Patricia R. Blank

Vaccination coverage rates in eleven European countries during two consecutive influenza seasons

OBJECTIVES This study assessed influenza vaccination coverage rates in eleven European countries during seasons 2006/07 and 2007/08. The aims were to analyse vaccine uptake rates in the general population and in high-risk groups, including children, as well as to understand the principal drivers and barriers towards vaccination. METHODS Community-based face-to-face interviews, telephone surveys or mailed surveys were conducted in UK, Germany, Italy, France, Spain, Austria, Czech Republic, Finland, Ireland, Poland and Portugal. Approximately 2000 representative adult individuals per country and season were interviewed. Data on the vaccination status of children were obtained by proxy interviews. For the analysis, five target groups were defined. RESULTS Vaccination coverage levels in the general population ranged from 9.5% (Poland) to 28.7% (UK) during season 2007/08. In comparison with the previous season, only minor increases were visible. The coverage in the elderly target group was highest at 70.2% in the UK and lowest at 13.9% in Poland. The vaccination rate of chronically ill persons ranged from 11.1% (Poland) to 56.0% (UK). Vaccination levels among health care workers were generally low. Vaccine uptake in children was lowest in Ireland (4.2%) and highest in Germany (19.3%). Respondents from all countries were aware of the seriousness of influenza as a disease. People who had never been vaccinated regarded being infected as unlikely. The advice from a family doctor or a nurse was deemed as the main encouraging factor for vaccination. CONCLUSIONS During 2007/08, influenza vaccination coverage rates differed widely between countries, not only in the general population but also in the predefined at-risk groups. Generally, the increases in coverage compared to the previous season were marginal. Overcoming the barriers and implementing the driving forces identified by our surveys may help to increase vaccine uptake and to reach the corresponding WHO goals.

Influenza vaccination coverage rates in five European countries during season 2006/07 and trends over six consecutive seasons

BackgroundThe objectives of the survey were to identify the level of influenza vaccination coverage in five European countries between 2001 and 2007, to understand the drivers and barriers to vaccination, to assess vaccination intentions for the winter 2007/08 as well as major encouraging factors for vaccination.MethodsBetween 2001 and 2007, representative household surveys were performed with telephone or mailed (France) interviews of individuals aged 14 and above. The questionnaire used in the UK, Germany, Italy, France and Spain was essentially the same in all seasons. The data were subsequently pooled. Four target groups were defined for the analysis: 1) persons aged 65 years and over; 2) persons working in the medical field; 3) chronically ill persons and 4) combined target group composed of individuals belonging to one or more of the previous groups 1, 2 or 3.ResultsIn 2006/07, vaccination coverage was, 25.0% in UK, 27.4% in Germany, 21.8% in Spain, 24.2% in France and 24.4% in Italy. During six influenza seasons (2001–2007), vaccination coverage showed a slight positive trend in the five countries (p ≤ 0.0001). In the elderly (≥ 65 years), across all countries, no significant trend was seen; the vaccination rate decreased non-significantly from a peak of 64.2% in season 2005/06 to 61.1% in season 2006/07. The most frequent reason for getting vaccinated was a recommendation by the family doctor or nurse (51%), and this was also perceived as the major encouraging factor for vaccination (61%). The main reason for not getting vaccinated was feeling unlikely to catch the flu (36%).ConclusionIn the UK, Germany and Spain, influenza vaccination coverage rates in season 2006/07 dropped slightly compared to the previous season. However, a trend of increasing vaccination coverage was observed from 2001/02 to 2006/07 across Europe. The family doctor is the major source of encouragement for individuals getting vaccinated. Efforts to overcome the barriers to vaccination need to be put in place to reach the WHO objective of 75% coverage in the elderly by 2010. This is a major challenge to be faced by governments, healthcare workers and healthcare organisations.

Influenza vaccination uptake and socioeconomic determinants in 11 European countries.

BACKGROUND The objective of this study was to assess the predictive effects of socioeconomic factors to explain influenza vaccination coverage rates in 11 European countries. METHODS Data from national household surveys collected over up to seven consecutive seasons between 2001/2002 and 2007/2008 were analyzed to assess the associations of socioeconomic factors with immunization against influenza. RESULTS In total, data from 92,101 household contacts representative for the national non-institutionalized population aged above 14 years were analyzed. Influenza vaccination coverage rates in Europe remain suboptimal with little or no progress in the last years. The results of this study indicate that gender, household income, size of household, educational level and population size of living residence may significantly contribute to explain chances of getting immunized against influenza apart from the known risk factors age and chronic illness. The effect of these socioeconomic factors was differently expressed among the countries and could not be explained solely on basis of economic characteristics of these countries. CONCLUSIONS Future measures should address inequalities to achieve the WHO target by 2010 with an influenza vaccination rate of 75% in the elderly. National vaccination campaigns may need to take socioeconomic segments of the population here identified as less likely of getting the influenza vaccine into account.

