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Importance of sexual transmission of hepatitis C virus in seropositive pregnant women: A case‐control study

The mode of hepatitis C virus (HCV) transmission in patients who deny parenteral exposure is still not understood. Seroprevalence studies of anti‐HCV in sexually promiscuous populations and in spouses of infected patients have given contradictory results. We investigated the role of sexual transmission of HCV in a case‐control study of risk factors for infection in a series of 43 anti‐HCV positive pregnant women and 172 matched controls (4 for each case). In the univariate analysis, the following factors were associated significantly with anti‐HCV seropositivity: low social class, unmarried, history of abortion, wounds which were sutured, tattooes, sharing toiletries with the partner, sexual contact outside the partnership without condom use, blood transfusion, and intravenous drug abuse, but only the last 3 factors remained significantly associated with HCV infection in multiple logistic regression analysis. The relative risk of HCV infection increased according to the increased number of sexual partners. Thus sexual transmission must be considered a possible mode of infection in HCV infected persons without parenteral exposures. J. Med. Virol. 52:164–167, 1997.

Economic benefits for the family of inactivated subunit virosomal influenza vaccination of healthy children aged 3-14 years during the annual health examination in private paediatric offices.

Taking the results of a prospective cohort study by our group that evaluated the effectiveness of the inactivated subunit virosomal influenza vaccine (Inflexal V), Crucell-Berna) in the prevention of influenza-related diseases and the reduction of its negative economic consequences, the economic costs and benefits for the family of vaccinating a theoretical cohort of 1000 healthy children aged 3-14 years with no risk factors with one dose of vaccine during the yearly health examination were quantiified. The economic analysis was carried out from the family perspective and the time horizon of the study was established at 6 months. In the base case, the net present value was 21,551.62 euros (21.5 euros per vaccinated child), and the benefit-cost ratio was 2.15, meaning that 1.15 euros is saved per euro invested.

Non-preventable mumps outbreaks in schoolchildren in Catalonia

Various doses of the combined MMR vaccine containing the Rubini mumps strain were distributed in Catalonia in 1994 and 1995. We studied outbreaks of mumps reported from 1997 to 2002 to determine the possible involvement of this vaccine in the appearance of non-preventable mumps outbreaks. A total of 17 mumps outbreaks were declared in the period 1997–2000, 14 of which were in schoolchildren. In 11, it was determined that children were correctly vaccinated. Of these, 10 were non-preventable outbreaks. 66% of cases investigated had ages which coincided with vaccination in the period 1994–1996, during which the MMR vaccine containing the Rubini mumps strain was administered. In Catalonia, during the period 1997–2000, at least two-thirds of mumps cases in schoolchildren could be explained by vaccination with the combined MMR vaccine containing the Rubini strain, which has also been associated with mumps outbreaks amongst vaccinated people in other countries.

Evaluación económica de intervenciones de salud pública

The scarcity of resources available to meet the growing demand for healthcare services has increased interest in economic evaluation as a tool to inform resource allocation. The aim of economic evaluation is to compare various alternatives for action, in terms of their costs and effects on health, by using several techniques: cost minimization analysis, cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. Irrespective of the methodology used, any assessment must include scope of the problem, selection of alternatives for comparison, explication of the perspective of analysis and the time horizon, measurement and evaluation of costs and health effects, presentation of results, and sensitivity analysis. In Spain, evaluation of currently ongoing preventive interventions, and adherence to the existing economic evaluation guidelines by researchers would be desirable.

Economic costs of outbreaks of acute viral gastroenteritis due to norovirus in Catalonia (Spain), 2010–2011

BackgroundTo determine the direct and indirect costs of outbreaks of acute viral gastroenteritis (AVG) due to norovirus in closed institutions (hospitals, social health centers or nursing homes) and the community in Catalonia in 2010–11.MethodsInformation on outbreaks were gathered from the reports made by epidemiological surveillance units. Direct costs (medical visits, hospital stays, drug treatment, sample processing, transport, diagnostic tests, monitoring and control of the outbreaks investigated) and indirect costs (lost productivity due to work absenteeism, caregivers time and working hours lost due to medical visits) were calculated.ResultsTwenty-seven outbreaks affecting 816 people in closed institutions and 74 outbreaks affecting 1,940 people in the community were detected. The direct and indirect costs of outbreaks were € 131,997.36 (€ 4,888.79 per outbreak) in closed institutions and € 260,557.16 (€ 3,521.04 per outbreak) in community outbreaks. The cost per case was € 161.76 in outbreaks in closed institutions and € 134.31 in community outbreaks. The main costs were surveillance unit monitoring (€ 116,652.93), laboratory diagnoses (€ 119,950.95), transport of samples (€ 69,970.90), medical visits (€ 25,250.50) and hospitalization (€ 13,400.00).ConclusionsThe cost of outbreaks of acute viral gastroenteritis due to norovirus obtained in this study was influenced by the number of people affected and the severity of the outbreak, which determined hospitalizations and work absenteeism. Urgent reporting of outbreaks would allow the implementation of control measures that could reduce the numbers affected and the duration of the illness and thus the costs derived from them.

