scholarly journals National- and state-level impact and cost-effectiveness of nonavalent HPV vaccination in the United States

2016 ◽  
Vol 113 (18) ◽  
pp. 5107-5112 ◽  
Author(s):  
David P. Durham ◽  
Martial L. Ndeffo-Mbah ◽  
Laura A. Skrip ◽  
Forrest K. Jones ◽  
Chris T. Bauch ◽  
...  
Keyword(s):  
United States ◽  
Cervical Cancer ◽  
Hpv Vaccination ◽  
National Level ◽  
Herd Immunity ◽  
State Level ◽  
Cost Effective ◽  
Health Impact ◽  
The United States ◽  
Cervical Cancers

Every year in the United States more than 12,000 women are diagnosed with cervical cancer, a disease principally caused by human papillomavirus (HPV). Bivalent and quadrivalent HPV vaccines protect against 66% of HPV-associated cervical cancers, and a new nonavalent vaccine protects against an additional 15% of cervical cancers. However, vaccination policy varies across states, and migration between states interdependently dilutes state-specific vaccination policies. To quantify the economic and epidemiological impacts of switching to the nonavalent vaccine both for individual states and for the nation as a whole, we developed a model of HPV transmission and cervical cancer incidence that incorporates state-specific demographic dynamics, sexual behavior, and migratory patterns. At the national level, the nonavalent vaccine was shown to be cost-effective compared with the bivalent and quadrivalent vaccines at any coverage despite the greater per-dose cost of the new vaccine. Furthermore, the nonavalent vaccine remains cost-effective with up to an additional 40% coverage of the adolescent population, representing 80% of girls and 62% of boys. We find that expansion of coverage would have the greatest health impact in states with the lowest coverage because of the decreasing marginal returns of herd immunity. Our results show that if policies promoting nonavalent vaccine implementation and expansion of coverage are coordinated across multiple states, all states benefit both in health and in economic terms.

scholarly journals Bayesian Inference of State-Level COVID-19 Basic Reproduction Numbers across the United States

2021 ◽  
Author(s):  
Abhishek Mallela ◽  
Jacob Neumann ◽  
Ely F Miller ◽  
Ye Chen ◽  
Richard G Posner ◽  
...  
Keyword(s):  
United States ◽  
Bayesian Inference ◽  
Disease Transmission ◽  
Case Reports ◽  
Herd Immunity ◽  
State Level ◽  
The United States ◽  
Expected Number ◽  
Reproduction Numbers ◽  
A Posteriori Estimates

Although many persons in the United States have acquired immunity to COVID-19, either through vaccination or infection with SARS-CoV-2, COVID-19 will pose an ongoing threat to non-immune persons so long as disease transmission continues. We can estimate when sustained disease transmission will end in a population by calculating the population-specific basic reproduction number R_0, the expected number of secondary cases generated by an infected person in the absence of any interventions. The value of R_0 relates to a herd immunity threshold (HIT), which is given by 1-1/R_0. When the immune fraction of a population exceeds this threshold, sustained disease transmission becomes exponentially unlikely (barring mutations allowing SARS-CoV-2 to escape immunity). Here, we report state-level R_0 estimates obtained using Bayesian inference. Maximum a posteriori estimates range from 7.1 for New Jersey to 2.3 for Wyoming, indicating that disease transmission varies considerably across states and that reaching herd immunity will be more difficult in some states than others. R_0 estimates were obtained from compartmental models via the next-generation matrix approach after each model was parameterized using regional daily confirmed case reports of COVID-19 from 21-January-2020 to 21-June-2020. Our R_0 estimates characterize infectiousness of ancestral strains, but they can be used to determine HITs for a distinct, currently dominant circulating strain, such as SARS-CoV-2 variant Delta (lineage B.1.617.2), if the relative infectiousness of the strain can be ascertained. On the basis of Delta-adjusted HITs, vaccination data, and seroprevalence survey data, we find that no state has achieved herd immunity as of 20-September-2021.