Disparities in influenza vaccination coverage rates by target group in five European countries: Trends over seven consecutive seasons

Background:The primary objective of this study was to measure influenza vaccination coverage rates in the general population, including children, and in high-risk groups of five European countries during the season 2007/2008. An additional aim was to analyze coverage trends over seven consecutive seasons and to gain an understanding of the primary drivers and barriers to immunization.Methods:Community-based telephone and mail surveys have been conducted in the UK, Germany, Italy, France, and Spain, yearly, since 2001/2002. Approximately 2,000 individuals per country and season were interviewed who were considered to be representative of the adult population aged 14 years and older. Data on the vaccination status of children were obtained by proxy interviews. The questionnaire used was essentially the same for all seven seasons. Five target groups were identified for the study: (1) persons aged ≥ 65 years; (2) elderly suffering from a chronic illness; (3) patients suffering from a chronic illness; (4) persons working in the health care sector; (5) children.Results:In the season 2007/2008, vaccination coverage rates in the general population remained stable in Germany. Compared to the coverage rates of the previous season, increases of 3.7%, 2.0%, and 1.8% were observed for the UK, Spain, and France, respectively, while a decrease of –1.5% was observed for Italy. Across all five countries, vaccination rates in the predefined target groups decreased to some extent (elderly) or increased slightly (chronically ill and health care workers). Vaccination rates among children varied strongly between countries and ranged from 6.1% in UK to 19.3% in Germany. The most powerful motivation for getting vaccinated in all countries was advice from a family doctor (58.6%) and the perception of influenza as a serious illness (51.9%). The major reasons why individuals did not become vaccinated were (1) the feeling of not being likely to catch influenza (39.5%) and (2) never having considered the option of being vaccinated (35.8%).Conclusions:The change in general influenza vaccination coverage in the 2007/2008 season compared to the previous season was small, but decreases were seen in some target groups. The underlying motivations for and against vaccination did not substantially change. An effort to activate those driving forces that would encourage vaccination as well as dealing with barriers that tend to prevent it may help enhance coverage rates in Europe in the future.

KRAS and BRAF Mutation Analysis in Metastatic Colorectal Cancer: A Cost-effectiveness Analysis from a Swiss Perspective

Purpose: Monoclonal antibodies against the epidermal growth factor receptor (EGFR), such as cetuximab, have led to significant clinical benefits for metastatic colorectal cancer (mCRC) patients but have also increased treatment costs considerably. Recent evidence associates KRAS and BRAF mutations with resistance to EGFR antibodies. We assessed the cost-effectiveness of predictive testing for KRAS and BRAF mutations, prior to cetuximab treatment of chemorefractory mCRC patients. Experimental Design: A life-long Markov simulation model was used to estimate direct medical costs (€) and clinical effectiveness [quality-adjusted life-years (QALY)] of the following strategies: KRAS testing, KRAS testing with subsequent BRAF testing of KRAS wild-types (KRAS/BRAF), cetuximab treatment without testing. Comparison was against no cetuximab treatment (reference strategy). In the testing strategies, cetuximab treatment was initiated if no mutations were detected. Best supportive care was given to all patients. Survival times/utilities were derived from published randomized clinical trials. Costs were assessed from the perspective of the Swiss health system. Results: Average remaining lifetime costs ranged from €3,983 (no cetuximab) to €38,662 (no testing). Cetuximab treatment guided by KRAS/BRAF achieved gains of 0.491 QALYs compared with the reference strategy. The KRAS testing strategy achieved an additional gain of 0.002 QALYs compared with KRAS/BRAF. KRAS/BRAF testing was the most cost-effective approach when compared with the reference strategy (incremental cost-effectiveness ratio: €62,653/QALY). Conclusion: New predictive tests for KRAS and BRAF status are currently being introduced in pathology. Despite substantial costs of predictive testing, it is economically favorable to identify patients with KRAS and BRAF wild-type status. Clin Cancer Res; 17(19); 6338–46. ©2011 AACR.

