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Hassan MZ, Jubayer Biswas MAA, Shirin T, Rahman M, Chowdhury F, Azziz-Baumgartner E, Davis WW, Hussain M. Cost-effectiveness of seasonal influenza vaccination in WHO-defined high-risk populations in Bangladesh. J Glob Health 2024; 14:04126. [PMID: 39024624 PMCID: PMC11257706 DOI: 10.7189/jogh.14.04126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
Abstract
Background Bangladesh carries a substantial health and economic burden of seasonal influenza, particularly among the World Health Organization (WHO)-defined high-risk populations. We implemented a modelling study to determine the cost-effectiveness of influenza vaccination in each of five high-risk groups (pregnant women, children under five years of age, adults with underlying health conditions, older adults (≥60 years), and healthcare personnel) to inform policy decisions on risk group prioritisation for influenza vaccination in Bangladesh. Methods We implemented a Markov decision-analytic model to estimate the impact of influenza vaccination for each target risk group. We obtained model inputs from hospital-based influenza surveillance data, unpublished surveys, and published literature (preferentially from studies in Bangladesh, followed by regional and global ones). We used quality-adjusted life years (QALY) as the health outcome of interest. We also estimated incremental cost-effectiveness ratios (ICERs) for each risk group by comparing the costs and QALY of vaccinating compared to not vaccinating each group, where the ICER represents the additional cost needed to achieve one year of additional QALY from a given intervention. We considered a willingness-to-pay threshold (ICER) of less than one gross domestic product (GDP) per capita as highly cost-effective and of one to three times GDP per capita as cost-effective (per WHO standard). For Bangladesh, this threshold ranges between USD 2462 and USD 7386. Results The estimated ICERs were USD -99, USD -87, USD -4, USD 792, and USD 229 per QALY gained for healthcare personnel, older adults (≥60), children aged less than five years, adults with comorbid conditions, and pregnant women, respectively. For all risk groups, ICERs were below the WHO willingness-to-pay threshold for Bangladesh. Vaccinating pregnant women and adults with comorbid conditions was highly cost-effective per additional life year gained, while vaccinating healthcare personnel, older adults (≥60), and children under five years were cost-saving per additional life year gained. Conclusions Influenza vaccination to all target risk groups in Bangladesh would be either cost-saving or cost-effective, per WHO guidelines of GDP-based thresholds.
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Affiliation(s)
- Md Zakiul Hassan
- Program for Emerging Infections, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
- Pandemic Sciences Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Md Abdullah Al Jubayer Biswas
- Program for Emerging Infections, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Mahmudur Rahman
- Global Health Development the Eastern Mediterranean Public Health Network (EMPHNET), Dhaka, Bangladesh
| | - Fahmida Chowdhury
- Program for Emerging Infections, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | | | - William W Davis
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mofakhar Hussain
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
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Hassan MZ, Biswas MAAJ, Rahman M, Shoshi HR, Pyash AS, Islam MA, Haque MA, Parvin SR, Hossen MT, Hussain M, Rahman M, Shirin T, Chowdhury F. Acceptability, cost-effectiveness, and capacity of a facility-based seasonal influenza vaccination among high-risk groups: a study protocol in selected tertiary care hospitals of Bangladesh. BMC Public Health 2024; 24:242. [PMID: 38245668 PMCID: PMC10800039 DOI: 10.1186/s12889-024-17724-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/10/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND In Bangladesh, seasonal influenza imposes considerable disease and economic burden, especially for those at high-risk of severe disease. The most successful approach for influenza prevention is the administration of a vaccine. Many poor and middle-income nations, including Bangladesh, do not have a national strategy or program in place for seasonal influenza vaccines, despite the World Health Organization's (WHO) advice to prioritize high-risk populations. Additionally, there is a scarcity of substantial data on the cost-effectiveness of seasonal influenza vaccination in these countries. The aim of our study is to determine acceptability, health beliefs, barriers, and intention of receiving influenza vaccine among high-risk populations, assess the cost-effectiveness of implementing a facility-based seasonal influenza vaccination programme, and investigate the required capacity for a potential seasonal influenza vaccination programme. METHODS We will undertake this study following STROBE guidelines. We will conduct the study in inpatient and outpatient departments of three selected tertiary-level hospitals leveraging the ongoing hospital-based influenza surveillance (HBIS) platform. The study population will include the WHO-defined four high-risk groups excluding healthcare workers: children six months to eight years, pregnant women, elderly ≥ 60 years, and adults with chronic diseases. We will collect quantitative data on participants' acceptability, health beliefs, barriers, and vaccination intentions using the health belief model (HBM) from patients meeting the criteria for high-risk populations attending two public tertiary-level hospitals. In one of the two public tertiary-level hospitals, we will arrange an influenza vaccination campaign before the influenza season, where the vaccine will be offered free of cost to high-risk patients, and in the second hospital, vaccination will not be offered. Both the vaccinated and unvaccinated participants will then be followed-up once a month for one year to record any influenza-like illness, hospitalization, and death. Additional data for objective two will be collected from patients with symptoms of influenza-like illness (ILI) and severe acute respiratory infection (SARI) at one public and one private hospital to determine both direct and indirect costs associated with influenza illness. We will estimate the required number of influenza vaccines, safe injections, and total storage volume utilizing secondary data. We will use a deterministic Markov decision-analytic model to estimate the cost-effectiveness of facility-based influenza vaccination in Bangladesh. DISCUSSION The results of this study will enable the National Immunization Technical Advisory Group and the Ministry of Health & Family Welfare of Bangladesh to decide what steps to take to develop and implement an influenza vaccination strategy targeting high-risk populations. TRIAL REGISTRATION The Clinicaltrials.gov registration number is NCT05996549. The registration for the protocol version 2.0 took place in August 2023, with the initial participant being enrolled in March 2022.
