scholarly journals Vaccination against Pneumococcal Infections of High-Risk People: Pharmacoeconomic Aspects

2020 ◽  
Vol 18 (6) ◽  
pp. 39-44
Author(s):  
A. V. Rudakova ◽  
S. M. Kharit ◽  
Yu. V. Lobzin
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
High Risk ◽  
Time Horizon ◽  
Risk Group ◽  
Pneumococcal Infection ◽  
High Risk Group ◽  
Cost Effectiveness Ratio ◽  
Pneumococcal Infections ◽  
Incidence And Mortality

Relevance. Vaccination of people at high risk against pneumococcal infection with a 13-valent conjugate vaccine (PCV13) can significantly reduce the corresponding incidence and mortality.The aim of the work was to assess the pharmacoeconomic aspects of vaccination of 65 year olds with a high risk of pneumococcal infection.Material and methods. The analysis was carried out by the method of Markov modeling from the position of the health care system. The time horizon is 5 and 15 years. It was assumed that vaccination is carried out with 1 dose of PCV13 and 1 dose of polysaccharide pneumococcal vaccine (PPV23) after 8 weeks with revaccination with 1 dose of PPV23 after 5 years. The costs of treatment of pneumococcal infections were calculated on the basis of the Compulsory medical insurance rates for St. Petersburg in 2019. The costs of vaccination were calculated on the basis of the price of auctions for the purchase of PCV13 and PPV23 for 2019.Results. For 15 years, vaccination of 100 ths people from the high risk group will prevent 1.7 ths cases of community-acquired pneumonia, 1.4 ths cases of invasive pneumococcal infections, and 397 cases of pneumococcal infections deaths. The cost-effectiveness ratio with a 15-year horizon is 161.4 ths rubles/quality-adjusted life year gained (QALY). Even if the time horizon is reduced to 5 years, vaccination can be considered as an economically highly effective intervention (cost-effectiveness ratio –571.9 ths rubles/QALY). At the same time, in 5 years, 37.6% of the money spent on vaccination will be returned to the budget of the health care system, and in 15 years – 49.3%.Conclusion. Vaccination of citizens of the Russian Federation from a high-risk group against pneumococcal infection can be considered as a socially and economically highly effective intervention that provides a significant reduction in the incidence and mortality caused by it.

scholarly journals VACCINATION AGAINST PNEUMOCOCCAL INFECTIONS IN RUSSIAN FEDERATION: SOCIAL AND PHARMACOECONOMIC ASPECTS

2018 ◽  
Vol 10 (3) ◽  
pp. 11-22 ◽  
Author(s):  
A. V. Rudakova ◽  
N. I. Briko ◽  
Yu. V. Lobzin ◽  
L. S. Namazova-Baranova ◽  
S. N. Avdeev ◽  
...  
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
High Risk ◽  
Russian Federation ◽  
Time Horizon ◽  
Pneumococcal Infection ◽  
Risk Groups ◽  
Cost Effectiveness Ratio ◽  
Pneumococcal Infections ◽  
The Cost

