Cost of pneumococcal infections and cost-effectiveness analysis of pneumococcal vaccination in at risk adults and elderly in Turkey

Pneumococcal infections have a substantial burden in Turkey, particularly in the elderly (>60 years) and at-risk adults (18–59 years). VCR is low at approximately 2%. The first aim of this study was the evaluation of the burden of pneumococcal infections (pneumonia and bacteremia) from a public payer perspective in elderly and at-risk adults. The second aim was the evaluation of cost effectiveness of implementing a large PPV program in these populations. A decision tree model was employed using demographic and epidemiological inputs obtained from Turkish official sources and international literature. Vaccination was assumed to protect for 5 years with 60% and 50% effectiveness against BPP in elderly and at-risk adults respectively. Vaccination effectiveness of 21% against NBPP was assumed for both populations. Costs input were obtained from a previous study conducted between 2002 and 2008 in a public university hospital in Ankara, Turkey. Univariate sensitivity analyses and Monte-Carlo simulations were performed. The vaccination program was cost saving compared to no vaccination. Pneumococcal vaccination with 60% coverage led to a mean of 4,695 LYG in the elderly and 2,134 LYG in at-risk adults with 40% coverage. Mean incremental savings reached 45.4 million YTL in the elderly and 21.8 million YTL in at-risk adults. This analysis suggests that pneumococcal vaccination of elderly and at-risk adults is associated with a positive return on investment from a public payer perspective and supports the continued recommendation of pneumococcal vaccines, as well as their full funding in Turkey

The effect of physicians' awareness on influenza and pneumococcal vaccination rates and correlates of vaccination in patients with diabetes in Turkey An epidemiological Study "diaVAX"

We aimed to examine the effect of increased physician awareness on the rate and determinants of influenza and pneumococcal vaccinations in diabetic patients. Diabetic patients (n = 5682, mean [SD] age: 57.3 [11.6] years, 57% female) were enrolled by 44 physicians between Sept 2010 and Jan 2011. The physicians were initially questioned regarding vaccination practices, and then, they attended a training program. During the last five years, the physicians recommended influenza and pneumococcal vaccinations to 87.9% and 83.4% of the patients, respectively; however; only 27% of the patients received the influenza and 9.8% received the pneumococcal vaccines. One year after the training, the vaccination rates increased to 63.3% and 40.7%, respectively. The logistic regression models revealed that variables which increased the likelihood of having been vaccinated against influenza were: longer duration of diabetes, presence of hyperlipidemia and more use of concomitant medications whereas more use of anti-hyperglycemic medications was associated with increased odds of vaccination. On the other hand, older age, longer duration of diabetes and presence of a cardiovascular disease were variables which decreased the likelihood of having been vaccinated against pneumococcal disease during the past five years. However, during the study period, variables which decreased the odds of having been vaccinated included: older age and anti-hyperglycemic medications for influenza, and presence of hyperlipidemia and a family history of hypertension for pneumococcal disease. While variables which increased the likelihood of vaccination in the same period were: increased number of co-morbidities for influenza, and family history of diabetes for pneumococcal disease. We conclude that increased awareness of physicians may help improve vaccination rates against influenza and pneumococcal disease. However, diabetic patients with more severe health conditions are less likely to having been vaccinated. More structural/systematic vaccination programs are needed to increase the vaccination rates in patients with diabetes

Comparison of Intra-operative Pressure-Controlled Ventilation and Volume-Controlled Ventilation in Bariatric Surgery: A Prospective Randomized Study

Background: Mechanical ventilation may be particularly challenging in obese patients undergoing laparoscopic bariatric surgery. The present study aimed to compare the effects of pressure-controlled ventilation (PCV) with those of volume-controlled ventilation (VCV) on peripheral tissue oxygenation (PTO), respiratory function, hemodynamic status, and ventilation-related complications in patients undergoing laparoscopic bariatric surgery

Model structure.

<p>(A) Decision tree of patients with diabetes. The projected situation differs from the actual situation only in higher vaccination coverage. Each year, vaccinated and unvaccinated patients with diabetes in both situations have a specific risk of being infected by influenza, which depends on the attack rate and the vaccine effectiveness for those vaccinated. Decision nodes are indicated with squares, and chance nodes are indicated with circles. (B) Resource utilization pathway. GP, general practitioner.</p

Projected health outcomes and costs of different VCRs in Turkish adults with diabetes.

<p>Projected health outcomes and costs of different VCRs in Turkish adults with diabetes.</p

Probabilistic sensitivity analysis represented in a cost-effectiveness plane.

<p>Probabilistic sensitivity analysis using Monte Carlo simulation was performed to evaluate the impact of simultaneous variation of input parameters on the model outcomes. Outputs of 1000 simulations are presented in the cost-effectiveness plane. The black line represents a willingness-to-pay threshold of 21,511 Turkish Lira (TRY) (per capita gross domestic product) per quality-adjusted life year (QALY). Dots above the X-axis are very cost-effective (incremental cost-effectiveness ratio < per capita gross domestic product), those on the X-axis are cost-neutral (incremental cost-effectiveness ratio = 0), and those below the X-axis are cost-saving (incremental costs < TRY 0 are negative while incremental QALYs remain positive).</p

Deterministic sensitivity analysis.

<p>One-way deterministic sensitivity analysis was performed using the lower-bound (in gray) and upper-bound (in black) of parameters or, for cases where the upper- and lower-bounds were not set, a range of ± 20%. Abbreviations: TRY, Turkish Lira; QALY, quality-adjusted life years.</p

Input values.

<p>Input values.</p

Systemic Amelioration via Curcumin in Rats following Splenectomy: Lipid Profile, Endothelial and Oxidative Damage

Background We investigated the postsurgical effects of splenectomy with additional curcumin therapy, as an antioxidant, anti-inflammatory substance among the lipid profile and histopathological changes. Materials and Methods 32 rats were randomly divided into four groups: control group (L): laparotomy, sham group: splenectomy (S), splenectomy group treated with curcumin (SC) and splenectomy group treated with corn oil (SCO) for 28 days. The primary outcomes; total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), oxidized LDL (ox-LDL) very-low-density lipoprotein (VLDL) and lectin-type oxidized LDL receptor 1 (LOX-1), secondary outcomes: nuclear factor kappa B (NF-kB), malondialdehyde (MDA), glutathione peroxidase (GPx), superoxide dismutase (SOD) were measured. Histopathological changes were examined in vascular, intestinal and lung tissues. The analysis was performed by ANOVA. Results TG, LDL, ox-LDL, and LOX-1 elevated in S group while reduced by curcumin compared with L group (p < 0.05). Serum and tissue levels of NF-kB and MDA were higher in S group and lower in SC group than L group (p < 0.05). Serum and intestinal levels of SOD and GPx increased in L group while reduced by curcumin (p < 0.05). Total histopathological scores of intestinal tissues were higher in S and SCO groups compared to L and SC groups (p < 0.05). No major changes in vascular and lung tissues were observed except the lymphoid follicles which was higher in S and SCO groups compared to L and SC groups (p < 0.05). Conclusions Curcumin partially improved the lipid profile dysfunction by modulating NF-kB, MDA, SOD, and GPx in splenectomized rats while less likely improving any vascular and alveolar regeneration