scholarly journals The Case against Universal Varicella Vaccination

2006 ◽  
Vol 25 (5) ◽  
pp. 313-317 ◽  
Author(s):  
Gary S. Goldman
Keyword(s):  
United States ◽  
Scientific Literature ◽  
Cost Benefit Analysis ◽  
Varicella Vaccine ◽  
Cost Benefit ◽  
Cost Effective ◽  
The United States ◽  
Vaccination Program ◽  
Varicella Vaccination ◽  
Benefit Analysis

In 1995, the United States became the first country to implement a Universal Varicella Vaccination Program. Several questions remain: Is the varicella (chickenpox) vaccine needed? Is it cost effective as a routine immunization for all susceptible children? Or is it more beneficial for the disease to remain endemic so that adults may receive periodic exogenous exposures (boosts) that help suppress the reactivation of herpes zoster (shingles). In addition, as vaccination coverage becomes widespread, does loss of immunologic boosting cause a decline in vaccine efficacy and result in a reduced period of immunity? Scientific literature regarding safety of the varicella vaccine and its associated cost-benefit analysis have often reported optimistic evaluations based on ideal assumptions. Deleterious outcomes and their associated costs must be included when making a circumspect assessment of the Universal Varicella Vaccination Program.

Precaution, Proportionality, and Cost/Benefit Analysis: False Analogies

2013 ◽  
Vol 4 (2) ◽  
pp. 281-286 ◽  
Author(s):  
Susan Rose–Ackerman
Keyword(s):  
United States ◽  
European Union ◽  
Precautionary Principle ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
The United States ◽  
Benefit Analysis ◽  
European Union Law ◽  
The Us ◽  
Proportionality Principle

The Politics of Precaution by David Vogel, and the edited volume, The Reality of Precaution each compare the United States with Europe over a range of regulatory areas. Vogel claims that the US and Europe changed places in recent years with Europe becoming more precautionary than the US. The edited volume covers a wider range of topics and finds that the results are mixed. The evidence of diversity in the edited volume appears convincing, but this essay argues that both volumes too narrowly focus on the precautionary principle. Rather it argues for a broader context that confronts precaution both with the proportionality principle, which is a mainstay of European Union law, and with the limitations of cost/benefit analysis and Impact Assessment. It unpacks the normative underpinnings of these concepts to suggest a broader frame for policy analysis.

A Cost-Benefit Analysis of a Potential Supervised Injection Facility in San Francisco, California, USA

2016 ◽  
Vol 47 (2) ◽  
pp. 164-184 ◽  
Author(s):  
Amos Irwin ◽  
Ehsan Jozaghi ◽  
Ricky N. Bluthenthal ◽  
Alex H. Kral
Keyword(s):  
Public Health ◽  
United States ◽  
San Francisco ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Cost Effective ◽  
The United States ◽  
Local Public Health ◽  
Supervised Injection ◽  
Overdose Deaths

Supervised injection facilities (SIFs) have been shown to reduce infection, prevent overdose deaths, and increase treatment uptake. The United States is in the midst of an opioid epidemic, yet no sanctioned SIF currently operates in the United States. We estimate the economic costs and benefits of establishing a potential SIF in San Francisco using mathematical models that combine local public health data with previous research on the effects of existing SIFs. We consider potential savings from five outcomes: averted HIV and hepatitis C virus (HCV) infections, reduced skin and soft tissue infection (SSTI), averted overdose deaths, and increased medication-assisted treatment (MAT) uptake. We find that each dollar spent on a SIF would generate US$2.33 in savings, for total annual net savings of US$3.5 million for a single 13-booth SIF. Our analysis suggests that a SIF in San Francisco would not only be a cost-effective intervention but also a significant boost to the public health system.

scholarly journals Cost-benefit Analysis of Maintaining a Fully Stocked Malignant Hyperthermia Cart versus an Initial Dantrolene Treatment Dose for Maternity Units

2018 ◽  
Vol 129 (2) ◽  
pp. 249-259 ◽  
Author(s):  
Phi T. Ho ◽  
Brendan Carvalho ◽  
Eric C. Sun ◽  
Alex Macario ◽  
Edward T. Riley
Keyword(s):  
United States ◽  
Malignant Hyperthermia ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
The United States ◽  
Sensitivity Analyses ◽  
Maternity Unit ◽  
Benefit Analysis ◽  
General Anesthetic ◽  
Tree Model

Abstract What We Already Know about This Topic What This Article Tells Us That Is New Background The Malignant Hyperthermia Association of the United States recommends that dantrolene be available for administration within 10 min. One approach to dantrolene availability is a malignant hyperthermia cart, stocked with dantrolene, other drugs, and supplies. However, this may not be of cost benefit for maternity units, where triggering agents are rarely used. Methods The authors performed a cost-benefit analysis of maintaining a malignant hyperthermia cart versus a malignant hyperthermia cart readily available within the hospital versus an initial dantrolene dose of 250 mg, on every maternity unit in the United States. A decision-tree model was used to estimate the expected number of lives saved, and this benefit was compared against the expected costs of the policy. Results We found that maintaining a malignant hyperthermia cart in every maternity unit in the United States would reduce morbidity and mortality costs by $3,304,641 per year nationally but would cost $5,927,040 annually. Sensitivity analyses showed that our results were largely driven by the extremely low incidence of general anesthesia. If cesarean delivery rates in the United States remained at 32% of all births, the general anesthetic rate would have to be greater than 11% to achieve cost benefit. The only cost-effective strategy is to keep a 250-mg dose of dantrolene on the unit for starting therapy. Conclusions It is not of cost benefit to maintain a fully stocked malignant hyperthermia cart with a full supply of dantrolene within 10 min of maternity units. We recommend that hospitals institute alternative strategies (e.g., maintain a small supply of dantrolene on the maternity unit for starting treatment).

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