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Xu X, Zhang T, Miao Y, Li X, Li Y. Management cost of acute respiratory infections in older adults in China: A systematic review and meta-analysis. J Glob Health 2024; 14:04165. [PMID: 39388681 PMCID: PMC11466502 DOI: 10.7189/jogh.14.04165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2024] Open
Abstract
Background Acute respiratory infection (ARI) poses a significant public health challenge worldwide, particularly among older adults. Understanding the cost of ARI management is important for optimising intervention strategy. We aimed to estimate the management cost of ARI in older adults in China. Methods We searched three English databases (MEDLINE, Embase, and Web of Science) and four Chinese databases (Chinese National Knowledge Infrastructure, Wanfang, SinoMed, and VIP) to identify studies published between 1 January 1995 and 27 February 2023 on the cost of ARI management in older adults in China. We pooled up age group and category-specific costs across individual studies by calculating median and interquartile range (IQR). All cost results were converted and inflated to USD in 2021. Results We included 99 studies, of which 50 were determined as high quality. In those aged >60 years, the median total cost of ARI, including direct medical, direct non-medical, and indirect cost, was USD 3263 (IQR = 2676-3786) in the inpatient setting and USD 104 (IQR = 80-129) in the outpatient setting. For both inpatient and outpatient settings, direct medical costs accounted for most of the costs (69.3% and 54.8%, respectively). There was an increasing trend over age in the median direct medical cost in the inpatient setting, ranging from USD 1517 (IQR = 1114-2017) in those aged ≥50 years to USD 3493 (IQR = 2608-4378) in those aged ≥80 years. Conclusions Our study fills the knowledge gap on the cost of ARI and suggests that the overall cost of ARI is substantial among older adults in China. Cost data stratified by region, pathogen, and presence of comorbidities are warranted to help further identify subpopulations with higher ARI management costs. Registration PROSPERO CRD42023485669.
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Affiliation(s)
- Xiaoyu Xu
- Department of Epidemiology, National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Tiantian Zhang
- Department of Epidemiology, National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yumeng Miao
- Department of Epidemiology, National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xiao Li
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), University of Antwerp, Belgium
| | - You Li
- Department of Epidemiology, National Vaccine Innovation Platform, School of Public Health, Nanjing Medical University, Nanjing, China
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- Changzhou Third People’s Hospital, Changzhou Medical Centre, Changzhou, China
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Langer J, Welch VL, Moran MM, Cane A, Lopez SMC, Srivastava A, Enstone A, Sears A, Markus K, Heuser M, Kewley R, Whittle I. The Cost of Seasonal Influenza: A Systematic Literature Review on the Humanistic and Economic Burden of Influenza in Older (≥ 65 Years Old) Adults. Adv Ther 2024; 41:945-966. [PMID: 38261171 PMCID: PMC10879238 DOI: 10.1007/s12325-023-02770-0] [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: 09/28/2023] [Accepted: 12/13/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Adults aged ≥ 65 years contribute a large proportion of influenza-related hospitalizations and deaths due to increased risk of complications, which result in high medical costs and reduced health-related quality of life (HRQoL). Although seasonal influenza vaccines are recommended for older adults, the effectiveness of current vaccines is dependent on several factors including strain matching and recipient demographic factors. This systemic literature review aimed to explore the economic and humanistic burden of influenza in adults aged ≥ 65 years. METHODS An electronic database search was conducted to identify studies assessing the economic and humanistic burden of influenza, including influenza symptoms that impact the HRQoL and patient-related outcomes in adults aged ≥ 65 years. Studies were to be published in English and conducted in Germany, France, Spain, and Italy, the UK, USA, Canada, China, Japan, Brazil, Saudi Arabia, and South Africa. RESULTS Thirty-eight studies reported on the economic and humanistic burden of influenza in adults aged ≥ 65 years. Higher direct costs were reported for people at increased risk of influenza-related complications compared to those at low risk. Lower influenza-related total costs were found in those vaccinated with adjuvanted inactivated trivalent influenza vaccine (aTIV) compared to high-dose trivalent influenza vaccine (TIV-HD). Older age was associated with an increased occurrence and longer duration of certain influenza symptoms. CONCLUSION Despite the limited data identified, results show that influenza exerts a high humanistic and economic burden in older adults. Further research is required to confirm findings and to identify the unmet needs of current vaccines.
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Affiliation(s)
- Jakob Langer
- Pfizer Patient & Health Impact, Lisbon, Portugal.
- Pfizer Portugal, Lagoas Park, Edifício 10, 2740-271, Porto Salvo, Portugal.
| | - Verna L Welch
- Pfizer Vaccines Medical & Scientific Affairs, Collegeville, PA, USA
| | - Mary M Moran
- Pfizer Vaccines Medical & Scientific Affairs, Collegeville, PA, USA
| | - Alejandro Cane
- Pfizer Vaccines Medical & Scientific Affairs, Collegeville, PA, USA
| | | | - Amit Srivastava
- Pfizer Emerging Markets, Vaccines Medical & Scientific Affairs, Cambridge, MA, USA
| | | | - Amy Sears
- Adelphi Values PROVE, Bollington, SK10 5JB, UK
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Ebrahimipour H, Haghparast-Bidgoli H, Aval SB, Hoseini SJ, Jamili S, Ebnehoseini Z, Vejdani M, Adel A. Diagnostic and Therapeutic Costs of Patients With a Diagnosis of or Suspected Coronavirus Disease in Iran. Value Health Reg Issues 2022; 27:21-24. [PMID: 34784544 PMCID: PMC8590483 DOI: 10.1016/j.vhri.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/30/2021] [Accepted: 05/26/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To understand the social and individual effects of the disease and make decisions on the allocation of health resources, it is necessary to understand the economic burden of coronavirus disease (COVID-19); however, there are limited data in this field. This study aimed to estimate diagnostic and therapeutic costs of patients with a diagnosis of or suspected of COVID-19 disease admitted to hospitals in northeast Iran. METHODS This descriptive and analytical research was conducted as a retrospective study using the data collected from 2980 patients admitted to 30 hospitals from February to April 2020 in Iran. For data collection, an appropriate data capture tool was designed to record detailed resource use. A multivariate regression analysis was performed to examine the association between the treatment costs and sociodemographic, disease severity, and underlying diseases. Data were analyzed using Excel 2017 (Microsoft, Redmond, WA) and SPSS version 21 software (SPSS Inc., Chicago, IL). RESULTS The inpatient costs per patient were Int$416, of which 74% were paid by social health insurance systems, 19% by the government, and 7% by the patients. The largest cost components were hoteling (37%) and medicine (36%). The 4 subscales of age, sex, underlying disease, and severity predicted 48.6% of the cost variance. CONCLUSION Understanding the economic consequences of diseases can help policymakers to make plans to reduce out-of-pocket payments and make plans for funding. Since COVID-19 is a newly emerging disease and there is no definitive cure for the disease, the discovery of an effective medicine may alter medical costs and reduce the hospital length of stay, therefore significantly reducing treatment costs.