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Affiliation(s)
- Md Zakiul Hassan
- Programme for Emerging Infections, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
| | - Md Abdullah Al Jubayer Biswas
- Programme for Emerging Infections, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Mahbubur Rahman
- Institute of Epidemiology, Disease Control and Research, Mohakhali, Dhaka, Bangladesh
| | - Homayra Rahman Shoshi
- Programme for Emerging Infections, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Ashrak Shad Pyash
- Programme for Emerging Infections, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Md Ariful Islam
- Programme for Emerging Infections, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Md Azizul Haque
- Department of Medicine, Rajshahi Medical College, Rajshahi, Bangladesh
| | | | - Md Tanvir Hossen
- The Expanded Programme on Immunization (EPI), Maternal Neonatal Child and Adolescent Health of the Ministry of Health & Family Welfare of Bangladesh, Dhaka, Bangladesh
| | - Mofakhar Hussain
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Mahmudur Rahman
- Global Health Development (GHD), The Eastern Mediterranean Public Health Network (EMPHNET), Abdallah Ben Abbas St, Building No. 42, Amman, Jordan
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research, Mohakhali, Dhaka, Bangladesh
| | - Fahmida Chowdhury
- Programme for Emerging Infections, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
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Nishikawa A, Yamaguchi T, Yamada Y, Urata H, Shinkawa T, Matsunari Y. How Do Disaster Relief Nurses in Japan Perceive and Respond to Risks? A Cross-Sectional Study. NURSING REPORTS 2023; 13:1410-1420. [PMID: 37873825 PMCID: PMC10594493 DOI: 10.3390/nursrep13040118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/27/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023] Open
Abstract
This study assessed the risk perceptions among disaster relief nurses (DRNs) in Japan by focusing on 15 risk factors associated with frequent natural disasters and the ongoing coronavirus disease 2019 (COVID-19) pandemic. We conducted a cross-sectional study that targeted DRNs across six prefectures in Japan and explored nurses' perceptions of risks including radiation exposure, volcanic eruptions, and mass infections. The findings indicated a heightened perception of radiation and nuclear-related risks. In the context of the COVID-19 pandemic, DRNs perceived "mass infection" as a significant risk. An age-based analysis revealed that younger nurses had more dread about "mass infection" and had heightened uncertainty about the "X-ray test" compared with their older peers. Understanding DRNs' risk perceptions is crucial for effective disaster response preparedness and training. The study highlights the need to address these perceptions to ensure that DRNs are well prepared and supported in their roles. This study was not pre-registered on a publicly accessible registry.
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Affiliation(s)
| | - Takumi Yamaguchi
- Research Administration Center, Saitama Medical University, Saitama 350-0495, Japan
- Nuclear Safety Research Association, Tokyo 105-0004, Japan
- School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan;
| | - Yumiko Yamada
- Department of Nursing, Kwassui Women’s University, Nagasaki 856-0835, Japan;
| | - Hideko Urata
- Atomic Bomb Disease Institute, Nagasaki University, Nagasaki 852-8523, Japan; (H.U.); (T.S.)
| | - Tetsuko Shinkawa
- Atomic Bomb Disease Institute, Nagasaki University, Nagasaki 852-8523, Japan; (H.U.); (T.S.)
| | - Yuko Matsunari
- School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan;
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