Maternal influenza vaccination relates to receiving relevant information among pregnant women in Japan

Maternal vaccination for seasonal influenza is currently not listed as a routine vaccination in the national vaccination schedule of Japan. However, many pregnant women voluntarily receive an influenza vaccination. We explored the factors related to influenza vaccine uptake. We particularly focused on factors related to any recommendation, such as advice or suggestions from another individual. We conducted a cross-sectional web-based questionnaire survey in Japan among pregnant women or mothers who had recently given birth in March 2017 and 2018. Logistic regression models were used to determine the factors influencing vaccination uptake. Key individuals regarding maternal vaccination were examined using the network visualization software Gephi. The total number of valid responses was 2204 in 2017 and 3580 in 2018. Over 40% of respondents had been vaccinated with the seasonal influenza vaccine at some point in both years. Of the vaccinated respondents, over 80% received advice regarding the influenza vaccination. Obstetricians were the most common source of advice in both years. Among respondents who chose more than two sources, the largest link in the network of sources was found between the obstetrician and family members. Attention to public concern or potential recommenders, by public health authorities, not just pregnant women, about the benefits of maternal influenza vaccination is important

Does subsidy work? Price elasticity of demand for influenza vaccination among the elderly in Japan

Objectives Subsidy for influenza vaccination is often provided to the elderly in order to encourage them to receive a flu shot in developed countries. However, its effect on uptake rate, i.e., price elasticity of demand, has not been well studied.Methods Japan's decentralised vaccination programme allows observation of various pairs in price and uptake rate of flu shots among the elderly by the municipality from 2001/2002 to 2004/2005 season. We combine our sample survey data (n = 281), which monitor price, subsidy and uptake rate, with published data on local characteristics in order to estimate price elasticity of demand with panel model.Results We find price elasticity of demand for influenza vaccine: nearly zero in nationwide, nearly zero in urban area, and -1.07 in rural area.Conclusions The results question the rationale for subsidy, especially in urban area. There are cases where maintaining or increasing the level of subsidy is not an efficient allocation of finite health care resources. When organising a vaccination programme, health manager should be careful about the balance between subsidy and other efforts in order to encourage the elderly to receive shots with price elasticity in mind.Demand Price elasticity Elderly Influenza Subsidy Vaccination

Demand for pneumococcal vaccination under subsidy program for the elderly in Japan

Abstract Background Vaccination programs often organize subsidies and public relations in order to obtain high uptake rates and coverage. However, effects of subsidies and public relations have not been studied well in the literature. In this study, the demand function of pneumococcal vaccination among the elderly in Japan is estimated, incorporating effects of public relations and subsidy. Methods Using a data from a questionnaire survey sent to municipalities, the varying and constant elasticity models were applied to estimate the demand function. The response variable is the uptake rate. Explanatory variables are: subsidy supported shot price, operating years of the program, target population size for vaccination, shot location intensity, income and various public relations tools. The best model is selected by c-AIC, and varying and constant price elasticities are calculated from estimation results. Results The vaccine uptake rate and the shot price have a negative relation. From the results of varying price elasticity, the demand for vaccination is elastic at municipalities with a shot price higher than 3,708 JPY (35.7 USD). Effects of public relations on the uptake rate are not found. Conclusions It can be suggested that municipalities with a shot price higher than 3,708 JPY (35.7 USD) could subsidize more and reduce price to increase the demand for vaccination. Effects of public relations are not confirmed in this study, probably due to measurement errors of variables used for public relations, and studies at micro level exploring individual’s response to public relations would be required.</p

Economic Evaluation of Immunisation Programme of 23-Valent Pneumococcal Polysaccharide Vaccine and the Inclusion of 13-Valent Pneumococcal Conjugate Vaccine in the List for Single-Dose Subsidy to the Elderly in Japan

