Cost effectiveness of pediatric pneumococcal conjugate vaccines: a comparative assessment of decision-making tools

BACKGROUND: Several decision support tools have been developed to aid policymaking regarding the adoption of pneumococcal conjugate vaccine (PCV) into national pediatric immunization programs. The lack of critical appraisal of these tools makes it difficult for decision makers to understand and choose between them. With the aim to guide policymakers on their optimal use, we compared publicly available decision-making tools in relation to their methods, influential parameters and results. METHODS: The World Health Organization (WHO) requested access to several publicly available cost-effectiveness (CE) tools for PCV from both public and private provenance. All tools were critically assessed according to the WHO's guide for economic evaluations of immunization programs. Key attributes and characteristics were compared and a series of sensitivity analyses was performed to determine the main drivers of the results. The results were compared based on a standardized set of input parameters and assumptions. RESULTS: Three cost-effectiveness modeling tools were provided, including two cohort-based (Pan-American Health Organization (PAHO) ProVac Initiative TriVac, and PneumoADIP) and one population-based model (GlaxoSmithKline's SUPREMES). They all compared the introduction of PCV into national pediatric immunization program with no PCV use. The models were different in terms of model attributes, structure, and data requirement, but captured a similar range of diseases. Herd effects were estimated using different approaches in each model. The main driving parameters were vaccine efficacy against pneumococcal pneumonia, vaccine price, vaccine coverage, serotype coverage and disease burden. With a standardized set of input parameters developed for cohort modeling, TriVac and PneumoADIP produced similar incremental costs and health outcomes, and incremental cost-effectiveness ratios. CONCLUSIONS: Vaccine cost (dose price and number of doses), vaccine efficacy and epidemiology of critical endpoint (for example, incidence of pneumonia, distribution of serotypes causing pneumonia) were influential parameters in the models we compared. Understanding the differences and similarities of such CE tools through regular comparisons could render decision-making processes in different countries more efficient, as well as providing guiding information for further clinical and epidemiological research. A tool comparison exercise using standardized data sets can help model developers to be more transparent about their model structure and assumptions and provide analysts and decision makers with a more in-depth view behind the disease dynamics. Adherence to the WHO guide of economic evaluations of immunization programs may also facilitate this process. Please see related article: http://www.biomedcentral.com/1741-7007/9/55

Meningococcal disease in North America: Updates from the Global Meningococcal Initiative

This review summarizes the recent Global Meningococcal Initiative (GMI) regional meeting, which explored meningococcal disease in North America. Invasive meningococcal disease (IMD) cases are documented through both passive and active surveillance networks. IMD appears to be decreasing in many areas, such as the Dominican Republic (2016: 18 cases; 2021: 2 cases) and Panama (2008: 1 case/100,000; 2021: <0.1 cases/100,000); however, there is notable regional and temporal variation. Outbreaks persist in at-risk subpopulations, such as people experiencing homelessness in the US and migrants in Mexico. The recent emergence of β-lactamase-positive and ciprofloxacin-resistant meningococci in the US is a major concern. While vaccination practices vary across North America, vaccine uptake remains relatively high. Monovalent and multivalent conjugate vaccines (which many countries in North America primarily use) can provide herd protection. However, there is no evidence that group B vaccines reduce meningococcal carriage. The coronavirus pandemic illustrates that following public health crises, enhanced surveillance of disease epidemiology and catch-up vaccine schedules is key. Whole genome sequencing is a key epidemiological tool for identifying IMD strain emergence and the evaluation of vaccine strain coverage. The Global Roadmap on Defeating Meningitis by 2030 remains a focus of the GMI.Medical writing support for the development of this manuscript, under the direction of the authors, was provided Matthew Gunther of Ashfield MedComms, an Inizio company. Medical writing support was funded by Sanofi Pasteur. All authors discussed and agreed to the objectives of this manuscript and con- tributed throughout its production. All authors read and approved the final manuscript.S