Vaccination against pneumococcal infections by 13-valent conjugate vaccine (PCV13) can significantly reduce morbidity and mortality.The study has been aimed to evaluate the social and pharmacoeconomic aspects of PCV13 vaccination of 65-year-old patients with various risks of pneumococcal infection.Material and methods. Markov model with 5 and 15 years time horizon was used for the analysis from the position of the health care system.The analysis was carried out for 65-year-old citizens with low (absence of immunocompromized conditions and chronic diseases), moderate (patients with chronic diseases without immunodeficiency) and high (immunocompromized conditions) risk of pneumococcal infection as well as for the entire population of 65-year-old citizens, regardless of the risk level.In base-case assumption has been made that 1 dose of PCV13 should be administered for the patients from low and moderate risk groups and in the high-risk group 1 dose of PCV13 and in 8 weeks a dose of polysaccharide pneumococcal vaccine (PPV23) should be given.The treatment and physician visit costs have been calculated using CHI rates for St. Petersburg in 2018. Vaccination cost was calculated using the auction price to purchase PCV13 and PPV23 in 2018.Results.Vaccination of 1 cohort of 65-year-old citizens in Russian Federation within 5 years will result in prevention of 2200 deaths, 3900 cases of invasive pneumococcal diseases (IPD) and 48700 cases of community-acquired pneumonia. In 15 years prevention of about 4,3 thousand deaths, 6,6 thousand IPD and 101,1 thousand cases of CAP will be provided.Within 15-year horizon the cost-effectiveness ratio will be RUR 30,3, 82,4 and 410,0 thousand per QALY in high, moderate and low risk groups, respectively. Even if the time horizon is reduced to 5 years the PCV13 vaccination can be considered as an economically high-efficient intervention in moderate and high risk groups (cost-effectiveness ratio - RUR 279,2 and 221,7 thousand / QALY, respectively).In the 15-year-horizon noting the distribution of 65-yearolds by risk levels the cost-effectiveness ratio of PCV13 in population as a whole will be RUR 216,4 thousand / QALY. If moderate and high risk groups only are vaccinated, the average cost-effectiveness ratio will drop to RUR 67,6 thousand /QALY. At universal PCV13 vaccination of 65 years old in 5 year time horizon return of investment to the health care system budget will be 33.2% and at vaccination of persons with moderate and high risk return of investment will be 44.0%. With the assumption of vaccination during the planned physician visit (without additional visit) the return to the budget will be 46.8% and 60.9% for vaccination of all 65-year-olds and patients from the moderate and high risk groups, respectively.Conclusions.Vaccination of the 65-year-old persons against PCV13 pneumococcal infection in Russian Federation can be considered as a highly socially and economically effective intervention resulting in significant reduction of pneumococcal infection incidence and related mortality. The cost-effectiveness of vaccination is increasing along with the level of the risk. PCV13 vaccination of patients with moderate and high risk only provides a significant reduction in the burden for the health care budget in comparison with the vaccination of the entire population of 65-year-olds.

Informed decision making (IDM) for prostate cancer (PCa) screening in a high-risk population.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 112-112 ◽  
Author(s):  
Puneet Dhillon ◽  
Petros Grivas ◽  
Paola Raska ◽  
Devon Hickman ◽  
Paul Elson ◽  
...  
Keyword(s):  
Decision Making ◽  
Family History ◽  
High Risk ◽  
Risk Group ◽  
High Risk Group ◽  
High Risk Population ◽  
Group Setting ◽  
Incidence And Mortality ◽  
Post Test

112 Background: PCa incidence and mortality in African Americans (AA) is higher than in Caucasians. Health-education programs and culturally appropriate outreach to high-risk groups in accordance with American Cancer Society IDM guidelines can reduce disparities. Data show that it is hard to provide comprehensive unbiased education about screening to patients (pts). This study aims to examine whether IDM guidelines in a large high risk group setting can improve knowledge on PCa and screening decision, and whether such education program is overall beneficial to pts. Methods: Pts were included in one-day outreach event and were given a 15-question pre and post- test focused on standard informative educational PowerPoint and then were offered screening (PSA + DRE). Components of IDM were reviewed during this educational intervention. Demographics and family history was collected and UCSF 10-year mortality index was assessed to help IDM. Pre- and post- test number of correct answers were compared (Wilcoxon signed rank); pts were surveyed on their opinion on the program. The decision regarding screening after the intervention was tracked as well as the % of PCa diagnosed. Pts were tracked via an established navigation system to ensure follow up care. Results: 106 pts were included in the current analysis. Median number of correct answers at pre and post test was 8 and 11 (p < 0.001). Overall, 86% responded that they wanted screening. Of those, 92% were AA and 21% had family history of PCa; 21 pts had PSA only, 60 had PSA + DRE. 13 pts (16%) had abnormal PSA per NCCN guidelines, 5 (8%) had abnormal DRE. 5 PCa were biopsy-diagnosed, 4 had abnormal DRE + PSA; 1 had only abnormal DRE. Overall, 82% pts favored IDM before screening, 18% would prefer screening without IDM. 75% of all pts found the information “very helpful” in decision-making (within a 5-point Likert scale). Conclusions: Our education-based IDM led to significant improvement in knowledge about PCa screening. Most pts preferred education prior to screening. Our approach paired with the use of navigation program is feasible and was positively received by a large high risk group. Project is ongoing with more pts and follow up, and further validation is pending. Clinical trial information: NCT02419846.