<div><p>Background</p><p>Currently in Japan, both 23-valent pneumococcal polysaccharide vaccine (PPSV–23) and 13-valent pneumococcal conjugate vaccine (PCV–13) are available for the elderly for the prevention of <i>S</i>. <i>pneumoniae</i>-related diseases. PPSV–23 was approved in 1988, while the extended use of PCV–13 was approved for adults aged 65 and older in June 2014. Despite these two vaccines being available, the recently launched national immunisation programme for the elderly only subsidised PPSV–23. The framework of the current immunisation programme lasts for five years. The elderly population eligible for the subsidised PPSV–23 shot for the 1st year are those aged 65, 70, 75, 80, 85, 90, 95 and ≥100. While from the 2nd year to the 5th year, those who will age 65, 70, 75, 80, 85, 90, 95 and 100 will receive the same subsidised shot.</p><p>Methods</p><p>We performed economic evaluations to (1) evaluate the efficiency of alternative strategies of PPSV–23 single-dose immunisation programme, and (2) investigate the efficiency of PCV–13 inclusion in the list for single-dose pneumococcal vaccine immunisation programme. Three alternative strategies were created in this study, namely: (1) current PPSV–23 strategy, (2) 65 to 80 (as “65–80 PPSV–23 strategy”), and (3) 65 and older (as “≥65 PPSV–23 strategy”). We constructed a Markov model depicting the <i>S</i>. <i>pneumoniae</i>-related disease course pathways. The transition probabilities, utility weights to estimate quality adjusted life year (QALY) and disease treatment costs were either calculated or cited from literature. Cost of per shot of vaccine was ¥8,116 (US$74; US$1 = ¥110) for PPSV–23 and ¥10,776 (US$98) for PCV–13. The model runs for 15 years with one year cycle after immunisation. Discounting was at 3$45,682) per QALY gained. PCV–13 inclusion into the list for single-dose subsidy has an ICER of ¥377,000 (US$3,427) per QALY gained regardless of the PCV–13 diffusion level. These ICERs were found to be cost-effective since they are lower than the suggested criterion by WHO of three times GDP (¥11,000,000 or US$113,636 per QALY gained), which is the benchmark used in judging the cost-effectiveness of an immunisation programmne.</p><p>Conclusions</p><p>The results suggest that switching current PPSV–23 strategy to ≥65 PPSV–23 strategy or including PCV–13 into the list for single-dose subsidy to the elderly in Japan has value for money.</p></div

Cost-effectiveness acceptability curve (CEAC) of ≥65 PPSV–23 strategy vs. current PPSV–23 strategy.

<p>Cost-effectiveness acceptability curve (CEAC) of ≥65 PPSV–23 strategy vs. current PPSV–23 strategy.</p

Model inputs.

<p>^aOn Markov model, transition probabilities from health state A to health state B by ages were calculated as follows</p><p>From “Health” to “Bacteremia without pneumococcal pneumonia” = Annual incidence rate of IPD × Bacteremia without pneumococcal pneumonia among IPD cases</p><p>From “Health” to “Bacteremia with pneumococcal pneumonia” = Annual incidence rate of IPD × Bacteremia with pneumococcal pneumonia among IPD cases</p><p>From “Health” to “Meningitis” = Annual incidence rate of IPD × Meningitis among IPD cases</p><p>From “Health” to “Non-bacteremic pneumococcal pneumonia” = Annual incidence rate of CAP × CAP caused by <i>S</i>. <i>pneumoniae</i></p><p>Model inputs.</p

Results of probabilistic sensitivity analyses.

<p>(A) Scatter plot of incremental cost and incremental effectiveness per person of ≥65 PPSV–23 strategy vs. current PPSV–23 strategy and 65–80 PPSV–23 strategy vs. current PPSV–23 strategy. (B) Enlarged view of ≥65 PPSV–23 strategy vs. current PPSV–23 strategy. (C) Enlarged view of 65–80 PPSV–23 strategy vs. current PPSV–23 strategy.</p