Should All Children Receive Two Measles Vaccinations?

1992 ◽  
Vol 31 (4) ◽  
pp. 194-199 ◽  
Author(s):  
Louis J. Tesoro ◽  
Mark B. Levin ◽  
M. David Atkin ◽  
Norman S. Katz ◽  
John M. Cotton ◽  
...  
Keyword(s):  
High Risk ◽  
Cost Effective ◽  
Risk Groups ◽  
Vaccine Failure ◽  
Waning Immunity ◽  
Rising Incidence

Because of the rising incidence of rubeola, we tested all our patients who were vaccinated prior to 15 months of age and those vaccinated after 15 months, if requested, for susceptibility to measles (IgG, ELISA). Those found to be susceptible were revaccinated. Of 1,228 tested, 264 (21.5%) were susceptible. In the group vaccinated before 1980, 237 of 901 (26.3%) were susceptible, whereas only 27 of 327 (8.3%) vaccinated after 1980 were not immune. Susceptibility was sharply divided by month of age at vaccination at the 14-month mark. Less than 5% of those vaccinated after age 15 months in the 1980s (one of 22, or 4.5%) were susceptible. Waning immunity (secondary vaccine failure) was not found to be a factor in our patients. Despite outbreaks of measles in surrounding communities and in our area, none of our patients developed measles. Identification of high-risk groups and selective measles revaccination should be considered as an alternative to universal revaccination in populations such as ours, since it is more cost-effective and may prove equally successful.

scholarly journals Cost-Effectiveness of the International Late Effects of Childhood Cancer Guideline Harmonization Group Screening Guidelines to Prevent Heart Failure in Survivors of Childhood Cancer

2020 ◽  
Vol 38 (33) ◽  
pp. 3851-3862 ◽  
Author(s):  
Matthew J. Ehrhardt ◽  
Zachary J. Ward ◽  
Qi Liu ◽  
Aeysha Chaudhry ◽  
Anju Nohria ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cost Effectiveness ◽  
High Risk ◽  
Childhood Cancer ◽  
Late Effects ◽  
Cost Effective ◽  
Risk Groups ◽  
Low Risk ◽  
Moderate Risk ◽  
Survivors Of Childhood Cancer

PURPOSE Survivors of childhood cancer treated with anthracyclines and/or chest-directed radiation are at increased risk for heart failure (HF). The International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) recommends risk-based screening echocardiograms, but evidence supporting its frequency and cost-effectiveness is limited. PATIENTS AND METHODS Using the Childhood Cancer Survivor Study and St Jude Lifetime Cohort, we developed a microsimulation model of the clinical course of HF. We estimated long-term health outcomes and economic impact of screening according to IGHG-defined risk groups (low [doxorubicin-equivalent anthracycline dose of 1-99 mg/m2 and/or radiotherapy < 15 Gy], moderate [100 to < 250 mg/m2 or 15 to < 35 Gy], or high [≥ 250 mg/m2 or ≥ 35 Gy or both ≥ 100 mg/m2 and ≥ 15 Gy]). We compared 1-, 2-, 5-, and 10-year interval-based screening with no screening. Screening performance and treatment effectiveness were estimated based on published studies. Costs and quality-of-life weights were based on national averages and published reports. Outcomes included lifetime HF risk, quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs). Strategies with ICERs < $100,000 per QALY gained were considered cost-effective. RESULTS Among the IGHG risk groups, cumulative lifetime risks of HF without screening were 36.7% (high risk), 24.7% (moderate risk), and 16.9% (low risk). Routine screening reduced this risk by 4% to 11%, depending on frequency. Screening every 2, 5, and 10 years was cost-effective for high-risk survivors, and every 5 and 10 years for moderate-risk survivors. In contrast, ICERs were > $175,000 per QALY gained for all strategies for low-risk survivors, representing approximately 40% of those for whom screening is currently recommended. CONCLUSION Our findings suggest that refinement of recommended screening strategies for IGHG high- and low-risk survivors is needed, including careful reconsideration of discontinuing asymptomatic left ventricular dysfunction and HF screening in low-risk survivors.

