Indirect costs of adult pneumococcal disease and the productivity-based rate of return to the 13-valent pneumococcal conjugate vaccine for adults in Turkey

Productivity benefits of health technologies are ignored in typical economic evaluations from a health payer’s perspective, risking undervaluation. We conduct a productivity-based cost-benefit analysis from a societal perspective and estimate indirect costs of adult pneumococcal disease, vaccination benefits from the adult 13-valent pneumococcal conjugate vaccine (PCV13 Adult), and rates of return to PCV13 Adult for a range of hypothetical vaccination costs. Our context is Turkey’s funding PCV13 for the elderly and for non-elderly adults with select comorbidities within the Ministry of Health’s National Immunization Program. We use a Markov model with one-year cycles. Indirect costs from death or disability equal the expected present discounted value of lifetime losses in the infected individual’s paid and unpaid work and in caregivers’ paid work. Vaccination benefits comprise averted indirect costs. Rates of return equal vaccination benefits divided by vaccination costs, minus one. Input parameters are from public data sources. We model comorbidities’ effects by scalar multiplication of the parameters of the general population. Indirect costs per treatment episode of inpatient community-acquired pneumonia (CAP), bacteremia, and meningitis - but not for outpatient CAP - approach or exceed Turkish per capita gross domestic product. Vaccination benefits equal $207.02 per vaccination in 2017 US dollars. The rate of return is positive for all hypothetical costs below this. Results are sensitive to herd effects from pediatric vaccination and vaccine efficacy rates. For a wide range of hypothetical vaccination costs, the rate of return compares favorably with those of other global development interventions with well-established strong investment cases

Economic Burden of Pneumococcal Infections in Children Under 5Years of Age

The present study aimed to determine the cost of childhood pneumococcal infections under 5years of age and to provide further data for future health economy studies. Electronic medical records of children diagnosed with meningitis caused by S. pneumoniae and all-cause pneumonia, and acute otitis media (AOM) between January 2013-April 2014 were retrospectively evaluated. Direct costs for the treatments of hospitalized patients (pneumonia and pneumococcal meningitis) including costs of healthcare services consisted of costs of hospital bed, examination, laboratory analyses, scanning methods, consultation, vascular access procedures, and infusion and intravenous treatments. Direct costs for patients (AOM) treated in outpatient setting included constant price paid for the examination and cost of prescribed antibiotics. Indirect costs included cost of work loss of parents and their transportation expenses. Data of 130 children with pneumococcal meningitis (n = 10), pneumonia (n = 53), and AOM (n = 67) were analyzed. The total median cost was Euro4,060.38 (direct cost: Euro3,346.38 and indirect cost: Euro829.18) for meningitis, Euro835.91 (direct cost: Euro480.66 and indirect cost: Euro330.09) for pneumonia, and Euro117.32 (direct cost: Euro17.59 and indirect cost: Euro99.73) for AOM. The medication cost (p = 0.047), indirect cost (p = 0.032), and total cost (p = 0.011) were significantly higher in pneumonia patients aged 36 months than those aged <36 months; however, direct cost of AOM were significantly higher in the patients aged <36 months (p = 0.049). Results of the present study revealed that the treatment cost was significantly enhanced for hospitalization and for advanced disease. Thus, preventive actions, mainly vaccination, should be conducted regularly.WoSScopu

Burden of community-acquired pneumonia in adults over 18 y of age

This study aimed to determine the economic burden and affecting factors in adult community-acquired pneumonia (CAP) patients (≥ 18 years) by retrospectively evaluating the data of 2 centers in Istanbul province, Turkey. Data of outpatients and inpatients with CAP from January 2013 through June 2014 were evaluated. The numbers of laboratory analyses, imaging, hospitalization days, and specialist visits were multiplied by the relevant unit costs and the costs of the relevant items per patient were obtained. Total medication costs were calculated according to the duration of use and dosage. The mean age was 61.56 ± 17.87 y for the inpatients (n = 211; 48.6% female) and 53.78 ± 17.46 y for the outpatients (n = 208; 46.4% male). The total mean cost was €556.09 ± 1,004.77 for the inpatients and €51.16 ± 40.92 for the outpatients. In the inpatients, laboratory, medication, and hospitalization costs and total cost were significantly higher in those ≥ 65 y than in those <65 y. Besides the hospitalization duration, specialist visit, imaging, laboratory, medication, and hospitalization costs and total cost were significantly higher in those hospitalized more than once than in those hospitalized once. While the specialist visit cost was higher in the inpatients with comorbidities, the imaging cost was higher in the outpatients with comorbidities. CAP poses a higher cost in inpatients, elders, and individuals with comorbidities. Costs can be decreased by rational decisions about hospitalization and antibiotic use according to the recommendations of guidelines and authorities. Vaccination may decrease medical burden and contribute to economy by preventing the disease, especially in risk groups

Winners and losers from sovereign debt inflows

Data de publicació electrónica: 08-02-2021We study the effects of sovereign debt inflows on domestic firms. To do so, we exploit episodes of large sovereign debt inflows, which follow the announcements of the inclusion of six emerging countries into major sovereign debt indexes. We find that these events reduce government bond yields, appreciate the domestic currency, and have heterogeneous stock-market effects on domestic firms. Firms operating in tradable industries experience lower returns than firms in non-tradable industries. In addition, financial firms, government-related firms, and firms that rely more on external financing experience higher returns. The effect on financial and government-related firms is stronger in countries that display larger reductions in government bond yields. The effect on tradable firms is stronger in countries that display stronger appreciations. We provide a stylized model that rationalizes these results. Our findings shed novel light on the channels through which sovereign debt inflows affect firms in emerging countries.Pandolfiand Williams acknowledge support from the Einaudi Institute for Economics and Finance (2017 EIEF research grant) and the Columbian College Facilitating Fund from George Washington University. Broner and Martin acknowledge support from the Spanish Ministry of Economy, Industry, and Competitiveness through the I + D Excelencia grant (ECO2016–79823-P), the Spanish Ministry of Science and Innovation through the Severo Ochoa Programme for Centers of Excellence in R&D grant (CEX2019–000915-S), the Generalitat de Catalunya (AGAUR grant 2017-SGR0–1393), the CERCA Programme/Generalitat de Catalunya, and the Barcelona GSE Research Network. Martin also acknowledges support from the European Research Council under EU Seventh Frame-work Programme (FP7/2007–2013) ERC Consolidator Grant (615651-MacroColl)