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Affiliation(s)
- Hosein Ebrahimipour
- Social Determinates of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Shapour Badiee Aval
- Department of Complementary and Chinese Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Javad Hoseini
- Department of Medical Biotechnology and Nanotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Jamili
- Social Determinates of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Ebnehoseini
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Marjan Vejdani
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Adel
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.
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Lai X, Rong H, Ma X, Hou Z, Li S, Jing R, Zhang H, Lyu Y, Wang J, Feng H, Peng Z, Feng L, Fang H. The Economic Burden of Influenza-Like Illness among Children, Chronic Disease Patients, and the Elderly in China: A National Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126277. [PMID: 34200619 PMCID: PMC8296061 DOI: 10.3390/ijerph18126277] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 12/03/2022]
Abstract
Background: The disease burden of seasonal influenza is substantial in China, while there is still a lack of nationwide economic burden estimates. This study aims to examine influenza-like illness (ILI) prevalence, healthcare-seeking behaviors, economic impact of ILI, and its influencing factors among three priority groups during the 2018–19 influenza season. Methods: From August to October 2019, 6668 children’s caregivers, 1735 chronic disease patients, and 3849 elderly people were recruited from 10 provinces in China to participate in an on-site survey. The economic burden of ILI consisted of direct (medical or non-medical) and indirect burdens, and a two-part model was adopted to predict the influencing factors of total economic burden. Results: There were 45.73% children, 16.77% chronic disease patients, and 12.70% elderly people reporting ILI, and most participants chose outpatient service or over-the-counter (OTC) medication after ILI. The average economic burden was CNY 1647 (USD 237.2) for children, CNY 951 (USD 136.9) for chronic disease patients, and CNY 1796 (USD 258.6) for the elderly. Two-part regression showed that age, gender, whether the only child in the family, region, and household income were important predictors of ILI economic burden among children, while age, region, place of residence, basic health insurance, and household income were significant predictors of ILI economic burden among chronic disease patients and the elderly. Conclusions: A large economic burden of ILI was highlighted, especially among the elderly with less income and larger medical burdens, as well as children, with higher prevalence and higher self-payment ratio. It is important to adopt targeted interventions for high-risk groups, and this study can help national-level decision-making on the introduction of influenza vaccination as a public health project.
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Affiliation(s)
- Xiaozhen Lai
- School of Public Health, Peking University, Beijing 100083, China; (X.L.); (R.J.); (H.Z.); (Y.L.); (J.W.); (H.F.)
- China Center for Health Development Studies, Peking University, Beijing 100083, China; (H.R.); (X.M.)
| | - Hongguo Rong
- China Center for Health Development Studies, Peking University, Beijing 100083, China; (H.R.); (X.M.)
- Institute for Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xiaochen Ma
- China Center for Health Development Studies, Peking University, Beijing 100083, China; (H.R.); (X.M.)
| | - Zhiyuan Hou
- School of Public Health, Fudan University, Shanghai 200032, China;
| | - Shunping Li
- School of Health Care Management, Cheeloo College of Medicine, Shandong University, Jinan 250012, China;
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan 250012, China
| | - Rize Jing
- School of Public Health, Peking University, Beijing 100083, China; (X.L.); (R.J.); (H.Z.); (Y.L.); (J.W.); (H.F.)
- China Center for Health Development Studies, Peking University, Beijing 100083, China; (H.R.); (X.M.)
| | - Haijun Zhang
- School of Public Health, Peking University, Beijing 100083, China; (X.L.); (R.J.); (H.Z.); (Y.L.); (J.W.); (H.F.)
- China Center for Health Development Studies, Peking University, Beijing 100083, China; (H.R.); (X.M.)
| | - Yun Lyu
- School of Public Health, Peking University, Beijing 100083, China; (X.L.); (R.J.); (H.Z.); (Y.L.); (J.W.); (H.F.)
- China Center for Health Development Studies, Peking University, Beijing 100083, China; (H.R.); (X.M.)
| | - Jiahao Wang
- School of Public Health, Peking University, Beijing 100083, China; (X.L.); (R.J.); (H.Z.); (Y.L.); (J.W.); (H.F.)
- China Center for Health Development Studies, Peking University, Beijing 100083, China; (H.R.); (X.M.)
| | - Huangyufei Feng
- School of Public Health, Peking University, Beijing 100083, China; (X.L.); (R.J.); (H.Z.); (Y.L.); (J.W.); (H.F.)
- China Center for Health Development Studies, Peking University, Beijing 100083, China; (H.R.); (X.M.)
| | - Zhibin Peng
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing 102206, China;
| | - Luzhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
- Correspondence: (L.F.); (H.F.); Tel.: +86-10-6525-6093 (L.F.); +86-10-8280-5702 (H.F.)
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing 100083, China; (H.R.); (X.M.)
- Peking University Health Science Center—Chinese Center for Disease Control and Prevention Joint Center for Vaccine Economics, Peking University, Beijing 100083, China
- Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Beijing 100083, China
- Correspondence: (L.F.); (H.F.); Tel.: +86-10-6525-6093 (L.F.); +86-10-8280-5702 (H.F.)
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Jang SY, Seon JY, Yoon SJ, Park SY, Lee SH, Oh IH. Comorbidities and Factors Determining Medical Expenses and Length of Stay for Admitted COVID-19 Patients in Korea. Risk Manag Healthc Policy 2021; 14:2021-2033. [PMID: 34040465 PMCID: PMC8140929 DOI: 10.2147/rmhp.s292538] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/20/2021] [Indexed: 01/22/2023] Open
Abstract
Purpose No previous investigations of coronavirus disease 2019 (COVID-19) have estimated medical expenses, length of stay, or factors influencing them using administrative datasets. This study aims to fill this research gap for the Republic of Korea, which has over 10,000 confirmed COVID-19 cases. Patients and Methods Using the nationwide health insurance claims data of 7590 confirmed COVID-19 patients, we estimated average medical expenses and inpatient days per patient, and performed multivariate negative binomial, and gamma regressions to determine influencing factors for higher outcomes. Results According to the results, COVID-19 patients with history of ICU admission, chest CT imaging, lopinavir/ritonavir and hydroxychloroquine use stayed longer in the hospital and spent more on medical expenses, and anti-hypertensive drugs were insignificantly associated with the outcomes. Female patients stayed longer in the hospital in the over 65 age group but spent less in medical expenses that the 20-39 group. In the 40-69 age group, patients with health insurance stayed longer in the hospital and spent more on medical expenses than those aged over 65 years. Comorbidities did not affect outcomes in most age groups. Conclusion In summary, contrary to popular beliefs, medical expenses and length of hospitalization were mostly influenced by age, and not by comorbidities, anti-viral, or anti-hypertensive drugs. Thus, responses should focus on infection prevention and control rather than clinical countermeasures.