Trends in influenza vaccination coverage rates in Germany over five seasons from 2001 to 2006

BackgroundTo assess influenza vaccination coverage from 2001 to 2006 in Germany, to understand drivers and barriers to vaccination and to identify vaccination intentions for season 2006/07.Methods9,990 telephone-based household surveys from age 14 were conducted between 2001 and 2006. Essentially, the same questionnaire was used in all seasons.ResultsThe influenza vaccination coverage rate reached 32.5% in 2005/06. In the elderly (≥60 years), the vaccination rate reached 58.9% in 2005/06. In those aged 65 years and older, it was 63.4%. Perceiving influenza as a serious illness was the most frequent reason for getting vaccinated. Thirteen percent of those vaccinated in 2005/06 indicated the threat of avian flu as a reason. The main reason for not getting vaccinated was thinking about it without putting it into practice. The major encouraging factor to vaccination was a recommendation by the family doctor. 49.6% of the respondents intend to get vaccinated against influenza in season 2006/07.ConclusionIncreasing vaccination rates were observed from 2001 to 2006 in Germany. The threat of avian influenza and the extended reimbursement programs may have contributed to the recent increase.

Health economic assessment of ferric carboxymaltose in patients with iron deficiency and chronic heart failure based on the FAIR-HF trial: an analysis for the UK

The purpose of this study was to evaluate the cost‐effectiveness of iron repletion using intravenous (i.v.) ferric carboxymaltose (FCM) in chronic heart failure (CHF) patients with iron deficiency with or without anaemia. Cost‐effectiveness was studied from the perspective of the National Health Service in the UK.

Personalized cancer medicine and the future of pathology.

In February 2011, a group of pathologists from different departments in Europe met in Zurich, Switzerland, to discuss opportunities and challenges for pathology in the era of personalized medicine. The major topics of the meeting were assessment of the role of pathology in personalized medicine, its future profile among other biomedical disciplines with an interest in personalized medicine as well as the evolution of companion diagnostics. The relevance of novel technologies for genome analysis in clinical practice was discussed. The participants recognize that there should be more initiatives taken by the pathology community in companion diagnostics and in the emerging field of next-generation sequencing and whole genome analysis. The common view of the participants was that the pathology community has to be mobilized for stronger engagement in the future of personalized medicine. Pathologists should be aware of the challenges and the analytical opportunities of the new technologies. Challenges of clinical trial design as well as insurance and reimbursement questions were addressed. The pathology community has the responsibility to lead medical colleagues into embracing this new area of genomic medicine. Without this effort, the discipline of pathology risks losing its key position in molecular tissue diagnostics.

Increasing influenza vaccination coverage in recommended population groups in Europe

The clinical and economic burden of seasonal influenza is frequently underestimated. The cornerstone of controlling and preventing influenza is vaccination. National and international guidelines aim to implement immunization programs and targeted vaccination-coverage rates, which should help to enhance the vaccine uptake, especially in the at-risk population. This review purposes to highlight the vaccination guidelines and the actual vaccination situation in four target groups (the elderly, people with underlying chronic conditions, healthcare workers and children) from a European point of view.

The impact of European vaccination policies on seasonal influenza vaccination coverage rates in the elderly

Despite strong recommendations, seasonal influenza vaccination coverage rates (VCRs) remain limited in Europe, even in high-priority groups. There is a need for understanding the impact of vaccination-related policy elements and barriers toward vaccination. We aimed at assessing essential elements of vaccination policies and the influence of policy-related driving factors on VCRs among elderly. Sixteen European National Vaccine Industry Groups (NVIGs) were included in a survey to make an inventory of vaccination policies implemented at national level (2009). The questionnaire was structured around four topics: management of vaccination programs; influence of health care workers (HCWs); role of information/ communication campaigns; and access to vaccine. The information retrieved was put in relation to current VCRs among the elderly (≥65 y). Correlation coefficients between policy elements and vaccination rates were calculated. Several policy elements may be suitable to increase influenza vaccination uptake in the elderly, but only few countries make use of all alternatives. Countries with good monitoring systems regarding vaccine uptake rates (Spearmans rho = 0.639, p = 0.010) or sending personal letters offering free vaccination (Sp = 0.728, p = 0.002) showed on average higher coverage among the elderly than countries with less developed vaccine management systems. The presence of additional policy elements (setting national objectives, HCW incentives, vaccination reimbursement systems, awareness campaigns and clear VCR objectives) led to numerically increased VCRs. The presence of several elements of vaccination policies at national level, including broad information and reminding systems, strong official recommendations and good access to the vaccine may help to achieve improved influenza vaccine coverage rates among elderly.