Health and economic outcomes of 20-valent pneumococcal conjugate vaccine compared to 15-valent pneumococcal conjugate vaccine strategies for adults in Greece

ObjectiveHigher valency pneumococcal conjugate vaccines (PCVs) are expected to improve protection against pneumococcal disease through coverage of additional serotypes. The aim of the present study was to evaluate the cost-effectiveness of 20-valent pneumococcal conjugate vaccine (PCV20) compared to 15-valent pneumococcal conjugate vaccine (PCV15) alone or followed by 23-valent polysaccharide vaccine (PPV23) for adults in Greece.MethodsA published Markov model was adapted to simulate lifetime risk of clinical and economic outcomes from the public payer’s perspective. The model population was stratified based on age and risk profile (i.e., low, moderate, or high-risk of developing pneumococcal disease). Epidemiologic parameters, serotype coverage and vaccines’ effectiveness were based on published literature, while direct medical costs (prices €, 2022) were obtained from official sources. Main model outcomes were projected number of invasive pneumococcal disease (IPD) and all-cause non-bacteremic pneumonia (NBP) cases and attributable deaths, costs and quality-adjusted life-years (QALY) for each vaccination strategy. Sensitivity analyses were performed to ascertain the robustness of model results.ResultsOver the modeled time horizon, vaccination with PCV20 compared to PCV15 alone or PCV15 followed by PPV23 prevents an additional 747 and 646 cases of IPD, 10,334 and 10,342 cases of NBP and 468 and 455 deaths respectively, resulting in incremental gain of 1,594 and 1,536 QALYs and cost savings of €11,183 and €48,858, respectively. PSA revealed that the probability of PCV20 being cost-effective at the predetermined threshold of €34,000 per QALY gained was 100% compared to either PCV15 alone or the combination of PCV15 followed by PPV23.ConclusionPCV20 is estimated to improve public health by averting additional pneumococcal disease cases and deaths relative to PCV15 alone or followed by PPV23, and therefore translates to cost-savings for the public payer. Overall results showed that vaccination with PCV20 was estimated to be a dominant vaccination strategy (improved health outcomes with reduced costs) over PCV15 alone or followed by PPV23 for prevention of pneumococcal disease in adults in Greece

