Praveen Dhankhar

Public Health Impact and Cost-Effectiveness of Hepatitis A Vaccination in the United States: A Disease Transmission Dynamic Modeling Approach

OBJECTIVE To assess the population-level impact and cost-effectiveness of hepatitis A vaccination programs in the United States. METHODS We developed an age-structured population model of hepatitis A transmission dynamics to evaluate two policies of administering a two-dose hepatitis A vaccine to children aged 12 to 18 months: 1) universal routine vaccination as recommended by the Advisory Committee on Immunization Practices in 2006 and 2) Advisory Committee on Immunization Practicess previous regional policy of routine vaccination of children living in states with high hepatitis A incidence. Inputs were obtained from the published literature, public sources, and clinical trial data. The model was fitted to hepatitis A seroprevalence (National Health and Nutrition Examination Survey II and III) and reported incidence from the National Notifiable Diseases Surveillance System (1980-1995). We used a societal perspective and projected costs (in 2013 US

Cost-effectiveness of stockpiling 23-valent pneumococcal polysaccharide vaccine to prevent secondary pneumococcal infections among a high-risk population in the united states during an influenza pandemic

), quality-adjusted life-years, incremental cost-effectiveness ratio, and other outcomes over the period 2006 to 2106. RESULTS On average, universal routine hepatitis A vaccination prevented 259,776 additional infections, 167,094 outpatient visits, 4781 hospitalizations, and 228 deaths annually. Compared with the regional vaccination policy, universal routine hepatitis A vaccination was cost saving. In scenario analysis, universal vaccination prevented 94,957 infections, 46,179 outpatient visits, 1286 hospitalizations, and 15 deaths annually and had an incremental cost-effectiveness ratio of

Cost-effectiveness of a pentavalent rotavirus vaccine in Japan

21,223/quality-adjusted life-year when herd protection was ignored. CONCLUSIONS Our model predicted that universal childhood hepatitis A vaccination led to significant reductions in hepatitis A mortality and morbidity. Consequently, universal vaccination was cost saving compared with a regional vaccination policy. Herd protection effects of hepatitis A vaccination programs had a significant impact on hepatitis A mortality, morbidity, and cost-effectiveness ratios.

Economics of stockpiling for an influenza pandemic

BACKGROUND Secondary bacterial infections (especially pneumococcal infections) were a major cause of death during prior influenza pandemics. One strategy to prevent pneumococcal infections in adults during a future pandemic is to stockpile 23-valent pneumococcal polysaccharide vaccine (PPSV23). Stockpiling a pneumococcal vaccine can ensure that it is available when needed most-that is, at the onset of a pandemic. OBJECTIVE The purpose of this article was to project the health and economic impact of stockpiling PPSV23 to prevent secondary pneumococcal infections among high-risk adults aged 18 to 64 years during an influenza pandemic within the United States. METHODS A cost-effectiveness model was developed to evaluate the health and economic effects of stockpiling PPSV23 versus not stockpiling this vaccine for preventing secondary pneumococcal infections among 20 million high-risk US adults aged 18 to 64 years during an influenza pandemic. The model was used to project the number of pneumococcal cases, hospitalizations, deaths, and days of work loss averted. Three health outcomes (deaths, hospitalizations, and outpatient care) were estimated from secondary pneumococcal infections. To assess the overall effectiveness of the different strategies, the quality-adjusted life-year (QALY) was used as a measure of these 3 health outcomes. The results are presented for 3 scenarios based on the pandemic severity and anticipated prepandemic influenza vaccine availability: base case, more-severe case, and less-severe case. RESULTS In the base-case scenario, vaccinating 20 million high-risk adults with PPSV23 avoided 2858 deaths, 878 hospitalizations, 41,881 pneumococcal pneumonia cases, and 232,891 days of work loss during a pandemic. Under the more-severe case scenario, vaccination avoided 21,921 deaths, 10,280 hospitalizations, 70,345 pneumococcal cases, and approximately 1.12 million days of work loss. Under the less-severe case scenario, pneumococcal vaccination avoided 715 deaths, 219 hospitalizations, 10,470 pneumococcal cases, and 58,235 days of work loss. The incremental cost-effectiveness ratio for stockpiling PPSV23 versus no stockpiling for the base-case and less-severe case scenarios was

