Consumer willingness to pay for a hypothetical Chikungunya vaccine in Brazil and the implications

Background: Chikungunya fever is an important infectious disease transmitted by the bite of Aedes genus mosquitoes infected with the Chikungunya Virus (CHIKV). Information about consumers’ willingness to pay (WTP) for a hypothetical vaccine against CHIKV can help discussions about prices and funding in countries with limited resources. Methods: Cross-sectional study among adult residents of Minas Gerais, Brazil, asking if they were willing to pay the price for a hypothetical chikungunya vaccine defined by the authors with an effective protection of 80% and the possibility of local and systemic side-effects. Residents were provided with information if not familiar with the virus. The price was randomly varied between participants in five values: US$11.69 (45.00BRL), US$23.38 (90.00BRL), US$46.75 (180.00BRL), US$93.51 (360.00BRL) and US$187.90 (720.00BRL). We included this aspect due to issues with any anchoring effect. Results: 496 individuals were interviewed. Among these, 23 were excluded. Most of the respondents were female (57.3$ 31.17 (120.00 BRL) for a unique dose vaccine. There was a statistical significant correlation with monthly family income and access to private health insurance. Conclusion: This study can contribute to decision-making about potential prices for a CHIKV vaccine when it becomes available in Brazil. We also showed the anchoring effect as a possible influence on consumers’ WTP in studies with similar techniques. Finally, we encourage the development of a chikungunya virus vaccine to benefit the Brazilian population

CYD-TDV dengue vaccine: systematic review and meta-analysis of efficacy, immunogenicity and safety

Introduction: Dengue virus (DENV) is a serious global health problem. CYD-TDC (Dengvaxia®) was the first vaccine to gain regulatory approval to try and address this problem. Aim: Summarize all available evidence on the immunogenicity, efficacy and safety of the CYD-TDV dengue vaccine. Method: Meta-analysis and systematic review. Results: The best and worst immunogenicity results were for DENV4 and DENV1, respectively. Vaccine efficacy of 60% was derived from studies with participants aged 2–16 years old, with DENV4 and DENV2 presenting the best and worst results, respectively. Erythema and swelling were more frequent with CYD-TDV. No differences were detected for systemic adverse events. Conclusion: CYD-TDV showed moderate efficacy in children and adolescents. From the immunogenicity results in adults, we can expect satisfactory efficacy from vaccination in this population. </jats:p

Consumer willingness to pay for dengue vaccine (CYD-TDV, Dengvaxia®) in Brazil : implication for future pricing considerations

Introduction and objective: Dengue virus is a serious global health problem with an estimated 3.97 billion people at risk for infection worldwide. In December 2015, the first vaccine (CYD-TDV) for dengue prevention was approved in Brazil, developed by Sanofi Pasteur. However, given that the vaccine will potentially be paid via the public health system, information is need regarding consumers’ willingness to pay for the dengue vaccine in the country as well as discussions related to the possible inclusion of this vaccine into the public health system. This was the objective of this research. Methods: We conducted a cross-sectional study with residents of Greater Belo Horizonte, Minas Gerais, about their willingness to pay for the CYD-TDV vaccine. Results: 507 individuals were interviewed. These were mostly female (62.4%) had completed high school (62.17%), were working (74.4%), had private health insurance (64.5%) and did not have dengue (67.4%). The maximum median value of consumers’ willingness to pay for CYD-TDV vaccine is US$33.61 (120.00BRL) for the complete schedule and US$11.20 (40.00BRL) per dose. At the price determined by the Brazil's regulatory chamber of pharmaceutical products market (CMED) for the commercialization of Dengvaxia® for three doses, only 17% of the population expressed willingness to pay for this vaccine. Conclusion: Brazil is currently one of the largest markets for dengue vaccine and the price established is a key issue. We believe the manufacturer should asses the possibility of lower prices to reach a larger audience among the Brazilian population