Hepatitis C virus antibodies are absent among high risk group of health care workers in Damascus Hospital

2018 ◽  
Vol 19 (2) ◽  
pp. 80-83 ◽  
Author(s):  
Hoda Alhamoudi ◽  
Nawras Alhalabi ◽  
Mouhammed Zein ◽  
Nazir Ibrahim
Keyword(s):  
Health Care ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
High Risk ◽  
Health Care Workers ◽  
Risk Group ◽  
High Risk Group ◽  
Care Workers

scholarly journals Influenza vaccination rate among high risk group patients in primary health care in Greece

2020 ◽  
Vol 28 (4) ◽  
pp. 297-301
Author(s):  
Anastasia Papaioannou ◽  
Apostolia-Evangelia Konstantinidi ◽  
Ekaterini Primikiri ◽  
Foteini Asimakopoulou ◽  
Dimitrios Aravantinos ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
High Risk ◽  
Influenza Vaccination ◽  
Risk Group ◽  
Vaccination Rate ◽  
High Risk Group ◽  
Primary Health

scholarly journals A Framework for SARS-CoV-2 Testing on a Large University Campus: Statistical Considerations

2020 ◽  
Author(s):  
Paul J Rathouz ◽  
Catherine A Calder
Keyword(s):  
Health Care ◽  
High Risk ◽  
Risk Group ◽  
High Risk Group ◽  
Reproductive Number ◽  
Surveillance Program ◽  
Testing Program ◽  
Community Population ◽  
The University ◽  
University Community

We consider testing strategies for active SARS-CoV-2 infection for a large university community population, which we define. Components of such a strategy include individuals tested because they self-select or are recommended for testing by a health care provider for their own health care; individuals tested because they belong to a high-risk group where testing serves to disrupt transmission; and, finally, individuals randomly selected for testing from the university community population as part of a proactive community testing, or surveillance, program. The proactive community testing program is predicated on a mobile device application that asks individuals to self-monitor COVID-like symptoms daily. The goals of this report are (i) to provide a framework for estimating prevalence of SARS-CoV-2 infection in the university community wherein proactive community testing is a major component of the overall strategy, (ii) to address the issue of how many tests should be performed as part of the proactive community testing program, and (iii) to consider how effective proactive community testing will be for purposes of detection of new disease clusters. We argue that a comprehensive prevalence estimate informed by all testing done of the university community is a good metric to obtain a global picture of campus SARS-CoV-2 infection rates at a particular point in time and to monitor the dynamics of infection over time, for example, estimating the population-level reproductive number, R0). Importantly, the prevalence metric can be useful to campus leadership for decision making. One example involves comparing campus prevalence to that in the broader off-campus community. We also show that under some reasonable assumptions, we can obtain valid statements about the comprehensive prevalence by only testing symptomatic persons in the proactive community testing component. The number of tests performed for individual-level and high-risk group-level needs will depend on the disease dynamics, individual needs, and testing availability. For purposes of this report, we assume that, for these groups of individuals, inferential precision --- that is, the accuracy with which we can estimate the true prevalence from testing a random sample of individuals --- does not drive decisions on the number of tests. On the other hand, for proactive community testing, the desired level of inferential precision {in a fixed period of time can be used to justify the number of tests to perform {in that period. For example, our results show that, if we establish a goal of ruling out with 98\% confidence a background prevalence of 2\% {in a given week, and the actual prevalence is 1\% among those eligible for proactive community testing, we would need to test 835 randomly-selected symptomatics (i.e., those presenting with COVID-like symptoms) per week via the proactive community testing program in a campus of 80k individuals. In addition to justifying decisions about the number of tests to perform, inferential precision can formalize the intuition that testing of symptomatic individuals should be prioritized over testing asymptomatic individuals in the proactive community testing program.

scholarly journals COVID-19 among nursing staff: Settings and regional differences

2020 ◽  
Author(s):  
Manuela Hoedl ◽  
Doris Eglseer ◽  
Silvia Bauer
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Nursing Home ◽  
High Risk ◽  
Nursing Homes ◽  
Nursing Staff ◽  
Regional Differences ◽  
Risk Group ◽  
High Risk Group ◽  
Primary Care Sector

