Public health impact and return on investment of Belgium’s pediatric immunization program

ObjectiveWe evaluated the public health impact and return on investment of Belgium’s pediatric immunization program (PIP) from both healthcare-sector and societal perspectives.MethodsWe developed a decision analytic model for 6 vaccines routinely administered in Belgium for children aged 0–10 years: DTaP-IPV-HepB-Hib, DTaP-IPV, MMR, PCV, rotavirus, and meningococcal type C. We used separate decision trees to model each of the 11 vaccine-preventable pathogens: diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b, measles, mumps, rubella, Streptococcus pneumoniae, rotavirus, and meningococcal type C; hepatitis B was excluded because of surveillance limitations. The 2018 birth cohort was followed over its lifetime. The model projected and compared health outcomes and costs with and without immunization (based on vaccine-era and pre–vaccine era disease incidence estimates, respectively), assuming that observed reductions in disease incidence were fully attributable to vaccination. For the societal perspective, the model included productivity loss costs associated with immunization and disease in addition to direct medical costs. The model estimated discounted cases averted, disease-related deaths averted, life-years gained, quality-adjusted life-years gained, costs (2020 euros), and an overall benefit–cost ratio. Scenario analyses considered alternate assumptions for key model inputs.ResultsAcross all 11 pathogens, we estimated that the PIP prevented 226,000 cases of infections and 200 deaths, as well as the loss of 7,000 life-years and 8,000 quality-adjusted life-years over the lifetime of a birth cohort of 118,000 children. The PIP was associated with discounted vaccination costs of €91 million from the healthcare-sector perspective and €122 million from the societal perspective. However, vaccination costs were more than fully offset by disease-related costs averted, with the latter amounting to a discounted €126 million and €390 million from the healthcare-sector and societal perspectives, respectively. As a result, pediatric immunization was associated with overall discounted savings of €35 million and €268 million from the healthcare-sector and societal perspectives, respectively; every €1 invested in childhood immunization resulted in approximately €1.4 in disease-related cost savings to the health system and €3.2 in cost savings from a societal perspective for Belgium’s PIP. Estimates of the value of the PIP were most sensitive to changes in input assumptions for disease incidence, productivity losses due to disease-related mortality, and direct medical disease costs.ConclusionBelgium’s PIP, which previously had not been systematically assessed, provides large-scale prevention of disease-related morbidity and premature mortality, and is associated with net savings to health system and society. Continued investment in the PIP is warranted to sustain its positive public health and financial impact

0179: Polyphenol-rich blackcurrant juice induces NO-mediated relaxation in porcine coronary artery rings via a copper- and iron-dependent redox-sensitive activation of the Src/PI3-kinase/Akt/eNOS pathway

The beneficial cardiovascular effect of polyphenol-rich food and beverages has been attributed, at least in part, to the improvement of the vascular function through the induction of two major endothelial vasoprotective mechanisms. The aim of the present study is to determine whether a polyphenol-rich blackcurrant juice (PRBJ, 2.7g/l), improves the vasoprotective endothelial function, and, if so, to characterize the underlying mechanism. The reactivity of porcine coronary artery rings was assessed in organ chambers, and the expression and phosphorylation levels of proteins in cultured porcine coronary endothelial cells by Western blot analysis. PRBJ caused potent endotheliumdependent relaxations that were significantly reduced by an eNOS inhibitor, not affected by inhibition of endothelium-dependent hyperpolarization, and abolished by both treatments. PRBJ-induced NO-mediated relaxations were significantly reduced by chelators of either copper or iron, membrane permeant analogues of superoxide dismutase and catalase, inhibitors of either Src or PI3-kinase, and by calmidazolium, a calmodulin inhibitor. The NO-mediated relaxation was not affected by inhibitors of either PKC, EGFR, IGFR, or of several endogenous enzymes involved in the formation of ROS (NADPH oxidase, xanthine oxidase, mitochondrial respiration chain, cytochrome P450). In cultured endothelial cells, PRBJ increased the formation of NO as assessed by electron paramagnetic resonance spectroscopy. Moreover, PRBJ induced the phosphorylation of Akt and eNOS on activator sites, which were inhibited membrane permeant analogues of superoxide dismutase and catalase and inhibitors of either Src or PI3-kinase. PRBJ is a potent inducer of endothelium- dependent NO-mediated relaxations in porcine coronary artery rings. The NO-mediated relaxation involves an intracellular copper- and iron-dependent redox-sensitive activation the Src/PI3-kinase/Akt pathway leading to activation of eNOS and subsequent formation of NO

Public Health Impact and Return on Investment of Belgium’s Pediatric Immunization Program

info:eu-repo/semantics/publishe

Public health impact and return on investment of Belgium’s pediatric immunization program

Objective: We evaluated the public health impact and return on investment of Belgium’s pediatric immunization program (PIP) from both healthcare-sector and societal perspectives. Methods: We developed a decision analytic model for 6 vaccines routinely administered in Belgium for children aged 0–10 years: DTaP-IPV-HepB-Hib, DTaP-IPV, MMR, PCV, rotavirus, and meningococcal type C. We used separate decision trees to model each of the 11 vaccine-preventable pathogens: diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b, measles, mumps, rubella, Streptococcus pneumoniae, rotavirus, and meningococcal type C; hepatitis B was excluded because of surveillance limitations. The 2018 birth cohort was followed over its lifetime. The model projected and compared health outcomes and costs with and without immunization (based on vaccine-era and pre–vaccine era disease incidence estimates, respectively), assuming that observed reductions in disease incidence were fully attributable to vaccination. For the societal perspective, the model included productivity loss costs associated with immunization and disease in addition to direct medical costs. The model estimated discounted cases averted, disease-related deaths averted, life-years gained, quality-adjusted life-years gained, costs (2020 euros), and an overall benefit–cost ratio. Scenario analyses considered alternate assumptions for key model inputs. Results: Across all 11 pathogens, we estimated that the PIP prevented 226,000 cases of infections and 200 deaths, as well as the loss of 7,000 life-years and 8,000 quality-adjusted life-years over the lifetime of a birth cohort of 118,000 children. The PIP was associated with discounted vaccination costs of €91 million from the healthcare-sector perspective and €122 million from the societal perspective. However, vaccination costs were more than fully offset by disease-related costs averted, with the latter amounting to a discounted €126 million and €390 million from the healthcare-sector and societal perspectives, respectively. As a result, pediatric immunization was associated with overall discounted savings of €35 million and €268 million from the healthcare-sector and societal perspectives, respectively; every €1 invested in childhood immunization resulted in approximately €1.4 in disease-related cost savings to the health system and €3.2 in cost savings from a societal perspective for Belgium’s PIP. Estimates of the value of the PIP were most sensitive to changes in input assumptions for disease incidence, productivity losses due to disease-related mortality, and direct medical disease costs. Conclusion: Belgium’s PIP, which previously had not been systematically assessed, provides large-scale prevention of disease-related morbidity and premature mortality, and is associated with net savings to health system and society. Continued investment in the PIP is warranted to sustain its positive public health and financial impact.SCOPUS: ar.jinfo:eu-repo/semantics/publishe