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Affiliation(s)
- Su Yeon Jang
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Jeong-Yeon Seon
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Seok-Jun Yoon
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - So-Youn Park
- Department of Medical Education and Humanities, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Seung Heon Lee
- Division of Pulmonary, Sleep, and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea
| | - In-Hwan Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
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de Broucker G, Sim SY, Brenzel L, Gross M, Patenaude B, Constenla DO. Cost of Nine Pediatric Infectious Illnesses in Low- and Middle-Income Countries: A Systematic Review of Cost-of-Illness Studies. PHARMACOECONOMICS 2020; 38:1071-1094. [PMID: 32748334 PMCID: PMC7578143 DOI: 10.1007/s40273-020-00940-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Cost-of-illness data from empirical studies provide insights into the use of healthcare resources including both expenditures and the opportunity cost related to receiving treatment. OBJECTIVE The objective of this systematic review was to gather cost data and relevant parameters for hepatitis B, pneumonia, meningitis, encephalitis caused by Japanese encephalitis, rubella, yellow fever, measles, influenza, and acute gastroenteritis in children in low- and middle-income countries. DATA SOURCES Peer-reviewed studies published in public health, medical, and economic journals indexed in PubMed (MEDLINE), Embase, and EconLit. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS Studies must (1) be peer reviewed, (2) be published in 2000-2016, (3) provide cost data for one of the nine diseases in children aged under 5 years in low- and middle-income countries, and (4) generated from primary data collection. LIMITATIONS We cannot exclude missing a few articles in our review. Measures were taken to reduce this risk. Several articles published since 2016 are omitted from the systematic review results, these articles are included in the discussion. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS The review yielded 37 articles and 267 sets of cost estimates. We found no cost-of-illness studies with cost estimates for hepatitis B, measles, rubella, or yellow fever from primary data. Most estimates were from countries in Gavi preparatory (28%) and accelerated (28%) transition, followed by those who are initiating self-financing (22%) and those not eligible for Gavi support (19%). Thirteen articles compared household expenses to manage illnesses with income and two articles with other household expenses, such as food, clothing, and rent. An episode of illness represented 1-75% of the household's monthly income or 10-83% of its monthly expenses. Articles that presented both household and government perspectives showed that most often governments incurred greater costs than households, including non-medical and indirect costs, across countries of all income statuses, with a few notable exceptions. Although limited for low- and middle-income country settings, cost estimates generated from primary data collection provided a 'real-world' estimate of the economic burden of vaccine-preventable diseases. Additional information on whether common situations preventing the application of official clinical guidelines (such as medication stock-outs) occurred would help reveal deficiencies in the health system. Improving the availability of cost-of-illness evidence can inform the public policy agenda about healthcare priorities and can help to operationalize the healthcare budget in local health systems to respond adequately to the burden of illness in the community.
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Affiliation(s)
- Gatien de Broucker
- International Vaccine Access Center, 415 North Washington Street, Suite #530, Baltimore, MD, 21231, USA.
| | - So Yoon Sim
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Margaret Gross
- Welch Medical Library, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Bryan Patenaude
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dagna O Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- GlaxoSmithKline Plc, Panama City, Panama
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Chang YC, Yu-Tung H, Chen LS, Tung HJ, Huang KH, Ernawaty E, Wu SY. Protective Effect of Seasonal Influenza Vaccination in Elderly Individuals with Disability in Taiwan: A Propensity Score-Matched, Nationwide, Population-Based Cohort Study. Vaccines (Basel) 2020; 8:vaccines8010140. [PMID: 32235779 PMCID: PMC7157623 DOI: 10.3390/vaccines8010140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/14/2020] [Accepted: 03/17/2020] [Indexed: 11/16/2022] Open
Abstract
This is the first and largest population-based cohort study to demonstrate that influenza vaccination reduced all-cause mortality and influenza-related hospitalization in elderly individuals with a disability. PURPOSE To estimate the protective effect of influenza vaccination in elderly individuals with a disability by conducting a propensity score-matched (PSM), nationwide, population-based cohort study. METHODS Data from Taiwan's National Health Insurance Research Database were used in this study. Generalized estimating equations (GEEs) were used to compare outcomes between the vaccinated and unvaccinated cohorts. The GEE logit was used to estimate the relative risks of death and hospitalization after influenza vaccination. Adjusted odds ratios (aORs) were used to estimate relative risk. RESULTS The matching process yielded a final cohort of 272 896 elderly individuals with a disability (136 448 individuals in each cohort). In multivariate GEE analyses, aOR (vaccinated vs. unvaccinated) and 95% confidence interval (CI) of death were 0.70 (0.68-0.72). The aORs (95% CIs) of hospitalization for influenza and pneumonia, respiratory diseases, respiratory failure, heart disease, hemorrhagic stroke, and ischemic stroke were 0.98 (0.95-1.01), 0.96 (0.94-0.99), 0.85 (0.82-0.89), 0.96 (0.93-0.99), 0.85 (0.75-0.97), and 0.89 (0.84-0.95), respectively. The length of stay and medical expenditure exhibited greater reduction in vaccinated elderly individuals with a severe and very severe disability than in unvaccinated elderly individuals. CONCLUSIONS Influenza vaccination reduced all-cause mortality, influenza-related hospitalization, length of stay, and medical expenditure in elderly individuals with a disability. The decrease in the length of stay and medical expenditure because of influenza vaccination was proportional to the severity of disability.
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Affiliation(s)
- Yu-Chia Chang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan;
- Department of Medical Research, China Medical University, Taichung 40402, Taiwan
| | - Huang Yu-Tung
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
| | - Long-Sheng Chen
- Surveillance, Research and Health Education Division, Health Promotion Administration, Ministry of Health and Welfare, Taipei 10341, Taiwan;
| | - Ho-Jui Tung
- Department of Health Policy and Community Health, JPH College of Public Health, Georgia Southern University, Statesboro, GA 30458, USA;
| | - Kuang-Hua Huang
- Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan;
| | - Ernawaty Ernawaty
- Department of Health Policy and Administration, Faculty of Public Health, Universitas Airlangga, Surabaya 60115, Indonesia;
| | - Szu-Yuan Wu
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan;
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan
- Correspondence:
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Jiang M, Li P, Wang W, Zhao M, Atif N, Zhu S, Fang Y. Cost-effectiveness of quadrivalent versus trivalent influenza vaccine for elderly population in China. Vaccine 2019; 38:1057-1064. [PMID: 31787414 DOI: 10.1016/j.vaccine.2019.11.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/13/2019] [Accepted: 11/18/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Influenza-associated excess death occurred most in the elderly. We aimed to assess the cost-effectiveness of quadrivalent influenza vaccine (QIV) versus trivalent influenza vaccine (TIV) for prevention of influenza infection among elderly population in China. METHODS A decision-analytic model was developed to compare 1-year clinical and economic outcomes of three influenza vaccination options (no vaccination, TIV, and QIV) in a hypothetical cohort of Chinese elderly aged 69 years. Outcome measures included cost, influenza infection rate, influenza-related mortality rate, quality-adjusted life-years (QALY) loss, and incremental cost-effectiveness ratio (ICER) from societal perspective. Sensitivity analyses were performed to examine the uncertainty of model inputs. RESULTS Base-case results showed no vaccination was dominated (more costly at higher QALY loss) by TIV and QIV. QIV was more costly (USD56.29 versus USD54.28) with lower influenza infection rate (0.608 versus 0.623), mortality rate (0.00199 versus 0.00204), and QALY loss (0.01213 versus 0.01243) than TIV. QIV was cost-effective compared to TIV with ICER of 6,700 USD/QALY below the willingness-to-pay threshold (29,580 USD/QALY). One-way sensitivity analysis found the cost-effectiveness of QIV was subject to the relative risk of vaccine effectiveness of QIV versus TIV, and TIV would be cost-effective if the relative risk was below 1.05. In 10,000 Monte Carlo simulations, the probabilities of QIV, TIV, and no vaccination to be cost-effective were 86.3%, 13.7%, and 0%, respectively. CONCLUSION QIV appears to be a cost-effective option compared to TIV and no influenza vaccination for elderly population in China.