Purpose This study was carried out to describe settings of and regional differences in the occurrence of COVID-19 among nursing staff, analysing COVID-19 symptoms, testing and diagnosis procedures. Design We used an online survey to conduct this cross-sectional study among nursing staff in different settings. Data collection was carried out between 12 May and 13 July 2020. Methods The survey included questions that allowed us to collect demographic data (e.g. age), professional qualifications (e.g. nurse, nurse aid) and data regarding the federal states and settings in which the participants worked. In additon, we asked the participants to describe their COVID-19 symptoms, if any were experienced, and the result of COVID-19 testing that they underwent. We used descriptive statistics as well as bivariate analysis methods to calculate differences. Findings More than 80% of the nursing staff (N = 2600) were women, nearly half of these staff members worked in the province of Styria and about three-quarters worked in hospitals. In general, nearly every sixth nurse reported experiencing COVID-19 symptoms. We found statistically significant differences between the settings and the federal provinces with regard to the COVID-19 symptoms reported, but not the test results. The highest porportion of nurses who experienced symptoms worked in lower Austria and in the primary care sector. In total, 1.6% of the participating nurses were tested for COVID-19, as well as about 1% of the nurses who worked in the nursing homes. The highest number of tests were carried out in Vienna followed by the province of Burgenland. In total, all of the nurses who underwent testing were diagnosed with COVID-19. Conclusions Only 1% of the nurses who worked in nursing homes were tested. This group of nurses takes care of the most vulnerable and high-risk group in Austrian society. Therefore, the nursing home staff should have the possibility to be tested even though they did not experience/report any symptoms. The highest prorportion of nurses who experienced symptoms worked in the primary care sector. In the future during a pandemic, health care staff should be comprehensively tested in all settings. Clinical Relevance Providing insights into COVID-19 symptoms experienced by nursing staff workforce and testing for COVID-19 can help us address these aspects in future pandemics more efficiently. In addition, these insights can help to shift the perspectives from critical and acute settings to other settings, e.g. nursing homes. This is an important change in perspectives, as these nurses have worked with the most vulnerable and high-risk group during the COVID-19 pandemic. Ensuring the safety of nursing home residents and providing, high-quality nursing care and interventions can reduce hospital admission rates, decrease health care costs during such pandemics and might even reduce secondary morbidity and mortality.

scholarly journals Prevalence of SARS CoV-2 infection among Health Care Workers of a hybrid tertiary COVID 19 hospital in Kerala

2021 ◽  
Author(s):  
Jessy S J ◽  
Shamha Beegum ◽  
Genga Gopakumar ◽  
Bindu G ◽  
Chntha S ◽  
...  
Keyword(s):  
Health Care ◽  
High Risk ◽  
Health Care Workers ◽  
Risk Group ◽  
Previous History ◽  
High Risk Group ◽  
Low Risk ◽  
Risk Category ◽  
Care Workers ◽  
History Of

Back ground and objectives- This study was undertaken to estimate the prevalence of SARS-CoV-2 infection among Health care workers [HCWs] of a hybrid COVID treatment hospital in Kerala. Methods- The study was conducted during 3rd week of January 2021. Among 3550 HCWs, 979 subjects were selected by stratified random sampling and grouped into high risk and low risk category based on job setting. Demographic details and clinical information regarding previous history of COVID 19 were collected at the time of SARS-CoV-2 IgG testing. Results: From 979 subjects, the data with respect to 940 health care workers were analysed. SARS-CoV-2 IgG was detected in 19.1% of HCWs. Seroprevalence among high risk group was 20.3% and that in low risk group was 7.4% [p=0.005]. In high-risk group, seropositivity was noted in 30.54 % of nurses, 19% hospital attenders, 18.9% resident doctors and 6.4% consultant doctors. In those with past history of SARS-CoV-2 infection, seropositivity was 75.4%. In those who were COVID positive during July2020, 33.3% were still IgG reactive. Interpretation and conclusion- The study reported 19.1% SARS CoV-2 IgG reactivity among health care workers in our hospital. Seropositivity was significantly higher in high risk group compared to low risk group. Antibody decay kinetics in our study is comparable to that in published literature. Infection control challenges in hybrid hospitals account for higher seropositivity in this study compared to overall seroprevalence among HCWs in Kerala.