Perinatal Health in Belgium - An Introduction

The objectives of this special issue are reviewed. The principle aim is to discuss the relatively high perinatal mortality rate observed in Belgium. Belgian perinatal mortality is higher than that of Japan and very close to that of the USA, even though Belgium has fewer low-birthweight newborns and teenage pregnancies than the USA. This introduction also briefly describes the general organization of the Belgian health care system

Perinatal Morbidity in Belgium

This paper reviews the results of published and unpublished epidemiological studies on perinatal morbidity in Belgium. The most frequently studied variables are birthweight and gestational age, which are not only morbidity indicators but also morbidity and mortality predictors. Congenital anomalies are studied in Belgium through the results gathered by two regional birth defects registries, which have been operating since 1979. Major results of these registries are presented and discussed with relation to their implications on prevention policy. Subjective and reported health indicators are less commonly available for epidemiological studies, although some were collected in an interview survey conducted in 1981 in three districts of Wallonia. The results show important social inequalities and geographical disparities. Finally, the long-term consequences of perinatal problems are presented and discussed. A prospective study conducted at Leuven University Hospital on infants born between 1981 and 1986 suggests that improving survival of low-birthweight infants with appropriate perinatal care will not increase the number of handicapped children.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Trends of Hepatitis A hospitalization and risk factors in Quebec, Canada, between 1990 and 2003

<p>Abstract</p> <p>Background</p> <p>In Canada, targeted vaccination of at risk groups for hepatitis A (HA) is done since the mid 1990s resulting in declining incidence. This study estimated the year and age specific hospitalization rates and distribution of risk factors for HA in Quebec, Canada, between 1990 and 2003.</p> <p>Methods</p> <p>Records of patients hospitalized with HA-related diagnostic codes were retrieved from the provincial database. Hospital charts of all deceased cases and a random sample of all other records were reviewed.</p> <p>Results</p> <p>From 1503 hospitalization records, 573 charts were reviewed including 49 (91%) of the 54 deceased patients. Confirmed acute HA was present in 79% of records where HA was the primary diagnosis, and in 3%–8% of records where HA was a secondary diagnosis. From the total estimated number of hospitalizations, 96% had HA as the primary diagnosis. The hospitalization rate decreased from 1.06 per 100 000 person-years between 1990 and 1997 to 0.36 between 1998 and 2003. During the study period, 54% HA hospitalizations were in 20–39 year-olds. The overall case fatality ratio among hospitalized patients was 1.4%, increasing from 0.4% in those < 40 years old to 12.5% in those ≥60 years. By decreasing order, reported risk factors were travel to HA endemic countries (30%), MSM (18%) and household contacts (11%).</p> <p>Conclusion</p> <p>HA hospitalization rates have been low since 1998 but the cause of this is unclear given the cyclical pattern of HA. Travel to endemic countries remains the most important risk factor and improved control of HA will require better strategies to vaccinate travelers.</p

Public health in the Canadian Arctic: Contributions from International Polar Year research

The contributions of several IPY health projects are highlighted in the context of population health indicators for Inuit Nunangat. Food and housing are two critical social determinants of health contributing to health issues on many levels. The nutritional deficit associated with food insecurity and the transition away from traditional and towards market foods represents a dual risk with profound consequences. Knowledge of the physiological benefits associated with traditional food consumption is increasing, including for mental health and chronic disease. Ensuring the safety of traditional foods in terms of zoonotic diseases is thus highly valuable and efforts to institute adequate monitoring and address knowledge gaps are underway. Acute respiratory disease among the young remains a significant public health issue with potential long term effects. The human papilloma virus is manifesting itself among women across northern Canada with high risk types that are more similar to profiles observed in Europe than in North America with possible implications for immunization programs. Despite a high prevalence of Hepatitis B virus infections among residents of Inuit Nunangat, the outcomes appear to be relatively beni