Effect of breastfeeding promotion interventions on cost-effectiveness of rotavirus immunization in Indonesia

BACKGROUND: Rotavirus infection has been reported to be responsible for the majority of severe diarrhea in children under-5-years-old in Indonesia. Breast milk is considered to give protection against rotavirus infection. Increasing breastfeeding promotion programs could be an alternative target to reduce the incidence of rotavirus diarrhea. This study aims to investigate the effect of breastfeeding promotion interventions on cost-effectiveness of rotavirus immunization in Indonesia, focusing on breastfeeding education and support interventions.METHODS: An age-structured cohort model was developed for the 2011 Indonesia birth cohort. We compared four interventions in scenarios: (i) base-case (I₀) reflecting the current situation for the population of under-5-years-old, (ii) with an additional breastfeeding education intervention (I₁), (iii) with a support intervention on initiation and duration (I₂) and (iv) with both of these two interventions combined (I₃). The model applied a 5-years time horizon, with 1 month analytical cycles for children less than 1 year of age and annually thereafter. Monte Carlo simulations were used to examine the economic acceptability and affordability of rotavirus vaccination.RESULTS: Rotavirus immunization would effectively reduce severe cases of rotavirus during the first 5 years of a child's life even assuming various breastfeeding promotion interventions. The total yearly vaccine cost would amount to US$64 million under the market vaccine price. Cost-effectiveness would increase to US$ 153 per quality-adjusted-life-year (societal perspective) with an optimal breastfeeding promotion intervention. Obviously, this is much lower than the 2011 Gross Domestic Product (GDP) per capita of US$ 3,495. Affordability results showed that at the market vaccine price, rotavirus vaccination could be affordable for the Indonesian health system.CONCLUSIONS: Rotavirus immunization would be a highly cost-effective public health intervention for Indonesia even under various breastfeeding promotion interventions based on the WHO's criteria for cost-effectiveness in universal immunization.</p

Economic evaluations of non-traditional vaccinations in middle-income countries:Indonesia as a reference case

Ondanks toenemende economische welvaart zijn niet-traditionele vaccines nog steeds schaars in Indonesië en zijn er nog diverse uitdagingen voor brede introductie. Dit proefschrift presenteert een raamwerk voor beoordeling van dergelijke vaccins ter ondersteuning van de besluitvorming rond introductie, met rotavirus en hepatitis A vaccins als voorbeelden. Gegeven beperkte budgetten, is dergelijke introductie sterk afhankelijk van financiële arrangementen rondom immunisatie programma’s. Nieuwe bronnen van financiering zijn noodzakelijk om deze nieuwe vaccinatieprogramma’s te kunnen bestendigen. Transparante analyse van obstakels en adequate keuzes in fanianciële planning zijn daarbij cruciale aspecten, en zouden daarbij een integraal onderdeel moeten uitmaken van de planning van de EPI en de bijbehorende management in Indonesië

The impact of hospital surge capacity during the 2009 influenza pandemic on patient safety:A systematic review

During severe influenza pandemics, healthcare demand often exceeds clinical capacity forroutine care. This systematic study examined secondary and tertiary hospital surge capacityinterventions and outcomes during the H1N1 pandemic. We searched seven databases fororiginal research on hospital, acute, secondary, and tertiary patient safety outcomes duringthe 2009–2020 influenza pandemic. A descriptive narrative synthesis assessed influenza-related data. We used the JBI Critical Appraisal Checklist for Cross-Sectional Studies toevaluate each study’s methodology. The study found hospitals use various methods tomanage their workforce during an influenza pandemic. All hospitals’surge capacity plansmodified staff, resources, structure, and system which contributed to improve patient safety,patient and family satisfaction, fewer adverse events, shorter wait times, and better patientflow. Surge capacity strategies improved patient safety by influencing variables such asadverse events, patient and family satisfaction, wait times, and the number of patients wholeft without being seen. Thefindings highlight the significance of incorporating surgecapacity strategies into healthcare pandemic planning. However, more research in a varietyof settings and countries is required to strengthen the evidence bas