Comparison of costs and outcomes of dapagliflozin with other glucose-lowering therapy classes added to metformin using a short-term cost-effectiveness model in the US setting

39,946 and

Cost effectiveness of Pneumovax® 23 stockpile to prevent secondary pneumococcal infections among a high-risk population in the United States during an influenza pandemic

198,653 per QALY, respectively. For the more-severe case scenario, stockpiling PPSV23 was cost saving. Probabilistic sensitivity analyses found that the range of incremental cost-effectiveness ratio values was broad due to the large uncertainty regarding the timing and impact of the next pandemic. In addition, the shelf life of PPSV23 and stockpile management substantially influenced the cost-effectiveness ratio. CONCLUSIONS For severe pandemics or pandemics in which prepandemic influenza vaccine is unavailable, stockpiling of PPSV23 can be a cost-effective strategy for reducing the health and economic burden associated with secondary pneumococcal infections in a high-risk US population. However, for a mildly severe pandemic in which prepandemic influenza vaccine is available, stockpiling of PPSV23 may not be cost-effective.

Cost-effectiveness of the use 23-valent pneumococcal polysaccharide vaccine to prevent secondary bacterial infections related to pandemic influenza in Brazil

Abstract Objective: To evaluate the impact of universal vaccination with a pentavalent rotavirus vaccine (RV5) on the healthcare burden and costs associated with rotavirus gastroenteritis (RGE) in Japan. Methods: The model included a hypothetical cohort of 1,091,156 children followed for their first 5 years of life. In the absence of universal vaccination, there were 19 deaths, 78,000 hospitalizations, and 678,000 outpatient visits due to RGE. The efficacy of RV5 is based on international clinical trial data, which was similar to the efficacy observed in clinical trials conducted in Japan. The primary outcome measure is the cost per quality-adjusted-life-year (QALY) gained. In the base case, the QALY loss per 1000 RGE episodes included 2.2 for children and 1.8 per parent. Results: Universal vaccination is projected to reduce hospitalizations by 92%, outpatient visits by 74%, and work-loss days by 73%. For the base case analysis, the total vaccination cost was ¥26 billion. The estimated reduction in medical costs was ¥16 billion. Of 2500 QALYs gained with the vaccination program, approximately half are directly attributed to the child. In the base case analysis, the incremental cost-effectiveness ratio (ICER) for vaccination vs no vaccination is ¥4 million and ¥2 million per quality-adjusted life year (QALY) gained from the healthcare payer and societal perspectives, respectively. The ICERs are ¥8 million and ¥4 million if parental disutilities are excluded. Key limitation: The QALY decrements for children and parents were evaluated using different instruments, and the QALY decrements do not vary based on episode severity. Given the interdependence between children and their parents, excluding parental disutilities may under-estimate the impact of RGE. Conclusion: Universal vaccination with RV5 in Japan is projected to have a substantial public health impact and may be cost-effective from both the payer and societal perspectives if parental disutilities are included in the cost-effectiveness ratios.

Public health impact and cost effectiveness of hepatitis a vaccination in the united states: A population-based dynamic model

