scholarly journals 2769. The Clinical and Economic Impact of MMR Vaccinations to Prevent Measles Importations from US Pediatric Travelers Returning from Abroad

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S976-S977
Author(s):  
Emily P Hyle ◽  
Audrey C Bangs ◽  
Amy P Fiebelkorn ◽  
Alison T Walker ◽  
Paul Gastanaduy ◽  
...  
Keyword(s):  
At Risk ◽  
Clinical Impact ◽  
Vaccination Status ◽  
Sensitivity Analyses ◽  
Primary Immunization ◽  
Mmr Vaccine ◽  
Tree Model ◽  
Lost Work ◽  
Risk Of Exposure ◽  
Immunization Series

Abstract Background Although pediatric travelers comprise < 10% of US international travelers, they account for almost half of all measles importations among returning travelers. For travelers 1–18 years with no other evidence of measles immunity, the Advisory Committee on Immunization Practices (ACIP) recommends 2 MMR vaccine doses before departure; 1 dose is recommended for infant travelers (6 to <12 months) and does not count toward their primary immunization series. All US travelers (6 months to < 6 years) are at risk for being undervaccinated for measles because MMR is routinely given at 1 years and 4–6 years. Methods We developed a decision tree model to evaluate the clinical impact and cost per case averted of pretravel health encounters (PHE) that vaccinate MMR-eligible pediatric international travelers. We compared 2 strategies for infant (6 to < 12 months) and preschool-aged (1 to <6 years) travelers: (1) no PHE: travelers departed with baseline MMR vaccination status vs. (2) PHE: MMR-eligible travelers were offered vaccination. All simulated travelers experienced a destination-specific risk of measles exposure during travel (mean, 237exposures/10M travelers; range, 19–6,750 exposures/10M travelers); if exposed to measles, travelers were at risk of illness stratified by age and MMR vaccination status (range, 0.03–0.90). Costs include direct medical costs and lost work wages for guardians. Model outcomes included measles cases, costs, and cost per case averted. We varied inputs in sensitivity analyses. Results Compared with no PHE, PHE averted 451 measles cases at $985,000/case averted for infant travelers and 54 measles cases at $1.5 million/case averted for preschool-aged travelers (table, bottom). PHE can be cost-saving for travelers to regions with higher risk of measles exposure and if more MMR-eligible travelers are vaccinated at PHE (Figure 1). At a risk of exposure associated with European travel, PHE had better value when a measles importation led to a higher number of contacts or more US-acquired cases per importation (Figure 2). Conclusion PHE for pediatric travelers (6 months to <6 years) decreased the number of imported measles cases and saved costs, especially if targeted to travelers with higher-risk destinations, if more MMR-eligible travelers are vaccinated at PHE, or if outbreaks are larger. Disclosures All authors: No reported disclosures.

scholarly journals Alternating Cystoscopy with Bladder EpiCheck ® in the Surveillance of Low-Grade Intermediate-Risk NMIBC: A Cost Comparison Model

2021 ◽  
pp. 1-9
Author(s):  
Yair Lotan ◽  
Georgios Gakis ◽  
Matteo Manfredi ◽  
Juan Morote ◽  
Hugh Mostafid ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
High Specificity ◽  
Cancer Surveillance ◽  
European Countries ◽  
Cost Comparison ◽  
Sensitivity Analyses ◽  
Low Grade ◽  
Intermediate Risk ◽  
Tree Model ◽  
Urine Marker

BACKGROUND: Bladder cancer surveillance is invasive, intensive and costly. Patients with low grade intermediate risk non-muscle invasive bladder cancer (NMIBC) are at high risk of recurrence. OBJECTIVE: The objective of this model is to compare the cost of a strategy to alternate surveillance with cystoscopy and a urine marker, Bladder EpiCheck, to standard surveillance. METHODS: A decision tree model was built using TreeAge Pro Healthcare to compare standard surveillance (Standard) with a modified surveillance incorporating Bladder EpiCheck. The model was based on 2 years of surveillance. Outcomes were obtained from literature. Costs were obtained from US and 9 European countries. Sensitivity analyses were performed. RESULTS: The efficacy of the model was equivalent in terms of recurrence for each arm with median recurrence rate of 22%. When setting marker price at 200 local currency, the marker arm was less expensive in the USA, Netherlands, Switzerland, Belgium, Italy, Austria and UK by 154€ to 329€ per patient, for a 2-year period. Cost was higher in France, Spain, and Germany by 33–103€. Cost parity was achieved with marker price between 148€ and $421. Marker cost and specificity have the greatest impact on the overall model cost. CONCLUSIONS: A strategy alternating the urine marker Bladder EpiCheck with cystoscopy in the surveillance of patients with low grade intermediate risk bladder cancer is cost equivalent in the US and European countries when the marker is priced 148€ –$421, as a result of the marker’s high specificity (86%). Prospective studies will be necessary to validate these findings.