SATISFACTION LEVEL OF PATIENTS, PHYSICIANS, AND PRIVATE PRIMARY HEALTHCARE CENTER MANAGERS WITH CHRONIC DISEASE MANAGEMENT PROGRAM IN INDONESIA

Objective:Program PengelolaanPenyakitKronis (PROLANIS) or Chronic Disease Management Program (CDMP) is a healthcare system that was conducted by Healthcare and Social Security Agency in Indonesia to improve patients' quality of life. The objective of this study was to analyze level satisfaction of patients, physicians, and private Primary Healthcare Centers (PHCs) with this program, focusing on hypertension care.Methods:This study was conducted in 7 private PHCs in Bandung City, Indonesia. A cross sectional study was performed to measure patient satisfaction with PSQ-18 on 143 PROLANIS patients with hypertension. A total number of 8 physicians and 7 private PHC managers were involved in this study. Level satisfaction of physicians and private PHC managers were observed by using in-depth interviews.Results:The results showed that patient satisfaction was estimated to be 68.52±8.54, which could be interpreted that patient satisfy with PROLANIS. In-depth interviews showed that physicians did not satisfy with PROLANIS due to several factors (e.g., unintegrated prescription systems, lack of medicines, uncompleted laboratory facilities, lack of physicians, unintegrated referral services, and lack of collaboration between primary and secondary healthcare system). On the other hand, private PHC managers were quite satisfied with PROLANIS due to its linearity with other activities in private PHCs.Conclusion:Level satisfaction of patients with PROLANIS is quite good, while physicians might not satisfy with this program. In particular, private PHC managers confirmed that they are satisfied with this progra

Knowledge, acceptance and willingness to pay for Dengue vaccine in Yogyakarta and Jakarta

Despite the fact that Dengue Hemorrhagic Fever (DHF) is one of diseases with the highest incidence rate in Indonesia, its prevention strategies remain ineffective. One of the most cost-effective strategies to prevent DHF is through vaccination. This study aimed to investigate correlations between the knowledge of DHF, the behavior of DHF prevention and the knowledge of vaccine with the acceptance of dengue vaccine and willingness-to-pay (WTP) of dengue vaccine in Yogyakarta and Jakarta, Indonesia. A cross-sectional study was conducted by collecting data from people visiting primary healthcare centers (PHCs) through a valid and reliable questionnaire. A purposive sampling was applied, which resulted in 838 respondents among PHCs in Yogyakarta (two selected districts: Bantul and Kulon Progo) and Jakarta (two selected districts: West Jakarta and Central Jakarta). The result showed that the percentage of respondents who had good knowledge of vaccine was estimated to be 67-77% in all districts. The percentage of respondent who had good acceptance of vaccine was estimated to be 68-81%. WTP of dengue vaccine among respondents was estimated to be IDR 10,000-50,000. The result showed that the knowledge of DHF was significantly correlated (p&lt;0.05) with the acceptance of dengue vaccine in districts of West Jakarta, Bantul and Kulon Progo. In particular, the behavior of DHF prevention and the knowledge of dengue vaccine were significantly correlated (p&lt;0.05) with the acceptance of dengue vaccine in all districts. Additionally, the knowledge and acceptance of vaccine were significantly correlated (p&lt;0.05) with WTP in West Jakarta only. It can be concluded that correlation among variables in all districts are not the same. Hence, specific approach is required to be applied in each district

The Role of Administrative and Secondary Data in Estimating the Costs and Effects of School and Workplace Closures due to the COVID-19 Pandemic

As a part of mitigation strategies during a COVID-19 pandemic, the WHO currently recommends social distancing measures through school closures (SC) and work closures (WC) to control the infection spread and reduce the illness attack rate. Focusing on the use of administrative and secondary data, this study aimed to estimate the costs and effects of alternative strategies for mitigating the COVID-19 pandemic in Jakarta, Indonesia, by comparing the baseline (no intervention) with SC + WC for 2, 4, and 8 weeks as respective scenarios. A modified Susceptible-Exposed-Infected-Recovered (SEIR) compartmental model accounting for the spread of infection during the latent period was applied by taking into account a 1-year time horizon. To estimate the total pandemic cost of all scenarios, we took into account the cost of healthcare, SC, and productivity loss due to WC and illness. Next to costs, averted deaths were considered as the effect measure. In comparison with the baseline, the result showed that total savings in scenarios of SC + WC for 2, 4, and 8 weeks would be approximately $24 billion,$25 billion, and $34 billion, respectively. In addition, increasing the duration of SC and WC would increase the number of averted deaths. Scenarios of SC + WC for 2, 4, and 8 weeks would result in approximately 159,075, 173,963, and 250,842 averted deaths, respectively. A sensitivity analysis showed that the wage per day, infectious period, basic reproduction number, incubation period, and case fatality rate were found to be the most influential parameters affecting the savings and number of averted deaths. It can be concluded that all the mitigation scenarios were considered to be cost-saving, and increasing the duration of SC and WC would increase both the savings and the number of averted deaths

