G. Tormans

Cost-effectiveness analysis of hepatitis A prevention in travellers

The advent of new vaccines and the changing epidemiology of hepatitis A call for an update of the economic evaluation of costs and benefits associated with the various alternative preventative strategies. A decision-tree-based model has been developed which enables the calculation of expected costs and expected numbers of hepatitis A virus HAV infections based on different intervention strategies. The model is sufficiently generic to allow for the evaluation of both population-wide strategies and strategies targeted at particular risk groups. An economic analysis focusing on travellers from Europe to high-endemic countries compared a non-intervention strategy to the following three strategies: active immunization with HAV vaccine; screening for HAV antibodies and vaccinating only susceptibles; passive immunization by means of immunoglobulin. The net cost per HAV infection prevented proved very sensitive to a number of important input parameters of the model. These included epidemiological characteristics such as HAV attack rate and prevalence of immunity, behavioural characteristics such as compliance with the vaccination scheme and vaccine characteristics such as rate and duration of protection. Our estimated expected cost per HAV infection prevented among Belgian travellers to high-endemic countries for three weeks per year over ten years amounts to approximately US

Economic evaluation of antifungal agents in the treatment of toenail onychomycosis in Germany

4880 for active immunization, US

Cost Effectiveness of Alternative Hepatitis A Immunisation Strategies

5621 for screening followed by vaccination of susceptibles and US

Assumptions were confusing

29932 for passive immunization. Although these estimates are clearly sensitive to a number of crucial assumptions pertaining to the input parameters of the model, it seems safe to conclude that vaccination is more cost-effective than the currently recommended passive immunization with immunoglobulin.(ABSTRACT TRUNCATED AT 250 WORDS)

The cost-effectiveness of the 1440 El.U. hepatitis A vaccination for travellers

BACKGROUND The strategies for the management of onychomycosis have changed since the availability of the newer generation of antifungal agents, particularly, itraconazole and terbinafine. Itraconazole (1-week pulse) therapy may have higher efficacy and an improved adverse-effects profile compared to the continuous therapy regimen. OBJECTIVE We performed a pharmacoeconomic evaluation of the most commonly used treatments in Germany for toenail onychomycosis from a health care payer perspective. METHODS A 5-step approach was used. Firstly, the purpose of the study, the comparator drugs, their dosage regimens and the time frame of the analysis were defined. Next, the medical practice and resource consumption patterns associated with the treatment of onychomycosis were identified. In step III, a meta-analysis was used to determine the relative efficacy of the comparator drugs. In step IV, a decision tree of the treatment algorithms was constructed for each comparator. The expected cost analysis and cost-effectiveness analysis were also performed. Finally, a sensitivity analysis was carried out. RESULTS For the four main comparator drugs used to treat toenail onychomycosis in Germany, the clinical response rates (clinical cure plus marked improvement) at the end of the follow-up period (month 12 after starting therapy) were, for itraconazole (1-week pulse dosing): 89.8 +/- 3% (mean +/- SE), terbinafine: 79.4 +/- 10%, itraconazole (continuous dosing): 77.5 +/- 9%, and ciclopirox nail varnish: 55 +/- 5%. Itraconazole (1-week pulse dosing) was most cost-effective at DM 1,107 per successful treatment, followed by oral terbinafine at DM 1,224, ciclopirox nail varnish and itraconazole (continuous dosing). Sensitivity analyses indicated that itraconazole (1-week pulse dosing) and terbinafine had similar cost-effectiveness ratios. CONCLUSION Itraconazole is an effective, broad-spectrum triazole used as continuous or pulse therapy in the treatment of onychomycosis. Itraconazole (1-week pulse) and terbinafine are the most cost-effective therapies for toenail onychomycosis.

Costs And Benefits Of Routine Varicella Vaccination In German Children

The hepatitis A virus (HAV) is the most widespread of all the viruses that cause hepatitis. being prevalent wherever standards of hygiene and sanitation are poor. By far the mosl common route of transmission is through the ingestion of food or water contaminated with small amounts of infected faecal malerial. HAV is much more prevalent than the hepatitis B virus, but has a l ess serious and selflimiting morbidity and a much lower mortali ty.(ll It often appears in epidemic outbreaks, and its distribution across countries is closely related to the level of economic development. In developing countries (with high endemicity), most children become infected at a very young age, but the great majority do nol experience any symptoms and receive free lifelong natural immunity. Worldwide improvements in standards of hygiene and sanitation during the last 20 years have led to a reduction in circulating levels of HAY and the emergence of a growing population of nonimmune individuals,f21 These developments have been rewarded by a decrease in the incidence of hepatitis A in developed countries. However, there has been a concomitant shi ft in natural immunity towards older age groups, leaving an increasing number of chi ldren, adolescents and young adults susceptible to residual circulating virus. PI Consequently, the average age of exposure and subsequent infection wi th HAY now occurs later in life than it did 20 years ago. Because the expression of clinical disease is high ly age-re lated, with o lder people more likely to experience symptomatic disease, the sh ift of infection to older age groups will induce a proportional increase in the number of clinical infections. Hepatitis A is rarely fatal, but most infected adults become severely ill and are unable to work fo r several weeks or months. A small proportion of patients develop fulminant hepatic fai lure, wliich may require liver transplantation and has a high mortali ty. In developed countries, there are a number of groups of individuals whose risk of hepalitis A is higher than that of the general population. Typical examples of these higher risk groups include people travelling to high endemicity areas and certain occupational groups, such as military personnel stationed in developing countries, personnel of day care centres for chi ldren or institutions for mentally disabled people.

Cost-effectiveness analysis of vaccination against hepatitis A in travellers

EDITOR,—We have performed economic evaluations of prophylaxis against hepatitis A in travellers, and two of R H Behrens and J A Robertss main conclusions1 are in line with our findings2 3—namely, that hepatitis A vaccination is not cost saving for the average traveller and that vaccination becomes more cost effective than immunisation with human immunoglobulin when the expected frequency of travel exceeds two occasions in the …

Cost-effectiveness analysis of prenatal screening and vaccination against hepatitis B virus : the case of Belgium

Hepatitis A virus (HAV) infection is a substantial risk for travellers from low endemic countries to high endemic destinations. Costs and effects of alternative options for prevention were compared using formal decision analysis. General indications for the optimal prevention of hepatitis A were derived from a cost‐effectiveness analysis. Various possible strategies for prevention of hepatitis A in travellers were compared to doing nothing: active immunisation using either the existing vaccine (HAVRIX 720) or the new vaccine (HAVRIX(tm) 1440); first screening for the presence of HAV antibodies and then vaccinating only susceptibles; and passive immunisation with immunoglobulin. Using a number of assumptions as baseline and for an average duration and frequency of travel from low to high endemic countries, threshold values were obtained for the choice between passive and active immunisation. Passive immunisation remains the most cost‐effective prevention strategy for those expected to travel not more frequently than twice over the next 10 years and for short stays (£7,000–9,000 per infection prevented). For travellers expected to travel three or more times in 10 years or for trips exceeding a period of 6 months, active immunisation before the first trip is the most cost‐effective option (£7,500 or less per infection prevented). When travel frequency increases to once a year in the next 10 years, costs per infection prevented decrease to about £3,500. Screening for the presence of antibodies before vaccination is only justified for older travellers or those leaving from countries with moderate endemicity, i.e., with an average HAV prevalence Of at least 30%.