An integrated risk-assessment framework for multiple threats to floodplain values in the Kakadu Region, Australia, under a changing climate

2018 ◽  
Vol 69 (7) ◽  
pp. 1159 ◽  
Author(s):  
P. Bayliss ◽  
C. M. Finlayson ◽  
J. Innes ◽  
A. Norman-López ◽  
R. Bartolo ◽  
...  
Keyword(s):  
Risk Assessment ◽  
At Risk ◽  
Invasive Species ◽  
Freshwater Ecosystems ◽  
Sensitivity Analyses ◽  
Assessment Framework ◽  
Integrated Risk Assessment ◽  
Invasive Species Control ◽  
Integrated Risk ◽  
Time Frames

The internationally important river–floodplains of the Kakadu Region in northern Australia are at risk from invasive species and future sea-level rise–saltwater inundation (SLR–SWI), requiring assessments of multiple cumulative risks over different time frames. An integrated risk-assessment framework was developed to assess threats from feral animals and aquatic weeds at three SLR-scenario time frames (present-day, 2070 and 2100) to natural (magpie goose habitats), cultural (indigenous hunting–fishing sites) and economic (tourism revenue less invasive species control costs) values. Probability density functions (pdfs) were fitted to spatial data to characterise values and threats, and combined with Monte Carlo simulation and sensitivity analyses to account for uncertainties. All risks were integrated in a Bayesian belief network to undertake ‘what if’ management-scenario analyses, and incorporated known ecological interactions and uncertainties. Coastal landscapes and socio-ecological systems in the region will be very different by 2100 as a result of SLR; freshwater ecosystems will transform to marine-dominated ecosystems and cannot be managed back to analogue conditions. In this context, future invasive-species risks will decrease, reflecting substantial loss of freshwater habitats previously at risk and a reduction in the extent of invasive species, highlighting the importance of freshwater refugia for the survival of iconic species.

P14.41 Cost-effectiveness of FET PET for early treatment response assessment in glioma patients following adjuvant temozolomide chemotherapy

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii46-ii46
Author(s):  
J Rosen ◽  
G Ceccon ◽  
E K Bauer ◽  
J M Werner ◽  
C Kabbasch ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Response Assessment ◽  
Sensitivity Analyses ◽  
Tree Model ◽  
Fet Pet ◽  
Conventional Mri ◽  
Adjuvant Temozolomide ◽  
The Cost ◽  
Temozolomide Chemotherapy

Abstract BACKGROUND In light of increasing healthcare costs, higher medical expenses should be justified socio-economically. Therefore, we calculated the effectiveness and cost-effectiveness of PET using the radiolabeled amino acid O-(2-[18F]-fluoroethyl)-L-tyrosine (FET) compared to conventional MRI for early identification of responders to adjuvant temozolomide chemotherapy. A recent study in IDH-wildtype glioma patients suggested that after two cycles, FET-PET parameter changes predicted a significantly longer survival while MRI changes were not significant. MATERIALS AND METHODS To determine the effectiveness and cost-effectiveness of serial FET-PET imaging, we analyzed published clinical data and calculated the associated costs in the context of the German healthcare system.Based on a decision-tree model, FET-PET and MRI’s effectiveness was calculated, i.e., the probability to correctly identify a responder as defined by an overall survival ≥15 months. To determine the cost-effectiveness, the incremental cost-effectiveness ratio (ICER) was calculated, i.e., the cost for each additionally identified responder by FET-PET who would have remained undetected by MRI. The robustness of the results was tested by deterministic and probabilistic (Monte Carlo simulation) sensitivity analyses. RESULTS Compared to MRI, FET-PET increases the rate of correctly identified responders to chemotherapy by 26%; thus, four patients need to be examined by FET-PET to identify one additional responder. Considering the respective cost for serial FET-PET and MRI, the ICER resulted in €4,396.83 for each additional correctly identified responder by FET-PET. The sensitivity analyses confirmed the robustness of the results. CONCLUSION In contrast to conventional MRI, the model suggests that FET PET is cost-effective in terms of ICER values. Concerning the high cost of temozolomide, the integration of FET-PET has the potential to avoid premature chemotherapy discontinuation at a reasonable cost.