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Affiliation(s)
- Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an 710061, China; Shaanxi Center for Health Reform and Development Research, Xi'an 710061, China.
| | - Pengchao Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an 710061, China; Shaanxi Center for Health Reform and Development Research, Xi'an 710061, China.
| | - Weihua Wang
- Department of Non-communicable Chronic Disease Control and Prevention, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an 710054, China.
| | - Mingyue Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an 710061, China; Shaanxi Center for Health Reform and Development Research, Xi'an 710061, China.
| | - Naveel Atif
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an 710061, China; Shaanxi Center for Health Reform and Development Research, Xi'an 710061, China.
| | - Shan Zhu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an 710061, China; Shaanxi Center for Health Reform and Development Research, Xi'an 710061, China.
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an 710061, China; Shaanxi Center for Health Reform and Development Research, Xi'an 710061, China.
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Salcedo-Mejía F, Alvis-Zakzuk NJ, Carrasquilla-Sotomayor M, Redondo HP, Castañeda-Orjuela C, De la Hoz-Restrepo F, Alvis-Guzmán N. Economic Cost of Severe Acute Respiratory Infection Associated to Influenza in Colombian Children: A Single Setting Analysis. Value Health Reg Issues 2019; 20:159-163. [PMID: 31563859 DOI: 10.1016/j.vhri.2019.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 06/24/2019] [Accepted: 07/17/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Influenza is considered a leading public health problem because its large economic burden of disease worldwide, especially in low-and middle-income countries, such as Colombia. OBJECTIVE We aimed to estimate the economic costs of influenza-confirmed patients in a pediatric hospital in Cartagena, Colombia. METHODS We conducted a retrospective costing analysis. We estimated the direct (direct medical and out-of-pocket expenditures) and indirect costs for influenza-confirmed severe acute respiratory infection cases from a societal perspective. Total economic costs were calculated adding direct medical costs, out-of-pocket expenditures, and indirect costs owing to loss of productivity of caregivers. Mean, median, 95% confidence interval (95% CI) and interquartile range (IQR) of costs were measured. All costs are reported in USD ($1.00 = COP$2000.7) RESULTS: Forty-four cases were included in the analysis: 30 had influenza B, 10 influenza A and B, and 4 influenza AH1N1. Thirty patients were hospitalized in the general ward, 14 went to the intensive care unit. The average duration of stay was ∼9 days (95% CI, 6.3-11.5). The median direct medical cost for hospitalized case in general ward was $743.50 (IQR $590.20-$1404.60) and in intensive care unit $4669.80 (IQR $1614.60-$7801.50). The economic cost per hospitalized case was $1826.10 (IQR $1343.30-$2376.50); direct medical costs represented 93.8% of this cost. The median indirect cost was $82.10 (IQR $41.10-$133.40) and the median out-of-pocket expenditure per case was $45.70 (IQR $29.50-$64.90). CONCLUSIONS Severe acute respiratory infection is an important source of economic burden for the health system, families, and society in Colombia. Seasonal influenza vaccination should be strengthened to prevent more cases and save economic resources.
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Affiliation(s)
| | - Nelson J Alvis-Zakzuk
- Departamento de Ciencias Empresariales, Universidad de la Costa-CUC, Barranquilla, Colombia; Observatorio Nacional de Salud, Instituto Nacional de Salud, Bogotá, DC, Colombia.
| | | | - Hernando Pinzón Redondo
- Grupo de Investigación de Infectología Peditrica, Fundación Hospital Infantil Napoleón Franco Pareja, Universidad de Cartagena, Cartagena, Colombia
| | - Carlos Castañeda-Orjuela
- Observatorio Nacional de Salud, Instituto Nacional de Salud, Bogotá, DC, Colombia; Grupo de Evaluación en Epidemiología y Salud Pública, Universidad Nacional de Colombia, Bogotá, DC, Colombia
| | - Fernando De la Hoz-Restrepo
- Grupo de Evaluación en Epidemiología y Salud Pública, Universidad Nacional de Colombia, Bogotá, DC, Colombia
| | - Nelson Alvis-Guzmán
- Departamento de Ciencias Empresariales, Universidad de la Costa-CUC, Barranquilla, Colombia; Departamento de Economía, Universidad de Cartagena, Cartagena, Colombia
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Mukerji S, MacIntyre CR, Seale H, Wang Q, Yang P, Wang X, Newall AT. Cost-effectiveness analysis of N95 respirators and medical masks to protect healthcare workers in China from respiratory infections. BMC Infect Dis 2017; 17:464. [PMID: 28673259 PMCID: PMC5496227 DOI: 10.1186/s12879-017-2564-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 06/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are substantial differences between the costs of medical masks and N95 respirators. Cost-effectiveness analysis is required to assist decision-makers evaluating alternative healthcare worker (HCW) mask/respirator strategies. This study aims to compare the cost-effectiveness of N95 respirators and medical masks for protecting HCWs in Beijing, China. METHODS We developed a cost-effectiveness analysis model utilising efficacy and resource use data from two cluster randomised clinical trials assessing various mask/respirator strategies conducted in HCWs in Level 2 and 3 Beijing hospitals for the 2008-09 and 2009-10 influenza seasons. The main outcome measure was the incremental cost-effectiveness ratio (ICER) per clinical respiratory illness (CRI) case prevented. We used a societal perspective which included intervention costs, the healthcare costs of CRI in HCWs and absenteeism costs. RESULTS The incremental cost to prevent a CRI case with continuous use of N95 respirators when compared to medical masks ranged from US $490-$1230 (approx. 3000-7600 RMB). One-way sensitivity analysis indicated that the CRI attack rate and intervention effectiveness had the greatest impact on cost-effectiveness. CONCLUSIONS The determination of cost-effectiveness for mask/respirator strategies will depend on the willingness to pay to prevent a CRI case in a HCW, which will vary between countries. In the case of a highly pathogenic pandemic, respirator use in HCWs would likely be a cost-effective intervention.
