Fenton Howell

A cost-utility analysis of adding a bivalent or quadrivalent HPV vaccine to the Irish cervical screening programme.

BACKGROUND Cervical cancer is a leading cause of death worldwide, and in Ireland it is the ninth most commonly diagnosed cancer in women. Almost 100% of these cancers are caused by human papillomavirus (HPV) infection. Two newly developed vaccines against HPV infection have become available. This study is a cost-utility analysis of the HPV vaccine in Ireland, and it compares the cost-effectiveness profiles of the two vaccines. METHODS A cost-utility analysis of the HPV vaccine in Ireland was performed using a Markov model. A cohort of screened and vaccinated women was compared with an unvaccinated screened cohort, and both cohorts were followed over their lifetimes. The model looked at uptake of services related to HPV disease in both cohorts. Outcomes were measured in quality adjusted life years (QALYs). Extensive sensitivity analysis was done. RESULTS For the base case analysis, the model showed that the incremental cost-effectiveness ratio (ICER) for quadrivalent HPV vaccination would be 25,349 euros/QALY and 30,460 euros/QALY for the bivalent vaccine. The ICER for the quadrivalent vaccine ranged from 2877 euros to 36,548 euros, and for the bivalent from 3399 euros to 45,237 euros. At current prices, the bivalent vaccine would need to be 22% cheaper than the quadrivalent vaccine in order to have equivalent cost effectiveness. CONCLUSION HPV vaccination has the potential to be very cost effective in Ireland. The quadrivalent vaccine is more cost effective than the bivalent vaccine.

How to improve the uptake of influenza vaccination in older persons at risk.

A study was carried out to ascertain if those older persons at risk from influenza in Ireland would respond to a personalised invitation to attend for vaccination. Of the 193 patients invited to attend for vaccination, 126 (65.3 per cent) presented for vaccination. This rose to 142 (73.6 per cent) after a reminder letter was went out. In the year previous to the study only 80 (41.5 per cent) of the same cohort of patients were vaccinated. This study has demonstrated how a simple invitation for influenza vaccination can dramatically improve the uptake rates.

Determining the cost of genital warts: A study from Ireland

Objectives: To determine the average cost of a case of genital warts, for both males and females, with a view to informing the current debate as to which Human papillomavirus vaccine would have maximum cost-effectiveness in the Irish population. Methods: Contact time between patients and healthcare professionals was prospectively measured at five genitourinary medicine clinics in the south-west of Ireland, over a period of 3 weeks. By identifying all those with genital warts, it was possible to calculate the proportion of total time taken by patients with this condition, and from this to calculate a cost per incident case, by gender. Results: A total of 25.5% of attendances were for genital warts, and these patients used 26.2% of total clinic time (CI 25.4 to 27.0%). The average cost calculated for genital warts was €335 per incident case, and by gender €300 per male case and €366 per female case. Conclusions: There are considerable costs associated with the treatment of genital warts, with female cases representing a higher cost than males. By vaccinating with the quadrivalent HPV vaccine, there are significant savings to be made.

Hospitalisations and costs relating to ambulatory care sensitive conditions in Ireland

BackgroundAmbulatory care sensitive conditions (ACSCs) are conditions for which the provision of timely and effective outpatient care can reduce the risks of hospitalisation by preventing, controlling or managing a chronic disease or condition.AimsThe aims of this study were to report on ACSCs in Ireland, and to provide a baseline for future reference.MethodsUsing HIPE, via Health Atlas Ireland, inpatient discharges classified as ACSCs using definitions from the Victorian ACSC study were extracted for the years 2005–2008. Direct methods of standardisation allowed comparison of rates using the EU standard population as a comparison for national data, and national population as comparison for county data. Costs were estimated using diagnosis-related groups.ResultsThe directly age-standardised discharge rate for ACSC-related discharges increased slightly, but non-significantly, from 15.40 per 1,000 population in 2005 to 15.75 per 1,000 population in 2008. The number of discharges increased (9.5%) from 63,619 in 2005 to 69,664 in 2008, with the estimated associated hospital costs increasing (31.5%) from €267.8 million in 2005 to €352.2 million in 2008. Across the country, there was considerable variation in the discharge rates for the Top-10 ACSCs for the years 2005–2008. Significantly lower rates of hospitalisation were observed in more urban areas including Cork, Dublin and Galway. The most common ACSC in 2008 was diabetes with complications (29.8%).ConclusionsThe variation in rates observed indicates the scope of reducing hospitalisations and associated costs for ACSCs, across both adult’s and children’s services and particularly in relation to diabetes complications.

Factors associated with self-reported depression and self-esteem among school-going adolescents from a geographically defined region in Ireland

BackgroundRecent reviews indicate that mental health problems in the young are increasing.AimsTo measure the prevalence of, and risk factors associated with, depression and low self-esteem among Irish post-primary students.Method1,428 students, randomly selected from a sample of post-primary schools, were given an anonymised questionnaire. Analyses included bivariate and multivariate logistic regression.ResultsQuestionnaires were completed by 992 (69.9%) respondents. 206 (20.8%) had a high depression score. Being from a single parent family (OR 2.8, 95% Cl 1.5–5.4, p<0.001); having low self esteem (OR 13.44 95% Cl 8.9–20.3, p<0.001); being female (OR, 3.7, 95% Cl 2.5–5.6 p<0.001) and having a low fitness level (OR 1.8, 95% Cl 1.2–2.8 p<0.006) were independently associated with a high depression score.ConclusionsThe level of self-reported depression was high among these respondents and risk factors identified include having low self-esteem, being female, being from a single parent family and having a low fitness level.