Impact of Switch Options on the Economics of Pneumococcal Conjugate Vaccine (PCV) Introduction in Indonesia

As one of Gavi, the Vaccine Alliance (previously the Global Alliance for Vaccines and Immunization), graduating countries, Indonesia is still eligible to access Gavi price for PCV13, PCV10 A and B. This study aims to estimate the economic impact of switch from the existing product/presentation of PCV (single-dose of PCV13) to the new product/presentation of PCV (multi-dose of PCV13, PCV10 A and B) since PCV is one of the most expensive vaccines in the Expanded Program on Immunization (EPI) schedule. Assuming that Gavi-Advance Market Commitment (AMC) price for all PCVs can be accessed in 2021, the use of multi-dose PCV13, PCV10 A and PCV10 B with Gavi-AMC price in 2021-2024 were considered as respective scenarios. The result showed that the scenario assuming the use of single-dose of PCV13 with contract price in 2019-2020 that would be switched into multi-dose of PCV10 B with Gavi-AMC price in 2021-2024 resulted in the highest potential saving, compared with other scenarios. Our analysis suggests an economic advantage to switch from single-dose into a multi-dose presentation. Vaccination coverage, vaccine price, vaccine wastage and additional Gavi-AMC vaccine costs were considered to be the most influential parameter affecting the savings in all scenarios. Applying the effectiveness of PCV13 and PCV10 A on reducing the risk for invasive pneumococcal disease (IPD), potential averted incidence of IPD in children under one year of age during 2019-2024 would be 246,164 and 105,587 in both scenarios. Despite the result confirmed that PCV13 may provide an additional benefit, a more comprehensive economic evaluation study is required to investigate further the comparison of cost-effectiveness values among all PCVs in Indonesia

Cost-Effectiveness Analysis of Spending on Research and Development to Address the Needs for Innovative Therapeutic Products in Indonesia

Background: The annual gross domestic expenditure on research and development (GERD) per capita of Indonesia ($24) remains relatively lower than the annual GERD per capita of neighboring countries, such as Vietnam ($36), Singapore ($1804), Malaysia ($361), and Thailand (111). Objective: The aim of this study was to conduct a cost-effectiveness analysis of spending on healthcare R&D to address the needs of developing innovative therapeutic products in Indonesia. Methods: A decision tree model was developed by taking into account four stages of R&D: stage 1 from raw concept to feasibility, stage 2 from feasibility to development, stage 3 from development to early commercialization, and stage 4 from early to full commercialization. Considering a 3-year time horizon, a stage-dependent success rate was applied and analyses were conducted from a business perspective. Two scenarios were compared by assuming the government of Indonesia would increase GERD in health and medical sciences up to 2- and 3-times higher than the baseline (current situation) for the first and second scenario, respectively. Cost per number of innovative products in health and medical sciences was considered as the incremental cost-effectiveness ratio (ICER). Univariate sensitivity analysis was conducted to investigate the effects of different input parameters on the ICER. Results: There was a statistically significant association (P-value<0.05) between countries' GERD in medical and health sciences with the number of innovative products. We estimated the ICER would be 8.50 million and $2.04 million per innovative product for the first and second scenario, respectively. The sensitivity analysis showed that the success rates in all stages and total GERD were the most influential parameters impacting the ICER. Conclusion: The result showed that there was an association between GERD in medical and health sciences with the number of innovative products. In addition, the second scenario would be more cost-effective than the first scenario