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Affiliation(s)
- Shohini Mukerji
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
| | - C. Raina MacIntyre
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), University of Sydney, Westmead, NSW Australia
| | - Holly Seale
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
| | - Quanyi Wang
- The Beijing Centre for Disease Control and Prevention, Beijing, China
| | - Peng Yang
- The Beijing Centre for Disease Control and Prevention, Beijing, China
| | - Xiaoli Wang
- The Beijing Centre for Disease Control and Prevention, Beijing, China
| | - Anthony T. Newall
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
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Comparison of Influenza Epidemiological and Virological Characteristics between Outpatients and Inpatients in Zhejiang Province, China, March 2011-June 2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14020217. [PMID: 28241447 PMCID: PMC5334771 DOI: 10.3390/ijerph14020217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/17/2017] [Accepted: 02/19/2017] [Indexed: 11/18/2022]
Abstract
Given the rapid rate of global spread and consequently healthcare costs related to influenza, surveillance plays an important role in monitoring the emerging pandemics in China. However, the characteristics of influenza in Southeast of China haven’t been fully studied. Our study use the surveillance data collected from 16 sentinel hospitals across Zhejiang Province during March 2011 through June 2015, including the demographic information and respiratory specimens from influenza-like illness (ILI) patients and severe acute respiratory illness (SARI) patients. As analysis results, most SARI and ILI patients were in the age group of 0–4 years old (62.38% of ILI and 71.54% of SARI). The respiratory specimens have statistically significantly higher positive rate for influenza among ILI patients than that among SARI patients (p < 0.001). The comparison between ILI patients and SARI patients shows no statistically significantly difference in detecting influenza virus type and influenza A virus subtype. The SARI and ILI patients were found to be positively correlated for overall positive rate (r = 0.63, p < 0.001), the weekly percentage of A(H1N1)pdm09 (r = 0.51, p < 0.001), influenza B virus (r = 0.17, p = 0.013), and A/H3N2 (r = 0.43, p < 0.001) among all the positive numbers. Our study demonstrated that the activities of influenza virus, including its subtypes, had a similar temporal pattern between ILI and SARI cases.
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Torner N, Navas E, Soldevila N, Toledo D, Navarro G, Morillo A, Pérez MJ, Domínguez A. Costs associated with influenza-related hospitalization in the elderly. Hum Vaccin Immunother 2017; 13:412-416. [PMID: 27925855 PMCID: PMC5328227 DOI: 10.1080/21645515.2017.1264829] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Seasonal influenza epidemics remain a considerable burden in adults, especially in those at higher risk of complications. The aim of this study was to determine the costs associated with influenza-related hospitalization in patients aged ≥65 y admitted to 20 hospitals from 7 Spanish regions during the 2013-14 and 2014-15 influenza seasons. Bivariate analysis was used to compare costs in vaccinated and unvaccinated cases. Costs were calculated according to the Spanish National Health System diagnosis-related group tables for influenza and other respiratory system conditions (GRD 89 and GRD 101). A total of 728 confirmed influenza cases were recorded: 52.9% were male, 46.7% were aged 75-84 years, and 49.3% received influenza vaccine ≥15 d prior to hospital admission. Influenza-related mean hospitalization costs (MHC) were € 1,184,808 in unvaccinated and € 1,152,333 in vaccinated cases (2.75% lower). Influenza vaccination showed significant protection against ICU admission (OR 0.35, 95%CI 0.21-0.59; p < 0001); mechanical ventilation (OR 0.56, 95%CI 0.39-0.80; p = 0.002); secondary bacterial pneumonia (OR 0.61, 95%CI 0.39-0.98; p = 0.04) and a higher degree of dependence (OR 0.74, 95%CI 0.55-0.99; p = 0.04). No association was observed for the Charlson comorbidity index or the mean hospital stay. Although influenza vaccination of the elderly may not achieve significant savings in mean hospitalization costs, it may lessen the degree of severity and avoid complications.
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Affiliation(s)
- Núria Torner
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, Public Health Unit. University of Barcelona, Barcelona, Spain
- Public Health Agency of Catalonia, Barcelona, Spain
| | | | - Núria Soldevila
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Diana Toledo
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Gemma Navarro
- Epidemiology Unit, Corporació Sanitària i Universitaria Parc Taulí, Sabadell, Spain
| | - Aurea Morillo
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Preventive Medicine and Public Health Department, University Hospital Virgen del Rocio, Seville, Spain
| | - Maria José Pérez
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Preventive Medicine and Public Health Department, University Hospital of Valme, Seville, Spain
| | - Angela Domínguez
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, Public Health Unit. University of Barcelona, Barcelona, Spain
| | - the Working Group of the Project PI12/02079
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, Public Health Unit. University of Barcelona, Barcelona, Spain
- Public Health Agency of Catalonia, Barcelona, Spain
- Epidemiology Unit, Corporació Sanitària i Universitaria Parc Taulí, Sabadell, Spain
- Preventive Medicine and Public Health Department, University Hospital Virgen del Rocio, Seville, Spain
- Preventive Medicine and Public Health Department, University Hospital of Valme, Seville, Spain
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Zhang X, Zhang J, Chen L, Feng L, Yu H, Zhao G, Zhang T. Pneumonia and influenza hospitalizations among children under 5 years of age in Suzhou, China, 2005-2011. Influenza Other Respir Viruses 2017; 11:15-22. [PMID: 27383534 PMCID: PMC5155646 DOI: 10.1111/irv.12405] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The disease burden of influenza among children in China has not been well described. OBJECTIVE To estimate the influenza-associated excess hospitalization rate and compare the hospitalization length and costs between pneumonia and influenza (P&I) and other community-acquired diseases (CAD) in Suzhou, China. METHODS We retrospectively collected hospital discharge data on pediatric patients' discharge diagnosis, hospital costs, and length of hospital stay in Suzhou. P&I hospitalization was defined as a primary discharge diagnosis of pneumonia and influenza disease (ICD-10 codes J09-J18). Other CAD were common community-acquired diseases among children. Negative binomial regression models were used to estimate the weekly P&I hospitalizations in Suzhou. Excess P&I hospitalizations due to influenza were calculated as the difference in P&I hospitalizations between the epidemic period and the baseline period. Baseline was defined as when the influenza-positive rates were <5% for two consecutive weeks. RESULTS From October 2005 to September 2011, we identified a total of 180 091 all-cause hospitalizations among children <5 years of age in Suzhou City. The rates of P&I and influenza-associated excess hospitalizations were highest in the 2009-2010 pandemic and 2010-2011 post-pandemic seasons. Infants <6 months of age had the highest P&I hospitalization rates, the longest hospital stays (7.5-8.0 days), and the highest hospitalization costs for P&I. Compared with other CAD, children admitted for P&I had longer hospital stays and higher hospitalization costs. CONCLUSIONS The influenza-associated P&I hospitalization rates and economic burden were high among children. Targeted influenza prevention and control strategies for young children in Suzhou may reduce the influenza-associated hospitalizations in this age group.