scholarly journals Cervical cancer screening varies by HPV vaccination status among a National Cohort of privately insured young women in the United States 2006–2016

Medicine ◽  
2021 ◽  
Vol 100 (41) ◽  
pp. e27457
Author(s):  
Djibril M. Ba ◽  
Jennifer S. McCall-Hosenfeld ◽  
Paddy Ssentongo ◽  
Vernon M. Chinchilli ◽  
Edeanya Agbese ◽  
...  
Keyword(s):  
United States ◽  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Young Women ◽  
Hpv Vaccination ◽  
The United States ◽  
Vaccination Status ◽  
National Cohort ◽  
Privately Insured

scholarly journals Evaluating Surveillance for and Estimating Administration of Rabies Postexposure Prophylaxis in the United States, 2012–2018

2021 ◽  
Vol 15 (10) ◽  
pp. e0009878
Author(s):  
Erin R. Whitehouse ◽  
Marissa K. Person ◽  
Catherine M. Brown ◽  
Sally Slavinski ◽  
Agam K. Rao ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
National Level ◽  
State Level ◽  
The United States ◽  
Surveillance Data ◽  
Human Rabies ◽  
Accurate Assessment ◽  
Postexposure Prophylaxis ◽  
Ed Visits

Background An evaluation of postexposure prophylaxis (PEP) surveillance has not been conducted in over 10 years in the United States. An accurate assessment would be important to understand current rabies trends and inform public health preparedness and response to human rabies. Methodology/Principle findings To understand PEP surveillance, we sent a survey to public health leads for rabies in 50 U.S. states, Puerto Rico, Washington DC, Philadelphia, and New York City. Of leads from 54 jurisdictions, 39 (72%) responded to the survey; 12 reported having PEP-specific surveillance, five had animal bite surveillance that included data about PEP, four had animal bite surveillance without data about PEP, and 18 (46%) had neither. Although 12 jurisdictions provided data about PEP use, poor data quality and lack of national representativeness prevented use of this data to derive a national-level PEP estimate. We used national-level and state specific data from the Healthcare Cost & Utilization Project (HCUP) to estimate the number of people who received PEP based on emergency department (ED) visits. The estimated annual average of initial ED visits for PEP administration during 2012–2017 in the United States was 46,814 (SE: 1,697), costing upwards of 165 million USD. State-level ED data for initial visits for administration of PEP for rabies exposure using HCUP data was compared to state-level surveillance data from Maryland, Vermont, and Georgia between 2012–2017. In all states, state-level surveillance data was consistently lower than estimates of initial ED visits, suggesting even states with robust PEP surveillance may not adequately capture individuals who receive PEP. Conclusions Our findings suggest that making PEP a nationally reportable condition may not be feasible. Other methods of tracking administration of PEP such as syndromic surveillance or identification of sentinel states should be considered to obtain an accurate assessment.

Perceptual basemaps reloaded: The role basemaps play in eliciting perceptions

2018 ◽  
Vol 6 (2) ◽  
pp. 145-166
Author(s):  
Paulina Bounds ◽  
Charles J. Sutherland
Keyword(s):  
United States ◽  
National Level ◽  
State Level ◽  
The United States ◽  
The State ◽  
The Other ◽  
Striking Difference ◽  
Perceptual Dialectology ◽  
Other Hand ◽  
Perceptual Maps

This article describes the influence of various basemaps in Perceptual Dialectology, on the national and state levels. The 180 perceptual maps of the United States and Tennessee were divided into six types of basemaps; tabulated results show that basemaps play a different role on the national and state level. On the national level, basemaps that have features reminiscent of boundaries (state lines or interstates) bias the respondents’ answers. On the state level, on the other hand, the map features do not seem to influence the results in any discernible way: at times the informants seemingly go against the details present on the basemap. This striking difference indicates that, though the respondents rely on basemap details at the national level, where they may not have enough experience with the whole country, they don’t pay much attention to the state-level basemap details as they follow their own more detailed ideas about perceptions.