scholarly journals A Cost-Effectiveness Analysis of Newborn Screening for Severe Combined Immunodeficiency in the UK

2019 ◽  
Vol 5 (3) ◽  
pp. 28 ◽  
Author(s):  
Alice Bessey ◽  
James Chilcott ◽  
Joanna Leaviss ◽  
Carmen de la Cruz ◽  
Ruth Wong
Keyword(s):  
Cost Effectiveness ◽  
Severe Combined Immunodeficiency ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Combined Immunodeficiency ◽  
Tree Model ◽  
Life Years ◽  
The Uk ◽  
The Cost ◽  
The Impact

Severe combined immunodeficiency (SCID) can be detected through newborn bloodspot screening. In the UK, the National Screening Committee (NSC) requires screening programmes to be cost-effective at standard UK thresholds. To assess the cost-effectiveness of SCID screening for the NSC, a decision-tree model with lifetable estimates of outcomes was built. Model structure and parameterisation were informed by systematic review and expert clinical judgment. A public service perspective was used and lifetime costs and quality-adjusted life years (QALYs) were discounted at 3.5%. Probabilistic, one-way sensitivity analyses and an exploratory disbenefit analysis for the identification of non-SCID patients were conducted. Screening for SCID was estimated to result in an incremental cost-effectiveness ratio (ICER) of £18,222 with a reduction in SCID mortality from 8.1 (5–12) to 1.7 (0.6–4.0) cases per year of screening. Results were sensitive to a number of parameters, including the cost of the screening test, the incidence of SCID and the disbenefit to the healthy at birth and false-positive cases. Screening for SCID is likely to be cost-effective at £20,000 per QALY, key uncertainties relate to the impact on false positives and the impact on the identification of children with non-SCID T Cell lymphopenia.

scholarly journals Diagnosing heart failure with NT-proBNP point-of-care testing: lower costs and better outcomes. A decision analytic study

BJGP Open ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. bjgpopen18X101596 ◽  
Author(s):  
Christoffer Bugge ◽  
Erik Magnus Sether ◽  
Andreas Pahle ◽  
Sigrun Halvorsen ◽  
Ivar Sonbo Kristiansen
Keyword(s):  
Heart Failure ◽  
Clinical Diagnosis ◽  
Point Of Care ◽  
Adult Population ◽  
Delayed Diagnosis ◽  
Clinical Findings ◽  
Sensitivity Analyses ◽  
Tree Model ◽  
Diagnostic Strategies ◽  
Point Of Care Test

BackgroundAfflicting 1–2% of the adult population, heart failure (HF) is a condition with considerable morbidity and mortality. While echocardiography may be considered the gold standard diagnostic test, GPs have relied on symptoms and clinical findings in diagnosing the condition.AimThe aim of this study was to estimate 1-year health outcome and costs of three diagnostic strategies: 1) history and clinical findings ('clinical diagnosis'); 2) clinical diagnosis supplemented with NTproBNP point-of-care test ('POC test') in the GP’s surgery; or (3) in hospital laboratory ('hospital test').Design & settingA decision tree model was developed to simulate 1-year patient courses with each strategy in Norway.MethodSensitivity and specificity of clinical diagnosis (56% and 68%), and of N-terminal pro B-type natriuretic peptide test ([NT-proBNP] 90% and 65%), were based on published literature. The probabilities of referral to hospital were based on a survey of Norwegian GPs (n = 103). The costs were based on various Norwegian fee schedules. Sensitivity analyses were conducted to examine the uncertainty of the results.ResultsThe 1-year per person societal costs were €543, €505, and €607 for clinical diagnosis, POC test, and hospital test, respectively. Even though POC entails higher laboratory costs, the total primary care costs were lower because of fewer re-visits with the GP and less use of spirometry. While 38% of patients had a delayed diagnosis with clinical diagnosis, the proportions were 22% with both POC test and hospital test. Results were most sensitive to the probability of use of spirometry.ConclusionPOC testing results in earlier diagnosis and lower costs than the other diagnostic modalities.

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