Creating a Minimum Data Set on ageing in sub-Saharan Africa

The World Health Organisation, together with representatives of four sub-Saharan African countries (Ghana, South Africa, Tanzania, Zimbabwe) and other stakeholders, launched a project in 1999 to establish a Minimum Data Set on ageing and older persons in Africa. The project focusses on identifying what data are needed to build knowledge on the situation of older Africans and forging the centralised, in-country collation and dissemination of this information. This paper summarises the current state of the project and touches on issues of data availability and quality, while exploring methods for data collection, integration, collation and dissemination

Burden of varicella in Central and Eastern Europe : findings from a systematic literature review

Funding Information: The authors take full responsibility for the scope, direction, and content of the manuscript, and have approved the submitted manuscript. Medical writing assistance was provided by Eleanor Finn of PAREXEL International and was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. The authors wish to thank the following for contributions in development of the manuscript: Barbara J. Kuter, PhD, MPH, Global Vaccines Medical Affairs, and Tracey J. Weiss, Center for Observational and Real-World Evidence (CORE), Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. Funding Information: The study was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. Funding Information: J. Wysocki received travel grants to attend international scientific conferences and fees for lectures from Pfizer and payment from a grant sponsored by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. I. Ivaskeviciene has received a USA travel grant to attend international scientific meeting, from Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth. M. Pokorn has received a research grant from Pfizer and payment for lectures from Pfizer, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA and GSK. L. Jancoriene has received travel grants to attend international scientific conferences and fees for lectures from Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, AbbVie and Pfizer and payment for a clinical study sponsored by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. J. Pluta and L.J. Wolfson are employees of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, and stockholders of Merck & Co., Inc., Kenilworth, NJ, USA. Publisher Copyright: © 2019, © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.Introduction: Vaccination against varicella rapidly reduces disease incidence, resulting in reductions in both individual burden and societal costs. Despite these benefits, there is no standardization of varicella immunization policies in Europe, including countries in Central and Eastern Europe (CEE). Areas covered: This systematic literature review identified publications on the epidemiology of varicella, its associated health and economic burden, and vaccination strategies within the CEE region, defined as Albania, Bosnia-Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Serbia, Slovakia, and Slovenia. Twenty-six studies were identified from a search of PubMed, Embase®, and MEDLINE® biomedical literature databases, supplemented by gray literature and country-specific/global websites. Expert commentary: Limited information exists in published studies on the burden of varicella in CEE. The wide variability in incidence rates between countries is likely explained by a lack of consistency in reporting systems. Funded universal varicella vaccination (UVV) in CEE is currently available only in Latvia as a one-dose schedule, but Hungary together with Latvia are introducing a two-dose strategy in 2019. For countries that do not provide UVV, introduction of vaccination is predicted to provide substantial reductions in cases and rates of associated complications, with important economic benefits.publishersversionPeer reviewe

Carga económica de la varicela en niños en Perú, entre 2011 y 2016

Objective: The purpose of this study was to evaluate the clinical and economic burden associated with varicella in Peru. Methods: This was a multicenter, retrospective chart review study of patients aged 1-14 years with a varicella diagnosis between 2011 and 2016. Healthcare resource utilization (HCRU) associated with varicella, unit costs, and work loss were used to estimate direct and indirect costs, presented in USD (). The cost and HCRU data was combined with estimates of varicella disease burden to estimate the overall annual costs of management of varicella in Peru. Results: A total of 179 children with varicella (101 outpatients, 78 inpatients) were included. Among outpatients, 5.9% experienced ≥1 complication, compared with 96.2% of inpatients. HCRU estimates included use of over-the-counter (OTC) medications (72.3% vs. 89.7% of outpatient and inpatients, respectively), prescription medications (30.7% vs. 94.9%), tests/procedures (0.0% vs. 80.8%). Among outpatients, direct and indirect costs per case were 36 and $62, respectively; among inpatients, respective costs were$548 and 222. The total annual cost associated with varicella was estimated at 13 907 146. Conclusion: Varicella is associated with substantial clinical complications and high HCRU in Peru, supporting the need for implementation of a routine childhood varicella vaccination plan.Objetivo: Describir las complicaciones mas frecuentes y la carga económica asociada con la varicela en el Perú. Material y métodos: Estudio multicéntrico de revisión de historias clínicas de pacientes de 1 a 14 años con diagnóstico de varicela entre 2011 y 2016. El uso de recursos de atención médica (URAM) asociados con la varicela, los costos unitarios y la pérdida de trabajo se utilizaron para estimar los costos directos e indirectos, presentados en USD (). Los datos de costos y URAM se combinaron con estimaciones de carga de enfermedad para calcular el costo total anual de la varicela en el Perú. Resultados: Se incluyeron un total de 179 niños con varicela (101  ambulatorios, 78  hospitalizados). Entre los pacientes ambulatorios, el 5,9 % presentó una o más complicaciones, en comparación con 96,2 % de pacientes hospitalizados. El URAM incluyó el uso de medicamentos de venta libre (72,3 % frente a 89,7 % de pacientes ambulatorios y hospitalizados, respectivamente), medicamentos con receta (30,7 % frente a 94,9 %) y análisis y procedimientos (0,0 % frente a 80,8 %). Los costos directos e indirectos por caso ambulatorio fueron 36 y $62 respectivamente y por caso hospitalizado fueron$548 y $222. El costo anual total asociado con la varicela se estimó en$13 907 146. Conclusión: La varicela está asociada con complicaciones clínicas importantes y elevado URAM en Perú, lo que respalda la necesidad de implementación de un plan de vacunación universal