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Affiliation(s)
- Xiyan Zhang
- Department of EpidemiologySchool of Public HealthFudan UniversityShanghaiChina
- Key Laboratory of Public Health SafetyMinistry of EducationShanghaiChina
- Collaborative Innovation Center of Social Risks Governance in HealthShanghaiChina
| | - Jun Zhang
- Suzhou Center for Disease Prevention and ControlSuzhouChina
| | - Liling Chen
- Suzhou Center for Disease Prevention and ControlSuzhouChina
| | - Luzhao Feng
- Division of Infectious DiseaseChinese Center for Disease Control and PreventionBeijingChina
| | - Hongjie Yu
- Division of Infectious DiseaseChinese Center for Disease Control and PreventionBeijingChina
| | - Genming Zhao
- Department of EpidemiologySchool of Public HealthFudan UniversityShanghaiChina
- Key Laboratory of Public Health SafetyMinistry of EducationShanghaiChina
- Collaborative Innovation Center of Social Risks Governance in HealthShanghaiChina
| | - Tao Zhang
- Department of EpidemiologySchool of Public HealthFudan UniversityShanghaiChina
- Key Laboratory of Public Health SafetyMinistry of EducationShanghaiChina
- Collaborative Innovation Center of Social Risks Governance in HealthShanghaiChina
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14
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Huo X, Chen LL, Hong L, Xiang LH, Tang FY, Chen SH, Gao Q, Chen C, Dai QG, Sun CW, Xu K, Dai WJ, Qi X, Li CC, Yu HY, Zhou Y, Huang HD, Pan XY, Xu CS, Zhou MH, Bao CJ. Economic burden and its associated factors of hospitalized patients infected with A (H7N9) virus: a retrospective study in Eastern China, 2013-2014. Infect Dis Poverty 2016; 5:79. [PMID: 27580946 PMCID: PMC5007809 DOI: 10.1186/s40249-016-0170-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND H7N9 continues to cause human infections and remains a pandemic concern. Understanding the economic impacts of this novel disease is important for making decisions on health resource allocation, including infectious disease prevention and control investment. However, there are limited data on such impacts. METHODS Hospitalized laboratory-confirmed H7N9 patients or their families in Jiangsu Province of China were interviewed. Patients' direct medical costs of hospitalization were derived from their hospital bills. A generalized linear model was employed to estimate the mean direct medical costs of patients with different characteristics. RESULTS The mean direct cost of hospitalization for H7N9 was estimated to be ¥ 71 060 (95 % CI, 48 180-104 820), i.e., US$ 10 996 (95 % CI, 7 455-16 220), and was ¥12 060 (US$ 1 861), ¥136 120 (US$ 21 001) and ¥218 610 (US$ 33 728) for those who had mild or severe symptoms or who died, respectively. The principal components of the total fees differed among patients with different disease severity, although medication fees were always the largest contributors. Disease severity, proportion of reimbursement and family member monthly average income were identified as the key factors that contributed to a patient's direct medical cost of hospitalization. CONCLUSIONS The direct medical costs of hospitalized patients with H7N9 are significant, and far surpass the annual per capita income of Jiangsu Province, China. The influencing factors identified should be taken into account when developing related health insurance policies and making health resource allocation. TRIAL REGISTRATION Not applicable. This is a survey study with no health care intervention implemented on human participants.
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Affiliation(s)
- Xiang Huo
- Department of Acute Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiang-su Rd, Nanjing, 210009, China
| | - Li-Ling Chen
- Suzhou Center for Disease Prevention and Control, Suzhou, China
| | - Lei Hong
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Lun-Hui Xiang
- Baoshan District Center for Disease Control and Prevention, Shanghai, China
| | - Fen-Yang Tang
- Department of Acute Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiang-su Rd, Nanjing, 210009, China
| | - Shan-Hui Chen
- Wuxi Center for Disease Control and Prevention, Wuxi, China
| | - Qiang Gao
- Huaian Center for Disease Control and Prevention, Huaian, China
| | - Cong Chen
- Changzhou Center for Disease Control and Prevention, Changzhou, China
| | - Qi-Gang Dai
- Department of Acute Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiang-su Rd, Nanjing, 210009, China
| | - Chuan-Wu Sun
- Xuzhou Center for Disease Control and Prevention, Xuzhou, China
| | - Ke Xu
- Department of Acute Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiang-su Rd, Nanjing, 210009, China
| | - Wen-Jun Dai
- Taizhou Center for Disease Control and Prevention, Taizhou, China
| | - Xian Qi
- Department of Acute Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiang-su Rd, Nanjing, 210009, China
| | - Chang-Cheng Li
- Yancheng Center for Disease Control and Prevention, Yancheng, China
| | - Hui-Yan Yu
- Department of Acute Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiang-su Rd, Nanjing, 210009, China
| | - Yin Zhou
- Zhenjiang Center for Disease Prevention and Control, Zhenjiang, China
| | - Hao-Di Huang
- Department of Acute Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiang-su Rd, Nanjing, 210009, China
| | - Xing-Yang Pan
- Yangzhou Center for Disease Control and Prevention, Yangzhou, China
| | - Chang-Sha Xu
- Suqian Municipal Center for Disease Control and Prevention, Suqian, China
| | - Ming-Hao Zhou
- Department of Acute Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiang-su Rd, Nanjing, 210009, China
| | - Chang-Jun Bao
- Department of Acute Infectious Disease, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiang-su Rd, Nanjing, 210009, China.
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15
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de Francisco Shapovalova N, Donadel M, Jit M, Hutubessy R. A systematic review of the social and economic burden of influenza in low- and middle-income countries. Vaccine 2015; 33:6537-44. [PMID: 26597032 DOI: 10.1016/j.vaccine.2015.10.066] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 08/18/2015] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The economic burden of seasonal influenza outbreaks as well as influenza pandemics in lower- and middle-income countries (LMIC) has yet to be specifically systematically reviewed. The aim of this systematic review is to assess the evidence of influenza economic burden assessment methods in LMIC and to quantify the economic consequences of influenza disease in these countries, including broader opportunity costs in terms of impaired social progress and economic development. METHODS We conducted an all language literature search across 5 key databases using an extensive list of key words for the time period 1950-2013. We included studies which explored direct costs (medical and non-medical), indirect costs (productivity losses), and broader economic impact in LMIC associated with different influenza outcomes such as confirmed seasonal influenza infection, influenza-like illnesses, and pandemic influenza. RESULTS We included 62 full-text studies in English, Spanish, Russian, Chinese languages, mostly from the countries of Latin American and the Caribbean and East Asia and Pacific with pertinent cost data found in 39 papers. Estimates for direct and indirect costs were the highest in Latin American and the Caribbean. Compared to high-income economies, direct costs in LMIC were lower and productivity losses higher. Evidence on broader impact of influenza included impact on the wider national economy, security dimension, medical insurance policy, legal frameworks, distributional impact, and investment flows. CONCLUSION The economic burden of influenza in LMIC encompasses multiple dimensions such as direct costs to the health service and households, indirect costs due to productivity losses as well as broader detriments to the wider economy. Evidence from sub-Saharan Africa and in pregnant women remains very limited. Heterogeneity of methods used to estimate cost components makes data synthesis challenging. There is a strong need for standardizing research, data collection and evaluation methods for both direct and indirect cost components.