Study of lung mechanics in benign upper airways stenosis

Background: Benign upper airways stenosis may relapse after initial management. Objectives: This study aimed to assess the value of dyspnea and spirometry in detecting relapse of stenosis in patients with benign upper airways stenosis, with the majority of patients presenting with post-intubation/post-tracheostomy tracheal stenosis. Methods: Patients with benign tracheal stenosis were evaluated following initial management, at regular follow-up and emergency visits, with the Medical Research Council (MRC) dyspnea scale, spirometry and flexible bronchoscopy. Patient visits were categorized and compared, in terms of change in clinical and functional parameters, in 2 groups: visits with relapse (case group) and visits with no relapse (control group). The ability of the MRC dyspnea scale and spirometry to predict relapse was evaluated. Results: Thirty-five patients with benign tracheal stenosis were included. Mean follow-up duration was 3.2 years (standard deviation = 3.3). Spirometry data were analyzed from 43 relapse visits (23 patients) versus 90 non-relapse visits. The MRC dyspnea score and most spirometric indices were associated with relapse. In the analysis with receiver operating characteristic (ROC) curves, forced expiratory volume in the first second (FEV1), forced expiratory flow when 25% of forced vital capacity has been expired (FEF25%), peak expiratory flow (PEF) and total peak flow (TPF, TPF = PEF + |PIF|) were superior to the MRC dyspnea score in predicting relapse. Among spirometric indices, >10.8% of PEF reduction has been a very sensitive and specific marker. Conclusions: This study supports the role of dyspnea and spirometry in monitoring benign upper airways stenosis, with spirometry predicting relapse even in clinically stable patients. PEF being a very sensitive index has the additional advantage of being assessed by a portable peak flow meter and could potentially be used for remote monitoring (telemedicine).Πλαίσιο: Οι καλοήθεις στενώσεις των μεγάλων αεραγωγών μπορεί να υποτροπιάσουν μετά την αρχική αντιμετώπιση. Στόχοι: Αυτή η μελέτη είχε σαν στόχο να εκτιμήσει την αξία της δύσπνοιας και της σπιρομέτρησης στην αναγνώριση υποτροπής της στένωσης σε ασθενείς με καλοήθη στένωση στους μεγάλους αεραγωγούς, στην πλειοψηφία τους ασθενείς με μετά διασωλήνωση/τραχειοστομία στένωση της τραχείας. Μέθοδοι: Ασθενείς με καλοήθη στένωση τραχείας εκτιμήθηκαν μετά την αρχική αντιμετώπισή τους, σε προγραμματισμένες και σε επείγουσες επισκέψεις, με την Medical Research Council (MRC) κλίμακα δύσπνοιας, με σπιρομέτρηση και με εύκαμπτη βρογχοσκόπηση. Οι επισκέψεις των ασθενών κατατάχθηκαν και συγκρίθηκαν, ως προς τη μεταβολή των κλινικών και λειτουργικών παραμέτρων, σε 2 ομάδες: επισκέψεις με υποτροπή (case group) και επισκέψεις χωρίς υποτροπή (control group). Εκτιμήθηκαν η ικανότητα της MRC κλίμακας δύσπνοιας και της σπιρομέτρησης για την πρόβλεψη της υποτροπής. Αποτελέσματα: Συμπεριελήφθησαν τριάντα πέντε ασθενείς με καλοήθη στένωση τραχείας. Η μέση διάρκεια παρακολούθησης ήταν 3,2 χρόνια (τυπική απόκλιση = 3,3). Αναλύθηκαν τα δεδομένα από 43 επισκέψεις με υποτροπή (23 ασθενείς) έναντι 90 επισκέψεων χωρίς υποτροπή. Ο βαθμός δύσπνοιας στην MRC κλίμακα και οι περισσότεροι σπιρομετρικοί δείκτες σχετίζονταν με την υποτροπή. Στην ανάλυση με καμπύλες λειτουργικού χαρακτηριστικού δέκτη (ROC), ο βίαια εκπνεόμενος όγκος στο 1ο δευτερόλεπτο (FEV1), η βίαια εκπνεόμενη ροή μετά την εκπνοή του 25% της βίαιης ζωτικής χωρητικότητας (FEF25%), η μέγιστη εκπνευστική ροή (PEF) και το άθροισμα των μέγιστων ροών (TPF, TPF = PEF + |PIF|) ήταν ανώτεροι του βαθμού δύσπνοιας στην MRC κλίμακα για την πρόβλεψη της υποτροπής. Μεταξύ των σπιρομετρικών δεικτών, η μείωση της PEF κατά >10,8% ήταν πολύ ευαίσθητος και ειδικός δείκτης. Συμπεράσματα: Αυτή η μελέτη υποστηρίζει το ρόλο της δύσπνοιας και της σπιρομέτρησης στην παρακολούθηση της καλοήθους στένωσης των μεγάλων αεραγωγών, με τη σπιρομέτρηση να έχει τη δυνατότητα να προβλέπει την υποτροπή ακόμα και σε κλινικά σταθερούς ασθενείς. Η PEF ούσα ένας πολύ ευαίσθητος δείκτης έχει το επιπρόσθετο πλεονέκτημα ότι μπορεί να εκτιμηθεί με ένα φορητό ροόμετρο και μπορεί να χρησιμοποιηθεί για εξ αποστάσεως παρακολούθηση (τηλεϊατρική)