Expected Utility as a Policy Making Tool: An Environmental Health Example

Statistical decision theory can be a valuable tool when considering the results of a statistical analysis for health policy decisions. In this paper, we review briefly the history of decision theory in statistics, and introduce methods for eliciting loss functions to be used when two parties with possibly conflicting interests need to reach a decision. We illustrate the methods with examples concerning public exposure to potential health risks from environmental contamination. 1 Introduction Decision-making under uncertainty has long been an aim of statistical inference. Much work has been done on quantifying uncertainty for the purpose of constructing statistical models of various phenomena. However, when it comes to translating those statistical models into the framework of making a decision that is optimal in some sense, the problem of accounting for the evaluation of intangibles, such as goodwill or a willingness to compromise, is very difficult. In 2 this paper, we discuss how B..

Bayesian Environmental Policy Decisions: Two Case Studies

Statistical decision theory can be a valuable tool for policy-making decisions. In particular, environmental problems often benefit from the application of Bayesian and decision-theoretic techniques that address the uncertain nature of problems in the environmental and ecological sciences. This paper discusses aspects of implementing statistical decision-making tools in situations where uncertainty is present, looking at issues such as elicitation of prior distributions, covariate allocation, formulation of loss functions, and minimization of expected losses subject to cooperation constraints. These ideas are illustrated through two case studies in environmental remediation

Incremental cost-effectiveness of supplementary immunization activities to prevent neonatal tetanus in Pakistan.

OBJECTIVE: This study aimed to estimate the incremental cost-effectiveness of supplementary immunization activities to prevent neonatal tetanus in the Loralai district of Pakistan. The supplemental immunization activities were carried out in two phases during 2001-03. METHODS: A state-transition model was used to estimate the effect of routine vaccination with tetanus toxoid as well as vaccination with tetanus toxoid during supplementary immunization activities.The model follows each woman in the target population from birth until the end of her childbearing years, using age-specific fertility data and vaccination history to determine the number of births at risk for neonatal tetanus. Recently published data on the incidence of neonatal tetanus from Loralai were used to determine the number of cases occurring with and without supplementary immunization activities. Data on the costs of the activities were collected from the UNICEF office in Balochistan and from the Provincial Health Department. FINDINGS: Using base-case assumptions we estimated that the supplementary immunization activities would prevent 280 cases of neonatal tetanus and 224 deaths from neonatal tetanus between 2001 and 2034. Implementation of the supplementary activities was relatively inexpensive. The cost per tetanus toxoid dose delivered was 0.40 U.S. dollars. In the base-case analysis the cost per death averted was 117.00 U.S. dollars (95% confidence interval (CI) = 78-205 U.S. dollars) and the cost per disability-adjusted life year (DALY) averted was 3.61 U.S. dollars (95% Cl = 2.43-6.39 U.S. dollars). CONCLUSION: Compared with similar analyses of other interventions, the cost per DALY averted is a favourable cost-effectiveness ratio. However, if routine diphtheria-tetanus-pertussis vaccination coverage in the Loralai district had been higher (at a coverage rate of about 80%) the cost-effectiveness of the intervention would have been even more favourable, at 2.65 U.S. dollars per DALY averted