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Affiliation(s)
| | - Morgane Donadel
- Vaccines, Immunization and Biologicals, World Health Organization, 20 Avenue Appia, CH-1211 Geneva, Switzerland.
| | - Mark Jit
- Modelling and Economics Unit, Public Health England, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Raymond Hutubessy
- Vaccines, Immunization and Biologicals, World Health Organization, 20 Avenue Appia, CH-1211 Geneva, Switzerland.
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Yang J, Jit M, Leung KS, Zheng YM, Feng LZ, Wang LP, Lau EHY, Wu JT, Yu HJ. The economic burden of influenza-associated outpatient visits and hospitalizations in China: a retrospective survey. Infect Dis Poverty 2015; 4:44. [PMID: 26445412 PMCID: PMC4595124 DOI: 10.1186/s40249-015-0077-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/25/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The seasonal influenza vaccine coverage rate in China is only 1.9 %. There is no information available on the economic burden of influenza-associated outpatient visits and hospitalizations at the national level, even though this kind of information is important for informing national-level immunization policy decision-making. METHODS A retrospective telephone survey was conducted in 2013/14 to estimate the direct and indirect costs of seasonal influenza-associated outpatient visits and hospitalizations from a societal perspective. Study participants were laboratory-confirmed cases registered in the National Influenza-like Illness Surveillance Network and Severe Acute Respiratory Infections Sentinel Surveillance Network in China in 2013. Patient-reported costs from the survey were validated by a review of hospital accounts for a small sample of the inpatients. RESULTS The study enrolled 529 outpatients (median age: eight years; interquartile range [IQR]: five to 20 years) and 254 inpatients (median age: four years; IQR: two to seven years). Among the outpatients, 22.1 % (117/529) had underlying diseases and among the inpatients, 52.8 % (134/254) had underlying diseases. The average total costs related to influenza-associated outpatient visits and inpatient visits were US$ 155 (standard deviation, SD US$ 122) and US$ 1,511 (SD US$ 1,465), respectively. Direct medical costs accounted for 45 and 69 % of the total costs related to influenza-associated outpatient and inpatient visits, respectively. For influenza outpatients, the mean cost per episode in children aged below five years (US$ 196) was higher than that in other age groups (US$ 129-153). For influenza inpatients, the mean cost per episode in adults aged over 60 years (US$ 2,735) was much higher than that in those aged below 60 years (US$ 1,417-1,621). Patients with underlying medical conditions had higher costs per episode than patients without underlying medical conditions (outpatients: US$ 186 vs. US$ 146; inpatients: US$ 1,800 vs. US$ 1,189). In the baseline analysis, inpatients reported costs were 18 % higher than those found in the accounts review (n = 38). CONCLUSION The economic burden of influenza-associated outpatient and inpatient visits in China is substantial, particularly for young children, the elderly, and patients with underlying medical conditions. More widespread influenza vaccination would likely alleviate the economic burden of patients. The actual impact and cost-effectiveness analysis of the influenza immunization program in China merits further investigation.
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Affiliation(s)
- Juan Yang
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Mark Jit
- Modelling and Economics Unit of Public Health in England, London, UK. .,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Kathy S Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 2/F North Wing, Patrick Manson Building, 7 Sassoon Road, Pok Fu Lam, Hong Kong Special Administrative Region, China.
| | - Ya-Ming Zheng
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Lu-Zhao Feng
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Li-Ping Wang
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Eric H Y Lau
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 2/F North Wing, Patrick Manson Building, 7 Sassoon Road, Pok Fu Lam, Hong Kong Special Administrative Region, China.
| | - Joseph T Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 2/F North Wing, Patrick Manson Building, 7 Sassoon Road, Pok Fu Lam, Hong Kong Special Administrative Region, China.
| | - Hong-Jie Yu
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
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Peasah SK, Purakayastha DR, Koul PA, Dawood FS, Saha S, Amarchand R, Broor S, Rastogi V, Assad R, Kaul KA, Widdowson MA, Lal RB, Krishnan A. The cost of acute respiratory infections in Northern India: a multi-site study. BMC Public Health 2015; 15:330. [PMID: 25880910 PMCID: PMC4392863 DOI: 10.1186/s12889-015-1685-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/26/2015] [Indexed: 11/23/2022] Open
Abstract
Background Despite the high mortality and morbidity resulting from acute respiratory infections (ARI) globally, there are few data from low-income countries on costs of ARI to inform public health policy decisions We conducted a prospective survey to assess costs of ARI episodes in selected primary, secondary, and tertiary healthcare facilities in north India where no respiratory pathogen vaccine is routinely recommended. Methods Face-to-face interviews were conducted among a purposive sample of patients with ARI from healthcare facilities. Data were collected on out-of-pocket costs of hospitalization, medical consultations, medications, diagnostics, transportation, lodging, and missed work days. Telephone surveys were conducted two weeks after medical encounters to ask about subsequent missed work and costs incurred. Costs of prescriptions and diagnostics in public facilities were supplemented with WHO-CHOICE estimates of hospital bed costs. Missed work days were assigned cost based on the national annual per capita income (US$1,104). Non-medically attended ARI cases were identified from an ongoing community-based ARI surveillance project in Faridabad. Results During September 2012-March 2013, 1766 patients with ARI were enrolled, including 451 hospitalized patients, 1056 outpatients, and 259 non-medically attended patients. The total direct cost of an ARI episode requiring outpatient care was US$4- $6 for public and $3-$10 for private institutions based on age groups. The total direct cost of an ARI episode requiring hospitalized care was $54-$120 in public and $135-$355 in private institutions. The cost of ARI among those hospitalized was highest among persons aged > = 65 years and lowest among children aged < 5 years. Indirect costs due to missed work days were 16-25% of total costs. The direct out-of-pocket cost of hospitalized ARI was 34% of annual per capita income. Conclusions The cost of hospitalized ARI episodes in India is high relative to median per capita income. Data from this study can inform evaluations of the cost effectiveness of proven ARI prevention strategies such as vaccination. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1685-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samuel K Peasah
- College of Pharmacy, Mercer University, 3001 Mercer University Drive, Atlanta, GA, 30341-4155, USA. .,Centers for Disease Control and Prevention, Atlanta, USA.
| | - Debjani Ram Purakayastha
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Parvaiz A Koul
- Department of Internal and Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, 190011, J&K, India.
| | | | - Siddhartha Saha
- Influenza Division, Centre for disease control and Prevention, US Embassy, Shantipath, Chanakyapuri, New Delhi, 110021, India.
| | - Ritvik Amarchand
- The INCLEN Trust, 2nd Floor, F-1/5, Okhla Industrial Area, Phase-I, New Delhi, 110020, India.
| | - Shobha Broor
- The INCLEN Trust, 2nd Floor, F-1/5, Okhla Industrial Area, Phase-I, New Delhi, 110020, India.
| | - Vaibhab Rastogi
- The INCLEN Trust, 2nd Floor, F-1/5, Okhla Industrial Area, Phase-I, New Delhi, 110020, India.
| | - Romana Assad
- Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, 190011, J&K, India.
| | | | | | - Renu B Lal
- Influenza Division, Centre for disease control and Prevention, US Embassy, Shantipath, Chanakyapuri, New Delhi, 110021, India.