Μελέτη της μηχανικής της αναπνοής σε καλοήθεις στενώσεις των μεγάλων αεραγωγών

Πλαίσιο: Οι καλοήθεις στενώσεις των μεγάλων αεραγωγών μπορεί να υποτροπιάσουν μετά την αρχική αντιμετώπιση. Στόχοι: Αυτή η μελέτη είχε σαν στόχο να εκτιμήσει την αξία της δύσπνοιας και της σπιρομέτρησης στην αναγνώριση υποτροπής της στένωσης σε ασθενείς με καλοήθη στένωση στους μεγάλους αεραγωγούς, στην πλειοψηφία τους ασθενείς με μετά διασωλήνωση/τραχειοστομία στένωση της τραχείας. Μέθοδοι: Ασθενείς με καλοήθη στένωση τραχείας εκτιμήθηκαν μετά την αρχική αντιμετώπισή τους, σε προγραμματισμένες και σε επείγουσες επισκέψεις, με την Medical Research Council (MRC) κλίμακα δύσπνοιας, με σπιρομέτρηση και με εύκαμπτη βρογχοσκόπηση. Οι επισκέψεις των ασθενών κατατάχθηκαν και συγκρίθηκαν, ως προς τη μεταβολή των κλινικών και λειτουργικών παραμέτρων, σε 2 ομάδες: επισκέψεις με υποτροπή (case group) και επισκέψεις χωρίς υποτροπή (control group). Εκτιμήθηκαν η ικανότητα της MRC κλίμακας δύσπνοιας και της σπιρομέτρησης για την πρόβλεψη της υποτροπής. Αποτελέσματα: Συμπεριελήφθησαν τριάντα πέντε ασθενείς με καλοήθη στένωση τραχείας. Η μέση διάρκεια παρακολούθησης ήταν 3,2 χρόνια (τυπική απόκλιση = 3,3). Αναλύθηκαν τα δεδομένα από 43 επισκέψεις με υποτροπή (23 ασθενείς) έναντι 90 επισκέψεων χωρίς υποτροπή. Ο βαθμός δύσπνοιας στην MRC κλίμακα και οι περισσότεροι σπιρομετρικοί δείκτες σχετίζονταν με την υποτροπή. Στην ανάλυση με καμπύλες λειτουργικού χαρακτηριστικού δέκτη (ROC), ο βίαια εκπνεόμενος όγκος στο 1ο δευτερόλεπτο (FEV1), η βίαια εκπνεόμενη ροή μετά την εκπνοή του 25% της βίαιης ζωτικής χωρητικότητας (FEF25%), η μέγιστη εκπνευστική ροή (PEF) και το άθροισμα των μέγιστων ροών (TPF, TPF = PEF + |PIF|) ήταν ανώτεροι του βαθμού δύσπνοιας στην MRC κλίμακα για την πρόβλεψη της υποτροπής. Μεταξύ των σπιρομετρικών δεικτών, η μείωση της PEF κατά >10,8% ήταν πολύ ευαίσθητος και ειδικός δείκτης. Συμπεράσματα: Αυτή η μελέτη υποστηρίζει το ρόλο της δύσπνοιας και της σπιρομέτρησης στην παρακολούθηση της καλοήθους στένωσης των μεγάλων αεραγωγών, με τη σπιρομέτρηση να έχει τη δυνατότητα να προβλέπει την υποτροπή ακόμα και σε κλινικά σταθερούς ασθενείς. Η PEF ούσα ένας πολύ ευαίσθητος δείκτης έχει το επιπρόσθετο πλεονέκτημα ότι μπορεί να εκτιμηθεί με ένα φορητό ροόμετρο και μπορεί να χρησιμοποιηθεί για εξ αποστάσεως παρακολούθηση (τηλεϊατρική).Background: Benign upper airways stenosis may relapse after initial management. Objectives: This study aimed to assess the value of dyspnea and spirometry in detecting relapse of stenosis in patients with benign upper airways stenosis, with the majority of patients presenting with post-intubation/post-tracheostomy tracheal stenosis. Methods: Patients with benign tracheal stenosis were evaluated following initial management, at regular follow-up and emergency visits, with the Medical Research Council (MRC) dyspnea scale, spirometry and flexible bronchoscopy. Patient visits were categorized and compared, in terms of change in clinical and functional parameters, in 2 groups: visits with relapse (case group) and visits with no relapse (control group). The ability of the MRC dyspnea scale and spirometry to predict relapse was evaluated. Results: Thirty-five patients with benign tracheal stenosis were included. Mean follow-up duration was 3.2 years (standard deviation = 3.3). Spirometry data were analyzed from 43 relapse visits (23 patients) versus 90 non-relapse visits. The MRC dyspnea score and most spirometric indices were associated with relapse. In the analysis with receiver operating characteristic (ROC) curves, forced expiratory volume in the first second (FEV1), forced expiratory flow when 25% of forced vital capacity has been expired (FEF25%), peak expiratory flow (PEF) and total peak flow (TPF, TPF = PEF + |PIF|) were superior to the MRC dyspnea score in predicting relapse. Among spirometric indices, >10.8% of PEF reduction has been a very sensitive and specific marker. Conclusions: This study supports the role of dyspnea and spirometry in monitoring benign upper airways stenosis, with spirometry predicting relapse even in clinically stable patients. PEF being a very sensitive index has the additional advantage of being assessed by a portable peak flow meter and could potentially be used for remote monitoring (telemedicine)

Estimating the Clinical and Economic Impact of Switching from the 13-Valent Pneumococcal Conjugate Vaccine (PCV13) to Higher-Valent Options in Greek Infants

In June 2010, Greece introduced the 13-valent pneumococcal conjugate vaccine (PCV13) for pediatric vaccination and has since observed a large decrease in pneumococcal disease caused by these vaccine serotypes, yet the disease prevalence of non-vaccine serotypes has increased. Two higher-valent conjugate vaccines, a 15-valent (PCV15) and a 20-valent (PCV20), were developed to improve serotype coverage and combat serotype replacement. A decision-analytic model was adapted to the Greek setting using historical pneumococcal disease trends from PCV13 to forecast future clinical and economic outcomes of higher-valent PCVs over a 10-year period (2023–2033). The model estimated outcomes related to invasive pneumococcal disease (IPD), hospitalized and non-hospitalized pneumonia, and otitis media (OM) resulting from a switch in vaccination programs to PCV15 in 2023 or switching to PCV20 in 2024. Cost-effectiveness was evaluated from the third-party payer’s perspective in the Greek healthcare system. Compared to implementing PCV15 one year earlier, switching from PCV13 to PCV20 in 2024 was estimated to be a cost-saving strategy by saving the Greek health system over EUR 50 million in direct medical costs and averting over 250 IPD cases, 54,800 OM cases, 8450 pneumonia cases, and 255 deaths across all ages over a 10-year period