Secondary bacterial infections (especially Streptococcus pneumoniae infections) were the leading cause of death during past infl uenza pandemics. One way to prevent pneumococcal infections in adults during the next pandemic is to stockpile pneumococcal vaccines. The usefulness of strategies such as stockpiling can be evaluated using cost-eff ectiveness analysis. For example, vaccinating adults with the a 23-valent pneumococcal vaccine can be a cost-eff ective strategy that could prevent a substantial number of lost work days, hospitalisations, and deaths during a pandemic. Stockpiling of antiviral drugs can also be a cost-eff ective strategy. Although recent economic studies suggest that stockpiling of antiviral drugs and vaccines might be cost eff ective, additional insight could be gained by developing such models further. For example, because there is uncertainty about the timing of future benefi ts (or there might be no benefi ts at all until the pandemic strikes), including the probability of a pandemic in the economic evaluation of a stockpile might be informative. The fi gure shows the impact of probability of a pandemic and fi nite shelf life of a stockpiled product on the incremental cost-eff ectiveness ratio—the cost per quality adjusted life year gained. We assume that the shelf life of the product is 10 years and probability of pandemic has a uniform distribution. We chose this distribution for its simplicity. In a uniform distribution, the probability of a pandemic is the same across all years. If we assume that the pandemic will occur in the next 30 years, then the probability of a pandemic in any given year will be 0·033. The blue line (circles) is based on the assumption that the stockpile needs to be fully replenished every 10 years. The red line (squares) assumes that there is no cost in replacing the stockpile after the end of its shelf life. The fi gure shows the aff ect of shelf life and the time to pandemic on the costeff ectiveness ratio. The blue line mimics a step function, because there is a cost to periodically replenish the stockpile. Additionally, because of discounting, the steps get smaller as time progresses. Both lines slope upwards because future benefi ts have been discounted. Stockpile management is a broad term that includes the acquisition, maintenance, and delivery of the stockpile. The acquisition part of stockpile management also involves the particular form in which the product should be stockpiled. For example, 23-valent pneumococcal vaccine could be stockpiled either in liquid form (with a shorter shelf life, but available more quickly) or bulk-powder form (with a longer shelf life, but requiring packaging before use). The management of the stockpile involves some very important questions as to who maintains the stockpile (manufacturers or governments), whether a part of the stockpile can be put into mainstream use every year, and what proportion can be put into mainstream use. When some portion of the drug (vaccine or antiviral) is put into mainstream use, that product does not go to waste, which saves health-care resources and avoids the need to replace the entire stockpile at the end of its shelf life. The assessment could be extended by incorporating quantitative methods to estimate the optimum size and timing of the stockpile as a supportive analysis. Finally, since planning for a pandemic can involve multiple measures, the economic evaluation of a stockpile could include the eff ects of other nonpharmaceutical interventions (school closure, quarantine, etc), if policy makers identifi ed these as additional important alternatives. Stockpiling of drugs can be an important part of the preparation for the next infl uenza pandemic. Economic evaluations can help to guide policy makers on the economic feasibility of stockpiling. Extending these Full stockpile replacement cost No stockpile replacement cost

Original article Cost-effectiveness of a pentavalent rotavirus vaccine in Japan

Abstract Objective: To compare 1-year costs and benefits of dapagliflozin (DAPA), a sodium-glucose cotransporter-2 (SGLT-2) inhibitor, with those of other treatments for type 2 diabetes (T2D), such as glucagon-like peptide-1 receptor agonists (GLP-1RAs), sulfonylureas (SUs), thiazolidinediones (TZDs), and dipeptidyl peptidase-4 inhibitors (DPP-4i), all combined with metformin. Methods: A short-term decision-analytic model with a 1-year time horizon was developed from a payer’s perspective in the United States setting. Costs and benefits associated with four clinical end-points (glycated hemoglobin [A1C], body weight, systolic blood pressure [SBP], and risk of hypoglycemia) were evaluated in the analysis. The impact of DAPA and other glucose-lowering therapy classes on these clinical end-points was estimated from a network meta-analysis (NMA). Data for costs and quality-adjusted life-years (QALYs) associated with a per-unit change in these clinical end-points were taken from published literature. Drug prices were taken from an annual wholesale price list. All costs were inflation-adjusted to December 2016 costs using the medical care component of the consumer price index. Total costs (both medical and drug costs), total QALYs, and incremental cost-effectiveness ratios (ICERs) were estimated. Sensitivity analyses (SA) were performed to explore uncertainty in the inputs. To assess face validity, results from the short-term model were compared with long-term models published for these drugs. Results: The total annual medical cost for DAPA was less than that for GLP-1RA (

Iconographies supplémentaires de l'article : Economics of stockpiling for an influenza pandemic

186 less), DPP-4i (