scholarly journals Evaluation of a Family-Based Intervention Program for Children of Mentally Ill Parents: Study Protocol for a Randomized Controlled Multicenter Trial

2021 ◽  
Vol 11 ◽  
Author(s):  
Silke Wiegand-Grefe ◽  
Bonnie Filter ◽  
Mareike Busmann ◽  
Reinhold Kilian ◽  
Klaus-Thomas Kronmüller ◽  
...  
Keyword(s):  
Health Care ◽  
High Risk ◽  
Mentally Ill ◽  
Intervention Program ◽  
Risk Group ◽  
Multicenter Trial ◽  
High Risk Group ◽  
Randomized Controlled ◽  
Family Based ◽  
Mentally Ill Parents

Background: Children of mentally ill parents have a three to seven times higher risk of developing mental disorders compared to the general population. For this high-risk group, specialized prevention and intervention programs have already been developed. However, there has been insufficient sytematic evaluation to date. Moreover, effectiveness and the cost-effectiveness data of the respective programs until today is very scarce and at the same time constitutes the pre-condition for the program's implementation into regular health care.Methods: The study consists of a two-group randomized controlled multicenter trial conducted at seven study sites throughout Germany and Switzerland. Participants are families with mentally ill parents and their children aged from 3 to 19 years. The intervention comprises 6 to 8 semi-structured sessions over a period of about 6 months. Topics discussed in the intervention include parental mental illness, coping, family relations and social support. Families in the control condition will receive treatment as usual. The children's mental health, assessed using the K-SADS-PL by blinded external raters will constitute the primary efficacy outcome. Further outcomes will be assessed from the parents' as well as from the children's perspectives. Participants are investigated at baseline, 6, 12, and 18 months after baseline assessment. In addition to the assessment of various psychosocial outcomes, a comprehensive health-economic evaluation will be performed.Discussion: This paper describes the evaluation of a family-based intervention program for children of mentally ill parents (CHIMPs) in the regular health care system in Germany and Switzerland. A methodically sophisticated study design has been developed to reflect the complexity of the actual health care situation. This trial will contribute to the regular health care for the high-risk group of children of mentally ill parents.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT02308462; German Clinical Trials Register: DRKS00006806.

Cost Effectiveness Analysis Of High-Risk Group Tb Screening In Malaysia

2020 ◽  
Author(s):  
Nor Zam Azihan Mohd Hassan ◽  
Asmah Razali ◽  
Mohd Ridzwan Shahari ◽  
Mohd Shaiful Jefri Mohd Nor Sham Kunusagaran ◽  
Juanita Halili ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Risk Group ◽  
Cost Effective ◽  
Risk Groups ◽  
High Risk Group ◽  
Effective Strategy ◽  
Tree Model ◽  
Cost Effective Strategy ◽  
The Cost

Abstract Background: Screening of high-risk groups for TB is considered as the cornerstone for TB elimination but the measure of cost-effectiveness is also crucial in deciding the strategy for TB screening. This study aims to measure the cost-effectiveness of TB screening between the various high-risk groups in Malaysia.Methods: A decision tree model was developed to assess the cost-effectiveness of TB screening among the high-risk group from provider perspective using a secondary data from year 2016 to 2018. The outcome is presented in term of cost per TB case detected and the ICER. Deterministic and Probabilistic Sensitivity Analysis were also performed to measure the robustness of the model.Results: The most cost-effective strategy was TB screening among PL HIV, with MYR 2,597.00 per one TB case detected. This is followed by elderly, prisoners and smokers with MYR 2,868.62, MYR 3,065.24 and MYR 4,327.76 per one TB case detected respectively. There was an incremental costs of MYR 2.49 per screening, and 3.4 TB case detection per 1000 screening for TB screening among PL HIV in relation to TB screening among prisoners. The probability of symptomatic cases diagnosed as TB was the key driver for increasing cost effectiveness efficacy among PL HIV.Conclusions: Results of the study suggest prioritization of high-risk group TB screening programme by focusing on the most cost-effective strategy such as screening among PL HIV, prisoners and elderly, which has lower cost per TB case detected.

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