Burden of pneumococcal disease among adults in Southern Europe (Spain, Portugal, Italy, and Greece): a systematic review and meta-analysis

The aim was to summarize pneumococcal disease burden data among adults in Southern Europe and the potential impact of vaccines on epidemiology. Of 4779 identified studies, 272 were selected. Invasive pneumococcal disease (IPD) incidence was 15.08 (95% CI 11.01–20.65) in Spain versus 2.56 (95% CI 1.54–4.24) per 100,000 population in Italy. Pneumococcal pneumonia incidence was 19.59 (95% CI 10.74–35.74) in Spain versus 2.19 (95% CI 1.36–3.54) per 100,000 population in Italy. Analysis of IPD incidence in Spain comparing pre-and post- PCV7 and PCV13 periods unveiled a declining trend in vaccine-type IPD incidence (larger and statistically significant for the elderly), suggesting indirect effects of childhood vaccination programme. Data from Portugal, Greece and, to a lesser extent, Italy were sparse, thus improved surveillance is needed. Pneumococcal vaccination uptake, particularly among the elderly and adults with chronic and immunosuppressing conditions, should be improved, including shift to a higher-valency pneumococcal conjugate vaccine when available

The Value of Dyspnea and Spirometry in Detecting Relapse of Benign Tracheal Stenosis

Background: Benign tracheal stenosis may relapse after management. Objectives: This study aimed to assess the value of dyspnea and spirometry in detecting relapse of benign tracheal stenosis. Methods: Patients with benign tracheal stenosis were evaluated post-management, at regular follow-up and emergency visits, with the Medical Research Council (MRC) dyspnea scale, spirometry, and flexible bronchoscopy. Patient visits were categorized and compared, in terms of change in clinical and functional parameters, in 2 groups: visits with relapse (case group) and visits with no relapse (control group). The ability of the MRC dyspnea scale and spirometry to predict relapse was evaluated. Results: Thirty-five patients with benign tracheal stenosis were included. Mean follow-up duration was 3.2 years (standard deviation = 3.3). Spirometry data were analyzed from 43 relapse visits (23 patients) versus 90 nonrelapse visits. The MRC dyspnea score and most spirometric indices were associated with relapse. In the receiver operating characteristic analysis, forced expiratory volume in 1 s, forced expiratory flow when 25% of forced vital capacity has been expired, peak expiratory flow (PEF), and total peak flow were superior to the MRC dyspnea score in predicting relapse. Among spirometric indices, >10.8% of PEF reduction has been very sensitive and specific. Conclusions: This study supports the role of dyspnea and spirometry in monitoring benign tracheal stenosis, with spirometry predicting relapse even in clinically stable patients. PEF being a very sensitive index has the additional advantage of being assessed by peak flow meter and could potentially be used for remote monitoring

Pneumococcal serotypes in adults hospitalized with community-acquired pneumonia in Greece using urinary antigen detection tests: the EGNATIA study, November 2017 – April 2019

Greece introduced a 13-valent pneumococcal conjugate vaccine (PCV13) into the infant national immunization program in 2010 (3 + 1 schedule until June 2019). Since 2015, PCV13 has been recommended for adults aged 19–64 years with comorbidities and adults ≥65 years sequentially with 23-valent pneumococcal polysaccharide vaccine (PPSV23). We examined pneumococcal serotype distribution among Greek adults aged ≥19 years hospitalized with community-acquired pneumonia (CAP) during November 2017-April 2019. This was an interim analysis of EGNATIA, a prospective study of adult hospitalized CAP in the cities of Ioannina and Kavala. Pneumococcus was identified using cultures, BinaxNow®, serotype-specific urinary antigen detection assays (UAD-1/2). Our analysis included overall 482 hospitalized CAP patients (mean age: 70.5 years; 56.4% male). 53.53% of patients belonged to the highest pneumonia severity index (PSI) classes (IV-V). Pneumococcus was detected in 65 (13.5%) patients, with more than half (57%) of cases detected only by UAD. Approximately two-thirds of pneumococcal CAP occurred in those aged ≥65 years (n = 40, 8.3% of CAP). More than half of pneumococcal CAP (n = 35, 53.8%) was caused by PCV13 serotypes. Most frequently detected PCV13 serotypes were 3, 19A, 23F, collectively accounting for 83% of PCV13 vaccine-type (VT) CAP and 6% of all-cause CAP. Overall, 82.9% of PCV13 VT CAP occurred among persons with an indication (age/risk-based) for PCV13 vaccination. Even with a mature PCV13 childhood immunization program, a persistent burden of PCV13 VT CAP exists in Greek adults. Strategies to increase PCV13 (and higher-valency PCVs, when licensed) coverage in adults should be implemented to reduce the disease burden