scholarly journals Tuberculosis screening costs and cost-effectiveness in high-risk groups: a systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
H. Alsdurf ◽  
B. Empringham ◽  
C. Miller ◽  
A. Zwerling
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cost Effectiveness ◽  
High Risk ◽  
Cost Effective ◽  
Risk Groups ◽  
Screening Tools ◽  
Molecular Diagnostic ◽  
Systematic Screening ◽  
Structural Risk

Abstract Background Systematic screening for active tuberculosis (TB) is a strategy which requires the health system to seek out individuals, rather than waiting for individuals to self-present with symptoms (i.e., passive case finding). Our review aimed to summarize the current economic evidence and understand the costs and cost-effectiveness of systematic screening approaches among high-risk groups and settings. Methods We conducted a systematic review on economic evaluations of screening for TB disease targeting persons with clinical and/or structural risk factors, such as persons living with HIV (PLHIV) or persons experiencing homelessness. We searched three databases for studies published between January 1, 2010 and February 1, 2020. Studies were included if they reported cost and a key outcome measure. Owing to considerable heterogeneity in settings and type of screening strategy, we synthesized data descriptively. Results A total of 27 articles were included in our review; 19/27 (70%) took place in high TB burden countries. Seventeen studies took place among persons with clinical risk factors, including 14 among PLHIV, while 13 studies were among persons with structural risk factors. Nine studies reported incremental cost-effectiveness ratios (ICERs) ranging from US$51 to $1980 per disability-adjusted life year (DALY) averted. Screening was most cost-effective among PLHIV. Among persons with clinical and structural risk factors there was limited evidence, but screening was generally not shown to be cost-effective. Conclusions Studies showed that screening is most likely to be cost-effective in a high TB prevalence population. Our review highlights that to reach the “missing millions” TB programmes should focus on simple, cheaper initial screening tools (i.e., symptom screen and CXR) followed by molecular diagnostic tools (i.e., Xpert®) among the highest risk groups in the local setting (i.e., PLHIV, urban slums). Programmatic costs greatly impact cost-effectiveness thus future research should provide both fixed and variable costs of screening interventions to improve comparability.

Acute Urinary Tract Infections

2005 ◽  
Vol 4 (1) ◽  
pp. 21-26
Author(s):  
Arun Chaudhuri ◽  
Keyword(s):  
At Risk ◽  
Urinary Tract ◽  
High Risk ◽  
Urinary Tract Infections ◽  
Management Strategies ◽  
Cost Effective ◽  
Risk Groups ◽  
Effective Management ◽  
Proper Understanding ◽  
Tract Infections

Urinary tract infections remain a significant cause of morbidity throughout the globe. Proper understanding of the disease is extremely important for appropriate management. Recent studies have helped to define the population groups at risk for these infections, as well as the most cost-effective management strategies. This article will discuss aspects of initial diagnosis and subsequent management of different high risk groups.

Is screening for pancreatic cancer in high-risk groups cost-effective? – Experience from a Danish national screening program

Pancreatology ◽  
2016 ◽  
Vol 16 (4) ◽  
pp. 584-592 ◽  
Author(s):  
Maiken Thyregod Joergensen ◽  
Anne-Marie Gerdes ◽  
Jan Sorensen ◽  
Ove Schaffalitzky de Muckadell ◽  
Michael Bau Mortensen
Keyword(s):  
Pancreatic Cancer ◽  
High Risk ◽  
Screening Program ◽  
Cost Effective ◽  
Risk Groups

Outcomes of Tamoxifen Chemoprevention for Breast Cancer in Very High-Risk Women: A Cost-Effectiveness Analysis

2002 ◽  
Vol 20 (1) ◽  
pp. 9-16 ◽  
Author(s):  
Dawn Hershman ◽  
Vijaya Sundararajan ◽  
Judith S. Jacobson ◽  
Daniel F. Heitjan ◽  
Alfred I. Neugut ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Carcinoma In Situ ◽  
Lobular Carcinoma ◽  
Cost Effective ◽  
Risk Groups ◽  
Atypical Hyperplasia ◽  
Lobular Carcinoma In Situ ◽  
Very High