Costs associated with influenza-related hospitalization in the elderly

ABSTRACT Seasonal influenza epidemics remain a considerable burden in adults, especially in those at higher risk of complications. The aim of this study was to determine the costs associated with influenza-related hospitalization in patients aged ≥65 y admitted to 20 hospitals from 7 Spanish regions during the 2013–14 and 2014–15 influenza seasons. Bivariate analysis was used to compare costs in vaccinated and unvaccinated cases. Costs were calculated according to the Spanish National Health System diagnosis-related group tables for influenza and other respiratory system conditions (GRD 89 and GRD 101). A total of 728 confirmed influenza cases were recorded: 52.9% were male, 46.7% were aged 75–84 years, and 49.3% received influenza vaccine ≥15 d prior to hospital admission. Influenza-related mean hospitalization costs (MHC) were € 1,184,808 in unvaccinated and € 1,152,333 in vaccinated cases (2.75% lower). Influenza vaccination showed significant protection against ICU admission (OR 0.35, 95%CI 0.21–0.59; p < 0001); mechanical ventilation (OR 0.56, 95%CI 0.39–0.80; p = 0.002); secondary bacterial pneumonia (OR 0.61, 95%CI 0.39–0.98; p = 0.04) and a higher degree of dependence (OR 0.74, 95%CI 0.55–0.99; p = 0.04). No association was observed for the Charlson comorbidity index or the mean hospital stay. Although influenza vaccination of the elderly may not achieve significant savings in mean hospitalization costs, it may lessen the degree of severity and avoid complications.

Cost-effectiveness analysis of four alternative strategies of tetanus vaccination of the adult population of Catalonia

Objective In order to evaluate the most efficient form of raising tetanus vaccination coverage in the adult population of Catalonia in a five-year period, four vaccination strategies were compared: a) vaccination of the 15-24 years age group; b) vaccination of the 25-44 years age group; c) vaccination of the 45-64 years age group, and d) vaccination of the ≥ 65 age group. Methods A cost-effectiveness analysis (C-E) was carried out to compare the four alternative vaccination strategies. A decision-analysis model was designed for each strategy in order to establish the incidence and cost of tetanus in the adult population of Catalonia with and without the vaccination programme. The effectiveness of the programme was estimated by subtracting the estimated incidence of tetanus after the vaccination programme from the incidence of tetanus without the vaccination programme. The net cost of the programme was calculated by subtracting the cost of disease avoided and the indirect cost avoided from the cost of the vaccination programme. Results The four strategies differed in their cost, as well as in their effects on health in terms of the number of cases of tetanus avoided, deaths prevented and years of life gained. The most efficient strategy was vaccination of the ≥65 years age group, with a C-E ratio of 4.43 million PTA per case of tetanus avoided, and 12.5 million PTA per death prevented, the best of the four in each case. When effectiveness was measured by years of life gained, the most efficient strategy was vaccination of the 45-64 years age group, with a C-E ratio of 850,000 PTA per year of life gained. Conclusions If available resources are limited, vaccination of the adult population against tetanus should begin in the ≥65 years age group. The 45-64 years age group should be second in priority when the efficiency of the programme is taken into consideration.

Economic benefits of inactivated influenza vaccines in the prevention of seasonal influenza in children

The aim of this study was to systematically review published studies that evaluated the efficiency of inactivated influenza vaccination in preventing seasonal influenza in children. The vaccine evaluated was the influenza-inactivated vaccine in 10 studies and the virosomal inactivated vaccine in 3 studies. The results show that yearly vaccination of children with the inactivated influenza vaccine saves money from the societal and family perspectives but not from the public or private provider perspective. When vaccination does not save money, the cost-effectiveness ratios were very acceptable. It can be concluded, that inactivated influenza vaccination of children is a very efficient intervention.

Eficiencia de la vacunación antigripal inactivada virosómica aplicada a niños sanos en la práctica pediátrica privada durante el examen de salud anual

Resumen Los autores realizan una revision de los articulos cientificos que han evaluado la eficiencia de la vacunacion antigripal inactivada virosomal, aplicada de forma universal a ninos sanos. La revision se centra en un estudio efectuado en Cataluna (Espana) desde la perspectiva de la familia, y sus resultados se comparan con los de otros estudios efectuados en Cataluna e Italia desde la perspectiva de la sociedad y del proveedor. El estudio efectuado desde la perspectiva de la familia ha demostrado que la vacunacion de los ninos sanos en edad preescolar y escolar con una sola dosis de vacuna antigripal inactivada virosomal en el ambito privado, ademas de proporcionar importantes beneficios de salud a los ninos vacunados, aporta beneficios socioeconomicos a la familia: en el caso base (coste de la vacunacion, 18,73 euros; coste de la visita medica pediatrica, 40 euros; coste de un episodio de consuno de antibioticos, 7,8 euros, y coste del absentismo escolar, 20 euros, y del laboral, 40 euros por dia) se ahorran 1,15 euros por cada euro invertido. Cuando el estudio se realiza desde la perspectiva de la sociedad, el ahorro de dinero es menor (0,8 euros por euro invertido). Por ultimo, cuando el analisis se realiza desde la perspectiva del proveedor no se ahorra dinero, pero las razones coste-efectividad son de niveles muy razonables (5,8 euros por caso de enfermedad respiratoria febril aguda prevenido y 6,87 euros por visita pediatrica evitada).