Consumer willingness to pay for a hypothetical Zika vaccine in Brazil

Introduction: Zika virus is a newly emerging infection associated with increasingly large outbreaks especially in countries such as Brazil where an estimated 326,224 cases were confirmed between 2015 and 2018. Common symptoms associated with Zika include headache, conjunctivitis, fever, erythema, myalgia, vomiting, diarrhea, and abdominal pain. However, the symptoms are usually self-limiting and last on average for 4 to 7 days, with patients typically not accessing the public healthcare system (SUS). In severe cases, symptoms include neurological disorders and neonatal malformations. A future Zika vaccine can contribute to decreasing the number of cases and associated complications. However, this has to be balanced against continuing costs to control this and other vector borne diseases. Consequently, information about consumers’ willingness to pay (WTP) for a hypothetical Zika vaccine can help with price setting discussions in Brazil starting with the private market before being considered within SUS. Methods: A cross-sectional study was conducted among residents in one of the main provinces of Brazil (Minas Gerais) regarding their WTP for a hypothetical Zika Vaccine with agreed characteristics. This included a mean effective protection of 80%, with the possibility of some local and systemic side-effects. The discussed price was US$56.41(180.00 BRL) per vaccination as this figure was utilized in a previous WTP study for a dengue vaccine. Results: 517 people were interviewed. However, 30 would not be vaccinated even if the vaccine was free. Most of the resultant interviewees (489) were female (58.2$31.34 (BRL100.00). Conclusion: WTP research can contribute to decision-making about possible prices alongside other economic criteria once a Zika vaccine becomes available in Brazil alongside other programmes to control the virus

Economic and epidemiological impact of Dengue illness in Brazil

Dengue is a serious global health problem in endemic countries such as Brazil where it is the most important vector-borne infection. Overall there were 1.68 million notified cases in 2015. This has resulted in multiple initiatives to try and control the disease burden. Most patients with dengue in Brazil are self-treated at home. However, serious complications can arise including leukopenia, hemorrhage and circulatory collapse leading to deaths. Several studies have estimated the cost and disease burden but none from a public health perspective based on the entire population. Consequently, we sought to address this using Brazilian public health system (SUS) databases. Method: Descriptive study linking together several SUS databases from 2000 - 2015. All procedures and associated costs were obtained via the Hospital Information System (SIH). Data was broken down into specific age groups and incidences to better calculate associated disability-adjusted life years (DALYs) to improve understanding of the disease burden for future policy decisions. Results: 739,177 hospitalization procedures were verified as dengue and severe dengue during the study years. Overall, SUS spent almost US$159 million and US$10 million to treat dengue and severe dengue, respectively, between 2000-2015. The principal costs for SUS were hospitalization costs as the majority of patients were self-treated at home as only minor symptoms. On average, 273 per 100,000 inhabitants were notified to the authorities for dengue and 3 per 100,000 for severe dengue. Annual DALYs estimates ranged from 72.35 to 6,824.45 during the course of the study period. Conclusion: The epidemiological and morbidity burden associated with dengue is substantial in Brazil. However, the costs to SUS costs are affected by most patients self-treating at home. Consequently, the Brazilian government urgently needs to proactively evaluate the real costs and clinical benefits of any potential dengue vaccination program versus current prevention programmes and costs to guide future decision making

Consumer willingness to pay for a hypothetical Chagas disease vaccine in Brazil : a cross-sectional study and the implications

Aim: Chagas disease is a serious public health problem, endemic in 21 countries in Latin America. A future vaccine can contribute to decreasing the number of cases and its complications. Methods: A cross-sectional study was conducted with residents of the northern region of Brazil, on the willingness to pay for a hypothetical vaccine against Chagas disease (effective protection of 80%). Results: We interviewed 619 individuals and seven were excluded from the analysis and the value of willingness to pay was US$23.77 (100.00 BRL). Conclusion: The Northern region of Brazil is one of the largest markets for this vaccine, due to its epidemiological relevance, so economic studies with this vaccine will be important to assist in the assessment of technologies

Acceptability and willingness to pay for a hypothetical vaccine against SARS CoV-2 by the Brazilian consumer : a cross-sectional study and the implications

Introduction: The new coronavirus pandemic has appreciably impacted on morbidity and mortality as well as having appreciable economic impact worldwide. New vaccines are a potential way forward to reduce transmission rates and their subsequent impact. In Brazil vaccines are being distributed via the public sector. In the future, vaccines will be available in the private market. Information about consumers' willingness to pay (WTP) for a hypothetical vaccine against SARS CoV-2 can help future price setting discussions. Methods: A cross-sectional study was conducted with consumers in the five regions of Brazil regarding the willingness to pay (WTP) for a hypothetical vaccine against SARS CoV-2 with a 50% efficacy. Results: A total of 1402 individuals over 18 years of age who declared not having COVID-19 at the time of the survey were interviewed. The acceptability for this hypothetical vaccine was 80.7%. In addition, the amount of WTP by Brazilian consumers for a hypothetical SARS CoV-2 vaccine was estimated at US$ 22.18(120.00 BRL). Conclusion: This study can contribute to decision-making to inform potential pricing for a hypothetical SARS CoV-2 vaccine