PURPOSE: To estimate the effects on survival, quality-adjusted survival, and health care costs of using tamoxifen for primary prevention in subgroups of women at very high risk for breast cancer. PATIENTS AND METHODS: A decision analysis was performed using a hypothetical cohort of women that included subgroups with atypical hyperplasia, Gail risk greater than 5, lobular carcinoma-in-situ, or two or more first-degree relatives with breast cancer. Data sources were the Breast Cancer Prevention Trial, the Surveillance, Epidemiology, and End-Results program, time trade-off preference ratings, the Group Health Cooperative of Puget Sound, and the United States Health Care Financing Administration. RESULTS: Our model predicted that tamoxifen would prolong the average survival of cohort members initiating use at ages 35, 50, and 60 years by 70, 42, and 27 days, respectively. It would prolong survival even more for those in the higher-risk groups, especially those with atypical hyperplasia (202, 89, and 45 days). Tamoxifen use was also projected to extend quality-adjusted survival by 158, 80, and 50 days in the atypical hyperplasia group. For younger women in the highest risk groups, chemoprevention with tamoxifen was estimated to have cost savings or be cost-effective, both with and without quality adjustments. CONCLUSION: Chemoprevention with tamoxifen may be particularly beneficial to women with atypical hyperplasia, 5-year Gail model risk greater than 5%, lobular carcinoma-in-situ, or two or more first-degree relatives with breast cancer. The benefits may be greater if tamoxifen is initiated before age 50 years rather than after and if the breast cancer risk reduction conferred by tamoxifen lasts longer than 5 years. For women with a very high risk of invasive breast cancer, chemoprevention with tamoxifen seems to be cost-effective.

scholarly journals Surveillance and Targeted Action to Prevent HIV/AIDS

2016 ◽  
Vol 52 (04) ◽  
pp. 183-191
Author(s):  
Rajesh Kumar
Keyword(s):  
High Risk ◽  
Behaviour Change ◽  
Hiv Transmission ◽  
Cost Effective ◽  
Hiv Infections ◽  
Risk Groups ◽  
Epidemiological Surveillance ◽  
Mortality Trends ◽  
Behaviour Change Interventions ◽  
Hiv Aids

ABSTRACTEpidemiological surveillance has played a key role in the identification of AIDS and its modes of transmission. In India, laboratory-based surveillance of HIV was initiated among most at-risk populations in 1990s, which was later expanded to antenatal clinics. On the basis of surveillance, high risk geographic areas and high risk populations were identified; and preventive behaviour change interventions were targeted among high risk groups in mid1990s. In 2003, analysis of surveillance data revealed a declining trend in HIV. Further analysis, indicated that targeted sexual behaviour change interventions among high risk groups had been responsible for the decline. The targeted behaviour change strategy among high risk groups was also found to be cost-effective. In the era of anti-retroviral therapy (ART), HIV prevalence trends would no longer be useful for tracking the epidemic. Hence, new laboratory essays are needed for tracking HIV incidence. Verbal autopsy method can provide direct estimates of HIV mortality trends to evaluate the effectiveness of ART. Since the number of new HIV infections is showing plateauing trend, further intensification of HIV/AIDS prevention and control efforts is required to achieve the end of HIV transmission and deaths due to AIDS by 2030.

Screening and Treatment of Latent Tuberculosis Among Healthcare Workers at Low, Moderate, and High Risk for Tuberculosis Exposure: A Cost-Effectiveness Analysis

2004 ◽  
Vol 25 (12) ◽  
pp. 1056-1061 ◽  
Author(s):  
Shelley R. Salpeter ◽  
Edwin E. Salpeter
Keyword(s):  
High Risk ◽  
Healthcare Workers ◽  
Screening Program ◽  
Cost Savings ◽  
Cost Effective ◽  
Risk Groups ◽  
Published Data ◽  
Tuberculosis Case ◽  
Effective Screening ◽  
Screening Interval

