A cost-effectiveness analysis of antimicrobial treatment of community-acquired pneumonia taking into account resistance in Belgium

OBJECTIVE: This article assesses the cost-effectiveness of outpatient antimicrobial treatment of community-acquired pneumonia (CAP) taking into account resistance in Belgium. RESEARCH DESIGN AND METHODS: Our decision analytic model focused on mild to moderate CAP, but did not consider severe CAP. Treatment pathways reflected empirical treatment initiated in the absence of data on CAP aetiology. First-line treatment consisted of moxifloxacin, co-amoxiclav, cefuroxime or clarithromycin. If first-line treatment was unsuccessful, patients were either hospitalised or second-line treatment with a different antimicrobial was initiated. Clinical failure rates were obtained from the published literature or expert opinion. Costs were calculated using published sources from the third-party payer perspective. MAIN OUTCOME MEASURES: Effectiveness measures included first-line clinical failure avoided, second-line treatment avoided, hospitalisation avoided and death avoided. Healthcare costs were included, but costs of productivity loss were not considered. RESULTS: Costs of treating a CAP episode amounted to 144euro with moxifloxacin/co-amoxiclav; 222euro with co-amoxiclav/clarithromycin; 211euro with cefuroxime/moxifloxacin; and 193euro with clarithromycin/moxifloxacin. The rate of first-line failure was 5%, 16%, 19% and 18% for these four treatment strategies, respectively. The rate of second-line treatment amounted to 4%, 13%, 16% and 15%, respectively. The hospitalisation rate was 1%, 4%, 4% and 4%, respectively. The death rate was 0.01%, 0.04%, 0.03% and 0.03%, respectively. Sensitivity analyses supported the dominance of moxifloxacin/co-amoxiclav in nearly all scenarios. CONCLUSIONS: First-line treatment of CAP patients with moxifloxacin followed by co-amoxiclav or hospitalisation if required was more effective and less costly as compared with first-line treatment with co-amoxiclav, cefuroxime or clarithromycin.status: publishe

A critical literature review of health economic evaluations in pertussis booster vaccination

A review of worldwide economic evaluations of pertussis booster vaccination for adolescents and adults was conducted. Thirteen cost-effectiveness, cost-utility and economic impact models were identified. The most frequently studied strategies were adolescent booster, one-time adult booster, adult decennial boosters and cocoon strategy. All studies evaluating adolescent booster suggested this was a cost-effective or cost-saving strategy compared with no booster vaccination. Conclusions concerning adult vaccination, alone or in combination with adolescent vaccination, vary between studies. Studies were often strongly affected by assumptions regarding the amount of unreported cases and lack of reliable input data on real incidence, other epidemiological inputs, costs associated with mild disease and herd immunity effects. Reviewed studies were generally in favor of pertussis booster vaccination, but did not identify any optimal vaccination strategy. Future economic evaluations should explore a wider range of strategies, taking into account country-specific considerations

Cost-effectiveness of catch-up programs in human papillomavirus vaccination

We reviewed cost-effectiveness models that combine routine vaccination with the human papillomavirus (HPV) vaccine with temporary catch-up programs. Cost-effectiveness results of catch-up programs are variable, and we reviewed methods and underlying assumptions to get more insight into any factor with a potential impact on cost-effectiveness. Results were dependent on differences between models used, their design and input data. Modeling aspects and assumptions were not always sufficiently described, making comparison difficult. Despite this, several differences between models likely to impact results were identified. All models used dynamic transmission modeling techniques except for one, which did not incorporate the effect of herd immunity. Catch-up strategies varied between models and comparator strategies were not necessarily the same. Cervical diseases outcomes were considered in all base cases, but the impact of genital warts was not always considered. Our article suggests that a conclusion on cost-effectiveness should be based on a fully transparent model including all possible benefits of vaccination

Immunization funding across 28 European countries

info:eu-repo/semantics/publishe

Economic evaluation of vaccines:specificities and future challenges illustrated by recent European examples

<p>This study reviews the current challenges in the economic evaluation of vaccines with a focus on European countries. In particular, the type of clinical evidence generally available, the impact of discounting for time preference and the use of modeling to derive valid cost-effectiveness assessments are considered. First, the characteristics of evidence for vaccines are discussed, as well as potential difficulties faced when using evidence-based medicine applied to curative drugs to interpret vaccine evidence. Then, discounting is considered and specific examples illustrating issues with different types of discounting are described, taking HPV as the example. Finally, the need for sometimes complex dynamic models for vaccines is explored, and specific types of models are reviewed, keeping into consideration the adage "complex when needed, straightforward if allowed."</p>