The cost-effectiveness of influenza vaccination of healthy adults 50–64 years of age

Cost-effectiveness of cervical cancer screening with human papillomavirus DNA testing and HPV-16,18 vaccination

BACKGROUND

The availability of human papillomavirus (HPV) DNA testing and vaccination against HPV types 16 and 18 (HPV-16,18) motivates questions about the cost-effectiveness of cervical cancer prevention in the United States for unvaccinated older women and for girls eligible for vaccination.

METHODS

An empirically calibrated model was used to assess the quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (2004 US dollars per QALY) of screening, vaccination of preadolescent girls, and vaccination combined with screening. Screening varied by initiation age (18, 21, or 25 years), interval (every 1, 2, 3, or 5 years), and test (HPV DNA testing of cervical specimens or cytologic evaluation of cervical cells with a Pap test). Testing strategies included: 1) cytology followed by HPV DNA testing for equivocal cytologic results (cytology with HPV test triage); 2) HPV DNA testing followed by cytology for positive HPV DNA results (HPV test with cytology triage); and 3) combined HPV DNA testing and cytology. Strategies were permitted to switch once at age 25, 30, or 35 years.

RESULTS

For unvaccinated women, triennial cytology with HPV test triage, beginning by age 21 years and switching to HPV testing with cytology triage at age 30 years, cost $78,000 per QALY compared with the next best strategy. For girls vaccinated before age 12 years, this same strategy, beginning at age 25 years and switching at age 35 years, cost $41,000 per QALY with screening every 5 years and $188,000 per QALY screening triennially, each compared with the next best strategy. These strategies were more effective and cost-effective than screening women of all ages with cytology alone or cytology with HPV triage annually or biennially.

CONCLUSIONS

For both vaccinated and unvaccinated women, age-based screening by use of HPV DNA testing as a triage test for equivocal results in younger women and as a primary screening test in older women is expected to be more cost-effective than current screening recommendations.

Barriers and facilitators to influenza vaccination among high-risk groups aged less than 65 years - views from general practitioners and practice nurses

OBJECTIVES

To explore the views of general practitioners and practice nurses about barriers to influenza vaccination among under 65 high-risk patients and strategies to overcome those barriers.

METHODS

Focus group discussions with general practitioners and practice nurses.

RESULTS

Barriers identified included: lack of awareness among patients about influenza vaccination; GP workload; poor GP motivation; lack of practice nurses; lack of patient recall systems; cost of vaccine; and lack of media campaign. Strategies proposed included: public education campaigns; free supply of vaccine; dissemination of evidence to motivate GPs; incentives to establish recall systems; and greater involvement of practice nurses in the process.

CONCLUSION

Influenza vaccination has not been well accepted by people aged less than 65 years. Implementation of proposed strategies has the potential to improve the vaccination coverage.

IMPLICATIONS

An improvement in influenza vaccination coverage among people less than 65 years who are in high-risk groups has the potential to reduce hospitalisation and health care costs.

[Attitude of adults at work towards influenza vaccination]

OBJECTIVES

The authors had for aim to describe the main motivations of adults at work who spontaneously request influenza vaccine and the clinical profile of those vaccinated after the physician's suggestion.

METHODS

A national cross-sectional survey was made in primary care practice. The physicians filled out a questionnaire describing their opinion on their vaccine practice and described the 7 first vaccinated adults between 18 and 64 years of age.

RESULTS

1,456 physicians included 9,163 patients 46+/-12 years of age. Two thirds (64.8%) of them were vaccinated against influenza after spontaneously requesting it. The arguments justifying these spontaneous requests were the professional consequences of influenza (45.7%), its familial consequences (42.0%), the discomfort induced by the disease (41.7%), financial consequences (20.3%), the risk for the home environment (19.6%) and the family, and professional pressure (17.2%). The physicians preferentially suggested vaccination to patients presenting respiratory risk factors and in particular prone to frequent respiratory infections (75.2%), with a history of bronchitis (69.2%) or asthma (68.3%). Less than one physician out of two suggested it systematically to smokers (43.1%) or patients having presented with influenza on the previous year (41.1%).

CONCLUSION

Among the adults at work vaccinated against influenza, two thirds spontaneously requested it, essentially for socioprofessional reasons, whilst its proposal by medical practitioners still remained limited to patients presenting a medical status likely to be worsened by influenza.

Evaluation of the cost-effectiveness in the United States of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults

CONTEXT

A live-attenuated varicella-zoster virus vaccine, demonstrated to reduce the incidence of herpes zoster (HZ) and postherpetic neuralgia (PHN) and the morbidity associated with incident HZ and its sequelae, has recently been approved for use in the United States (U.S.).

OBJECTIVE

To examine the potential value of zoster vaccine for society and payers. DESIGN, SETTING AND POPULATION: An age-specific decision analytic model was designed to estimate the lifetime costs and outcomes associated with HZ, PHN and other HZ-related complications for vaccinated and non-vaccinated cohorts aged >or=60 years. Clinical trial data, published literature and other primary studies were used to inform the model. Robustness of results to key model parameters was explored through a series of one-way, multivariate and probabilistic sensitivity analyses. Both societal and payer perspectives were considered.

MAIN OUTCOME MEASURE

Incremental cost per quality-adjusted life year (QALY) gained.

RESULTS

For a representative cohort of 1,000,000 U.S. vaccine recipients aged >or=60 years, use of the zoster vaccine was projected to eliminate 75,548-88,928HZ cases and over 20,000 PHN cases. Over 300,000 outpatient visits, 375,000 prescriptions, 9,700 ER visits and 10,000 hospitalizations were projected to be eliminated with the vaccine translating into savings of US$ 82 million to US$ 103 million in healthcare costs associated with the diagnosis and treatment of HZ, PHN and other HZ-related complications. Cost-effectiveness ratios range from US$ 16,229 to US$ 27,609 per QALY gained, depending on the input data source and analytic perspective. Results were most sensitive to PHN costs, duration of vaccine efficacy, vaccine efficacy against PHN and HZ, QALY loss associated with pain states and complication costs.

CONCLUSIONS

The zoster vaccine at a price of US$ 150 is likely to be cost-effective for a cohort of immunocompetent U.S. vaccine recipients aged >or=60 years using commonly cited thresholds for judging cost-effectiveness. Conclusions are robust over plausible ranges of input parameter values and a broad range of scenarios and age cohorts.