AbstractObjective:To evaluate cost-effective screening and treatment strategies for healthcare workers (HCWs) at risk for tuberculosis exposure.Design:A Markov model was developed to track three hypothetical cohorts of HCWs at low, moderate, and high risk for tuberculosis exposure. For those found to be tuberculin reactors at entry, the choice was for isoniazid treatment or no treatment. For those without tuberculin reactivity, the choice of screening intervals was 6 months, 1 year, 2 years, or 5 years. Outcomes measured were tuberculosis cases, death, life expectancy, and cost. Assumptions were derived from published data and analyses.Results:Treatment of initial reactors with isoniazid in all three risk groups was associated with a net savings of $14,800 to $15,700 for each tuberculosis case prevented. For those without evidence of infection at entry, the most cost-effective screening interval was 1 year for high-risk groups, 2 years for moderate-risk groups, and 5 years for low-risk groups, with a net savings $0.20 to $26 per HCW per year. Screening at a more frequent interval was still cost-effective.Conclusions:For HCWs found to be tuberculin reactors, treatment of their latent infection is to their benefit and is associated with a net cost-savings. Regular tuberculin screening of HCWs can be cost-effective or result in a net cost-savings. Each institution could use its own skin test surveillance data to create an optimum screening program for its employees. However, for most HCWs, a 1-year screening interval would be a cost-effective and safe choice.

scholarly journals Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening

2015 ◽  
Vol 19 (74) ◽  
pp. 1-116 ◽  
Author(s):  
Peter H Scanlon ◽  
Stephen J Aldington ◽  
Jose Leal ◽  
Ramon Luengo-Fernandez ◽  
Jason Oke ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Risk Stratification ◽  
Cost Effective ◽  
Risk Groups ◽  
East Anglia ◽  
Effective Screening ◽  
Screening Interval ◽  
Screening Intervals ◽  
Qaly Threshold

BackgroundThe English NHS Diabetic Eye Screening Programme was established in 2003. Eligible people are invited annually for digital retinal photography screening. Those found to have potentially sight-threatening diabetic retinopathy (STDR) are referred to surveillance clinics or to Hospital Eye Services.ObjectivesTo determine whether personalised screening intervals are cost-effective.DesignRisk factors were identified in Gloucestershire, UK using survival modelling. A probabilistic decision hidden (unobserved) Markov model with a misgrading matrix was developed. This informed estimation of lifetime costs and quality-adjusted life-years (QALYs) in patients without STDR. Two personalised risk stratification models were employed: two screening episodes (SEs) (low, medium or high risk) or one SE with clinical information (low, medium–low, medium–high or high risk). The risk factor models were validated in other populations.SettingGloucestershire, Nottinghamshire, South London and East Anglia (all UK).ParticipantsPeople with diabetes in Gloucestershire with risk stratification model validation using data from Nottinghamshire, South London and East Anglia.Main outcome measuresPersonalised risk-based algorithm for screening interval; cost-effectiveness of different screening intervals.ResultsData were obtained in Gloucestershire from 12,790 people with diabetes with known risk factors to derive the risk estimation models, from 15,877 people to inform the uptake of screening and from 17,043 people to inform the health-care resource-usage costs. Two stratification models were developed: one using only results from previous screening events and one using previous screening and some commonly available GP data. Both models were capable of differentiating groups at low and high risk of development of STDR. The rate of progression to STDR was 5 per 1000 person-years (PYs) in the lowest decile of risk and 75 per 1000 PYs in the highest decile. In the absence of personalised risk stratification, the most cost-effective screening interval was to screen all patients every 3 years, with a 46% probability of this being cost-effective at a £30,000 per QALY threshold. Using either risk stratification models, screening patients at low risk every 5 years was the most cost-effective option, with a probability of 99-100% at a £30,000 per QALY threshold. For the medium-risk groups screening every 3 years had a probability of 43 –48% while screening high-risk groups every 2 years was cost-effective with a probability of 55–59%.ConclusionsThe study found that annual screening of all patients for STDR was not cost-effective. Screening this entire cohort every 3 years was most likely to be cost-effective. When personalised intervals are applied, screening those in our low-risk groups every 5 years was found to be cost-effective. Screening high-risk groups every 2 years further improved the cost-effectiveness of the programme. There was considerable uncertainty in the estimated incremental costs and in the incremental QALYs, particularly with regard to implications of an increasing proportion of maculopathy cases receiving intravitreal injection rather than laser treatment. Future work should focus on improving the understanding of risk, validating in further populations and investigating quality issues in imaging and assessment including the potential for automated image grading.Study registrationIntegrated Research Application System project number 118959.Funding detailsThe National Institute for Health Research Health Technology Assessment programme.

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