All Politics Is Local: The Reemergence of the Study of City Politics

2009 ◽  
Vol 7 (3) ◽  
pp. 611-618 ◽  
Author(s):  
Jessica Trounstine
Keyword(s):  
United States ◽  
Political Science ◽  
Local Politics ◽  
Local Level ◽  
National Level ◽  
State Politics ◽  
State Level ◽  
The United States ◽  
Political Events ◽  
Political Outcomes

The study of local politics has been relegated to the periphery of political science and many explanations have been offered for the marginalization of the subfield. I offer three related arguments for why scholars should revisit the study of sub-state politics. First, the local level is the source of numerous political outcomes that matter because they represent a large proportion of political events in the United States. Secondly, there are methodological advantages to studying local politics. Finally, analyzing politics at the sub-state level can generate thoroughly different kinds of questions than a purely national-level focus and can offer different answers to questions that apply more generally. Research on local politics can and should contribute to broader debates in political science and ensure that we understand both how and why cities are unique.

scholarly journals Human papillomavirus vaccination for adults aged 30 to 45 years in the United States: A cost-effectiveness analysis

PLoS Medicine ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. e1003534
Author(s):  
Jane J. Kim ◽  
Kate T. Simms ◽  
James Killen ◽  
Megan A. Smith ◽  
Emily A. Burger ◽  
...  
Keyword(s):  
United States ◽  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Hpv Vaccination ◽  
The United States ◽  
The Us ◽  
Age Limit ◽  
The Cost

Background A nonavalent human papillomavirus (HPV) vaccine has been licensed for use in women and men up to age 45 years in the United States. The cost-effectiveness of HPV vaccination for women and men aged 30 to 45 years in the context of cervical cancer screening practice was evaluated to inform national guidelines. Methods and findings We utilized 2 independent HPV microsimulation models to evaluate the cost-effectiveness of extending the upper age limit of HPV vaccination in women (from age 26 years) and men (from age 21 years) up to age 30, 35, 40, or 45 years. The models were empirically calibrated to reflect the burden of HPV and related cancers in the US population and used standardized inputs regarding historical and future vaccination uptake, vaccine efficacy, cervical cancer screening, and costs. Disease outcomes included cervical, anal, oropharyngeal, vulvar, vaginal, and penile cancers, as well as genital warts. Both models projected higher costs and greater health benefits as the upper age limit of HPV vaccination increased. Strategies of vaccinating females and males up to ages 30, 35, and 40 years were found to be less cost-effective than vaccinating up to age 45 years, which had an incremental cost-effectiveness ratio (ICER) greater than a commonly accepted upper threshold of $200,000 per quality-adjusted life year (QALY) gained. When including all HPV-related outcomes, the ICER for vaccinating up to age 45 years ranged from $315,700 to $440,600 per QALY gained. Assumptions regarding cervical screening compliance, vaccine costs, and the natural history of noncervical HPV-related cancers had major impacts on the cost-effectiveness of the vaccination strategies. Key limitations of the study were related to uncertainties in the data used to inform the models, including the timing of vaccine impact on noncervical cancers and vaccine efficacy at older ages. Conclusions Our results from 2 independent models suggest that HPV vaccination for adult women and men aged 30 to 45 years is unlikely to represent good value for money in the US.

scholarly journals Public health impact and cost effectiveness of routine and catch-up vaccination of girls and women with a nine-valent HPV vaccine in Japan: a model-based study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Palmer Cody ◽  
Keisuke Tobe ◽  
Machiko Abe ◽  
Elamin H. Elbasha
Keyword(s):  
Cervical Cancer ◽  
Cost Effectiveness ◽  
Hpv Vaccination ◽  
Cost Effective ◽  
Health Impact ◽  
Vaccination Program ◽  
Sensitivity Analyses ◽  
Screening Programs ◽  
Life Years ◽  
Catch Up