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Feng L, Yang P, Zhang T, Yang J, Fu C, Qin Y, Zhang Y, Ma C, Liu Z, Wang Q, Zhao G, Yu H. Technical guidelines for the application of seasonal influenza vaccine in China (2014-2015). Hum Vaccin Immunother 2015; 11:2077-101. [PMID: 26042462 PMCID: PMC4635867 DOI: 10.1080/21645515.2015.1027470] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022] Open
Abstract
Influenza, caused by the influenza virus, is a respiratory infectious disease that can severely affect human health. Influenza viruses undergo frequent antigenic changes, thus could spread quickly. Influenza causes seasonal epidemics and outbreaks in public gatherings such as schools, kindergartens, and nursing homes. Certain populations are at risk for severe illness from influenza, including pregnant women, young children, the elderly, and people in any ages with certain chronic diseases.
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Affiliation(s)
- Luzhao Feng
- Key Laboratory of Surveillance and Early-warning on Infectious Disease; Division of Infectious Disease; Chinese Center for Disease Control and Prevention; Beijing, China
| | - Peng Yang
- Beijing Center for Disease Control and Prevention; Beijing, China
| | - Tao Zhang
- School of Public Health; Fudan University; Shanghai, China
| | - Juan Yang
- Key Laboratory of Surveillance and Early-warning on Infectious Disease; Division of Infectious Disease; Chinese Center for Disease Control and Prevention; Beijing, China
| | - Chuanxi Fu
- Guangzhou Center for Disease Control and Prevention; Guangzhou, China
| | - Ying Qin
- Key Laboratory of Surveillance and Early-warning on Infectious Disease; Division of Infectious Disease; Chinese Center for Disease Control and Prevention; Beijing, China
| | - Yi Zhang
- Beijing Center for Disease Control and Prevention; Beijing, China
| | - Chunna Ma
- Beijing Center for Disease Control and Prevention; Beijing, China
| | - Zhaoqiu Liu
- Hua Xin Hospital; First Hospital of Tsinghua University; Beijing, China
| | - Quanyi Wang
- Beijing Center for Disease Control and Prevention; Beijing, China
| | - Genming Zhao
- School of Public Health; Fudan University; Shanghai, China
| | - Hongjie Yu
- Key Laboratory of Surveillance and Early-warning on Infectious Disease; Division of Infectious Disease; Chinese Center for Disease Control and Prevention; Beijing, China
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19
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Bilcke J, Coenen S, Beutels P. Influenza-like-illness and clinically diagnosed flu: disease burden, costs and quality of life for patients seeking ambulatory care or no professional care at all. PLoS One 2014; 9:e102634. [PMID: 25032688 PMCID: PMC4102549 DOI: 10.1371/journal.pone.0102634] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 06/23/2014] [Indexed: 11/24/2022] Open
Abstract
This is one of the first studies to (1) describe the out-of-hospital burden of influenza-like-illness (ILI) and clinically diagnosed flu, also for patients not seeking professional medical care, (2) assess influential background characteristics, and (3) formally compare the burden of ILI in patients with and without a clinical diagnosis of flu. A general population sample with recent ILI experience was recruited during the 2011–2012 influenza season in Belgium. Half of the 2250 respondents sought professional medical care, reported more symptoms (especially more often fever), a longer duration of illness, more use of medication (especially antibiotics) and a higher direct medical cost than patients not seeking medical care. The disease and economic burden were similar for ambulatory ILI patients, irrespective of whether they received a clinical diagnosis of flu. On average, they experienced 5–6 symptoms over a 6-day period; required 1.6 physician visits and 86–91% took medication. An average episode amounted to €51–€53 in direct medical costs, 4 days of absence from work or school and the loss of 0.005 quality-adjusted life-years. Underlying illness led to greater costs and lower quality-of-life. The costs of ILI patients with clinically diagnosed flu tended to increase, while those of ILI patients without clinically diagnosed flu tended to decrease with age. Recently vaccinated persons experienced lower costs and a higher quality-of-life, but this was only the case for patients not seeking professional medical care. This information can be used directly to evaluate the implementation of cost-effective prevention and control measures for influenza. In particular to inform the evaluation of more widespread seasonal influenza vaccination, including in children, which is currently considered by many countries.
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Affiliation(s)
- Joke Bilcke
- Centre for Health Economics Research & Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO) WHO collaborating Centre, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Samuel Coenen
- Centre for General Practice, Primary and Interdisciplinary Care (ELIZA), Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO) WHO collaborating Centre, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research & Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO) WHO collaborating Centre, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
- School of Public Health and Community Medicine, Sydney, Australia
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20
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Zhou L, Situ S, Feng Z, Atkins CY, Fung ICH, Xu Z, Huang T, Hu S, Wang X, Meltzer MI. Cost-effectiveness of alternative strategies for annual influenza vaccination among children aged 6 months to 14 years in four provinces in China. PLoS One 2014; 9:e87590. [PMID: 24498145 PMCID: PMC3909220 DOI: 10.1371/journal.pone.0087590] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 12/30/2013] [Indexed: 11/18/2022] Open
Abstract
Background To support policy making, we developed an initial model to assess the cost-effectiveness of potential strategies to increase influenza vaccination rates among children in China. Methods We studied on children aged 6 months to 14 years in four provinces (Shandong, Henan, Hunan, and Sichuan), with a health care system perspective. We used data from 2005/6 to 2010/11, excluding 2009/10. Costs are reported in 2010 U.S. dollars. Results In comparison with no vaccination, the mean (range) of Medically Attended Cases averted by the current self-payment policy for the two age groups (6 to 59 months and 60 months to 14 years) was 1,465 (23∼11,132) and 792 (36∼4,247), and the cost effectiveness ratios were $ 0 (-11-51) and $ 37 (6-125) per case adverted, respectively. In comparison with the current policy, the incremental cost effectiveness ratio (ICER) of alternative strategies, OPTION One-reminder and OPTION Two-comprehensive package, decreased as vaccination rate increased. The ICER for children aged 6 to 59 months was lower than that for children aged 60 months to 14 years. Conclusions The model is a useful tool in identifying elements for evaluating vaccination strategies. However, more data are needed to produce more accurate cost-effectiveness estimates of potential vaccination policies.
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Affiliation(s)
- Lei Zhou
- Public Health Emergency Center, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: (ZF); (LZ)
| | - Sujian Situ
- U.S. Centers for Disease Control and Prevention, Beijing, China
| | - Zijian Feng
- Public Health Emergency Center, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: (ZF); (LZ)
| | - Charisma Y. Atkins
- U.S. Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Preparedness and Emerging Infections, Atlanta, Georgia, United States of America
| | - Isaac Chun-Hai Fung
- U.S. Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Preparedness and Emerging Infections, Atlanta, Georgia, United States of America
- Department of Epidemiology, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, United States of America
| | - Zhen Xu
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ting Huang
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Shixiong Hu
- Hunan Center for Disease Control and Prevention, Changsha, Hunan, China
| | - Xianjun Wang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Martin I. Meltzer
- U.S. Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Preparedness and Emerging Infections, Atlanta, Georgia, United States of America
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