In addition, the WHO Hib Rapid Assessment Tool (RAT) was used to estimate the true Hib meningitis incidence and the number of Hib meningitis and pneumonia cases and deaths. The Hib meningitis annual incidence in three PICs was 70 to 84 per 100,000 children under five years. The high Hib disease burden and the relative cost-effectiveness of Hib vaccine, make the introduction of Hib vaccine a good investment for PICs costing US$ 1,000-10,000 for each death prevented - ignoring treatment cost savings.

High incidence of Haemophilus influenzae type b infection in children in Pacific island countries.

The Haemophilus influenzae type b (Hib) disease burden among children <5 years old in 4 Pacific island countries (PICs) was estimated. The incidence of confirmed Hib meningitis was calculated using the numbers of culture-confirmed isolates. In addition, the World Health Organization (WHO) Hib Rapid Assessment Tool (RAT) was used to estimate the true Hib meningitis incidence and the number of Hib meningitis and pneumonia cases, as well as the number of deaths due to Hib meningitis and pneumonia. The Hib meningitis annual incidence in 3 PICs was 70-84 cases per 100,000 children <5 years old. For PICs, the RAT is likely to overestimate the Hib pneumonia burden, as it assumes a 5 : 1 ratio of Hib pneumonia to Hib meningitis. The true ratio is likely to be 1 : 1. The high Hib disease burden and the relative cost-effectiveness of Hib vaccine make the introduction of Hib vaccine a good investment for PICs, costing US1000 dollars-US10,000 dollars for each death prevented--a number that ignores savings from reductions in the cost of treatment.

[Cost-effectiveness of 23-valent antipneumococcical vaccination in Catalonia (Spain)]. / Coste-efectividad de la vacunación antineumocócica 23-valente en Cataluña.

OBJECTIVES: Pneumococcal vaccination is an effective procedure for preventing pneumococcal pneumonia. In this study we evaluate the cost-effectiveness of pneumococcal vaccination strategies (23 serotypes) in the population aged 5 years and older in Catalonia. METHODS: Cost-effectiveness was evaluated in terms of cost per year of life gained (YLG) by comparing the net cost of the vaccination program with its effectiveness. The net cost of the vaccination program was calculated by subtracting 70% of the population from the vaccination costs, representing the reduction in health costs due to pneumococcal pneumonia that can ve achieved with vaccination. Vaccination costs were estimated based on a price of 12.41 euros (1,915 ptas.) for pneumococcal vaccine. The costs and benefits of the vaccination program were updated for 1996 by using a discount rate of 5%. RESULTS: A cost-effectiveness ratio of 9,023.27 euros per YLG was achieved for universal vaccination of the population. Cost-effectiveness was 11,3177.12 euros per YLG in individuals aged 5-24 years, 19,482.51 euros per TLG in those aged 25-44 years, 7,122.80 euros per YLG in those aged 45-64 years and less than 0 in those aged 65 years and older. In this group the reduction in cost of the disease was greater than the vaccination costs with a cost-benefit ratio of 1.58. The results of the cost-efecctiveness analysis were sensitive to vaccine costs and efficacy and the percentage of pneumonias caused by pneumococcus but were less sensitive to the costs of pneumococcal pneumonia, the rate of hospital admission among patients with community-acquired pneumonia and vaccine coverage. CONCLUSION: The results of this study show that pneumococcal vaccination should be a priority in individuals aged 65 years and older and in those aged 45-64 years.