Abstract Background Combined with cancer screening programs, vaccination against human papillomavirus (HPV) can significantly reduce the high health and economic burden of HPV-related disease in Japan. The objective of this study was to assess the health impact and cost effectiveness of routine and catch-up vaccination of girls and women aged 11–26 years with a 4-valent (4vHPV) or 9-valent HPV (9vHPV) vaccine in Japan compared with no vaccination. Methods We used a mathematical model adapted to the population and healthcare settings in Japan. We compared no vaccination and routine vaccination of 12–16-year old girls with 1) 4vHPV vaccine, 2) 9vHPV vaccine, and 3) 9vHPV vaccine in addition to a temporary catch-up vaccination of 17–26 years old girls and women with 9vHPV. We estimated the expected number of disease cases and deaths, discounted (at 2% per year) future costs (in 2020 ¥) and discounted quality-adjusted life years (QALY), and incremental cost effectiveness ratios (ICER) of each strategy over a time horizon of 100 years. To test the robustness of the conclusions, we conducted scenario and sensitivity analyses. Results Over 100 years, compared with no vaccination, 9vHPV vaccination was projected to reduce the incidence of 9vHPV-related cervical cancer by 86% (from 15.24 new cases per 100,000 women in 2021 to 2.02 in 2121). A greater number of cervical cancer cases (484,248) and cancer-related deaths (50,102) were avoided through the described catch-up vaccination program. Routine HPV vaccination with 4vHPV or 9vHPV vaccine prevented 5,521,000 cases of anogenital warts among women and men. Around 23,520 and 21,400 diagnosed non-cervical cancers are prevented by catch-up vaccination among women and men, respectively. Compared with no vaccination, the ICER of 4vHPV vaccination was ¥975,364/QALY. Compared to 4vHPV, 9vHPV + Catch-up had an ICER of ¥1,534,493/QALY. Conclusions A vaccination program with a 9-valent vaccine targeting 12 to 16 year-old girls together with a temporary catchup program will avert significant numbers of cases of HPV-related diseases among both men and women. Furthermore, such a program was the most cost effective among the vaccination strategies we considered, with an ICER well below a threshold of ¥5000,000/QALY.

scholarly journals Casinos and Economic Growth: An Update

2013 ◽  
Vol 7 (2) ◽  
pp. 80-87 ◽  
Author(s):  
Douglas M Walker
Keyword(s):  
United States ◽  
Economic Growth ◽  
State Government ◽  
Negative Impact ◽  
Relevant Literature ◽  
National Level ◽  
State Level ◽  
The United States ◽  
Casino Industry ◽  
Causality Model

As U.S. politicians and voters continue to grapple with the slower-than-expected recovery from the 2007-09 recession, the legalization (or expansion) of commercial casinos has become an increasingly popular policy. Casinos are politically popular because the state government legalizes them, and can thus create a new industry which pays high taxes and may stimulate employment and economic development. Despite the fact that casinos are now widespread in the United States – there are around 1,000 commercial and tribal casinos – the empirical evidence on their economic impacts is still negligible.In two previous studies ( we have tested the relationship between state-level casino revenues and per capita income (i.e., economic growth) to provide evidence on whether or not casinos have a positive economic impact on states’ economies. We have utilized a Granger causality model modified for use with panel data. Our initial evidence, from a paper published in 1998, indicated that casinos do Granger cause economic growth. However, when we re-tested the model using up-to-date data (at the time, through 2005), we found no significant results. The casino industry has grown extensively since 2005, and although the recession of 2007-09 had a negative impact on the casino industry, the national-level revenue numbers are again climbing.We extend our previous analyses in order to provide updated evidence on the economic growth impact of commercial casinos in the United States. Section 2 provides a more detailed background of our previous analysis and an overview of other relevant literature. Section 3 describes the data and model, and provides the results. Section 4 is a discussion and conclusion. 

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