Introduction and utilization of high priced HCV medicines across Europe; implications for the future

Background: Infection with the Hepatitis C Virus (HCV) is a widespread transmittable disease with a diagnosed prevalence of 2.0%. Fortunately, it is now curable in most patients. Sales of medicines to treat HCV infection grew 2.7% per year between 2004 and 2011, enhanced by the launch of the protease inhibitors (PIs) boceprevir (BCV) and telaprevir (TVR) in addition to ribavirin and pegylated interferon (pegIFN). Costs will continue to rise with new treatments including sofosbuvir, which now include interferon free regimens. de Bruijn et al. HCV Medicines Objective: Assess the uptake of BCV and TVR across Europe from a health authority perspective to offer future guidance on dealing with new high cost medicines. Methods: Cross-sectional descriptive study of medicines to treat HCV (pegIFN, ribavirin, BCV and TVR) among European countries from 2008 to 2013. Utilization measured in defined daily doses (DDDs)/1000 patients/quarter (DIQs) and expenditure in Euros/DDD. Health authority activities to influence treatments categorized using the 4E methodology (Education, Engineering, Economics and Enforcement). Results: Similar uptake of BCV and TVR among European countries and regions, ranging from 0.5 DIQ in Denmark, Netherlands and Slovenia to 1.5 DIQ in Tayside and Catalonia in 2013. However, different utilization of the new PIs vs. ribavirin indicates differences in dual vs. triple therapy, which is down to factors including physician preference and genotypes. Reimbursed prices for BCV and TVR were comparable across countries. Conclusion: There was reasonable consistency in the utilization of BCV and TVR among European countries in comparison with other high priced medicines. This may reflect the social demand to limit the transmission of HCV. However, the situation is changing with new curative medicines for HCV genotype 1 (GT1) with potentially an appreciable budget impact. These concerns have resulted in different prices across countries, with their impact on budgets and patient outcomes monitored in the future to provide additional guidance

Strategies to Improve Antimicrobial Utilization with a Special Focus on Developing Countries

From MDPI via Jisc Publications RouterHistory: accepted 2021-06-02, pub-electronic 2021-06-07Publication status: PublishedAntimicrobial resistance (AMR) is a high priority across countries as it increases morbidity, mortality and costs. Concerns with AMR have resulted in multiple initiatives internationally, nationally and regionally to enhance appropriate antibiotic utilization across sectors to reduce AMR, with the overuse of antibiotics exacerbated by the COVID-19 pandemic. Effectively tackling AMR is crucial for all countries. Principally a narrative review of ongoing activities across sectors was undertaken to improve antimicrobial use and address issues with vaccines including COVID-19. Point prevalence surveys have been successful in hospitals to identify areas for quality improvement programs, principally centering on antimicrobial stewardship programs. These include reducing prolonged antibiotic use to prevent surgical site infections. Multiple activities centering on education have been successful in reducing inappropriate prescribing and dispensing of antimicrobials in ambulatory care for essentially viral infections such as acute respiratory infections. It is imperative to develop new quality indicators for ambulatory care given current concerns, and instigate programs with clear public health messaging to reduce misinformation, essential for pandemics. Regular access to effective treatments is needed to reduce resistance to treatments for HIV, malaria and tuberculosis. Key stakeholder groups can instigate multiple initiatives to reduce AMR. These need to be followed up

Consumer willingness to pay for a hypothetical chikungunya vaccine in Brazil and the implications

Background: Chikungunya fever is an important infectious disease transmitted by the bite of the mosquitoes. Information about consumers’ willingness to pay (WTP) for a hypothetical vaccine can help with future discussions about its possible price. Methods: A cross-sectional study conducted among residents of Minas Gerais, Brazil, regarding their WTP for a hypothetical chikungunya vaccine defined by the authors as having a mean effective protection of 80%. Results: We interviewed 496 individuals. Among these, 23 were excluded from the analysis. Most of the respondents were female (57.3%), had completed at least high school (90.7%), were employed (87.7%) and had private health insurance (62.6%). The median value of the WTP was US$ 31.17 (120.00 BRL) for a unique dose vaccine. The WTP showed a statistical significant correlation with monthly family income and access to private health insurance. Conclusion: This study can contribute to decision-making about potential prices for a chikungunya vaccine once it becomes available in Brazil. We demonstrated the relevance of the anchoring effect as a possible influence applied to the maximum value of the WTP associated with respondents’ preference for a new vaccine. Finally, we encourage the development of a chikungunya virus vaccine to benefit the Brazilian population