Analysis of the profitability of adult vaccination in 13 private provider practices in the United States

Vaccination coverage among adults remains low in the United States. Understanding the barriers to provision of adult vaccination is an important step to increasing vaccination coverage and improving public health. To better understand financial factors that may affect practice decisions about adult vaccination, this study sought to understand how costs compared with payments for adult vaccinations in a sample of U.S. physician practices. We recruited a convenience sample of 19 practices in nine states in 2017. We conducted a time-motion study to assess the time costs of vaccination activities and conducted a survey of practice managers to assess materials, management, and dose costs and payments for vaccination. We received complete cost and payment data from 13 of the 19 practices. We calculated annual income from vaccination services by comparing estimated costs with payments received for vaccine doses and vaccine administration. Median annual total income from vaccination services was $90,343 at family medicine practices (range: $3968–$249,628), $28,267 at internal medicine practices (−$32,659–$141,034) and $2886 at obstetrics and gynecology practices (−$73,451–$23,820). Adult vaccination was profitable at the median of our sample, but there is wide variation in profitability due to differences in costs and payment rates across practices. This study provides evidence on the financial viability of adult vaccination and supports actions for improving financial viability. These results can help inform practices’ decisions whether to provide adult vaccines and contribute to keeping adults up-to-date with the recommended vaccination schedule.     

同感心护理对初产妇分娩结局及卫生经济学指标的影响

目的探讨同感心护理对初产妇分娩结局及卫生经济学指标的影响。方法将2013年11月至2014年4月产科收住的300例初产妇随机分为观察组150例和对照组150例。对观察组实施同感心护理,对照组实行传统护理。比较两组的分娩结局(包括分娩方式、总产程时间、产后2 h出血量及新生儿1 min Apgar评分)和卫生经济学指标(包括住院时间、住院费、药品费、检查费和治疗费)。结果 1观察组阴道分娩率高于对照组,差异具有统计学意义(P<0.05);观察组的总产程时间短于对照组,差异具有统计学意义(P<0.05);2观察组的住院费、药品费和治疗费均低于对照组,差异具有统计学意义(P<0.05)。结论同感心护理相对传统护理在一定程度上改善初产妇的分娩结局,节约了经济成本。     

企业员工职业成功与主观幸福感的关系

目的:了解企业员工职业成功及其各个维度与主观幸福感的关系。方法:利用《幸福感指数量表》的中文修订版,以及由徐娜编制的《中国职工职业生涯成功问卷》,对835名企业员工进行调查。结果:主观幸福感与职业成功及其各维度之间均存在显著正相关(P<0.001),其中,价值实现、经济成功和社会关系3个维度与幸福感的相关程度最高,并对幸福感具有显著的正向预测作用。此外,主观职业成功(F=25.738,P<0.001)和客观职业成功(F=50.082,P<0.001)分别对幸福感有显著影响。结论:企业员工的幸福感水平与职业成功息息相关。     

Regional status,epidemiology and impact of Taenia solium cysticercosis in Western and Central Africa

In West Africa, Taenia solium cysticercosis in both pigs and man has been reported in Benin, Burkina-Faso, Ghana, Ivory Coast, Senegal and Togo, and although official data are lacking, T. solium is anticipated to be present in most of the pig-raising regions of other West African countries as well. In some regions of Nigeria, the prevalence of porcine cysticercosis and human taeniosis is quite high (20.5 and 8.6%, respectively). Surprisingly, however, no cases of human cysticercosis have been reported, although epilepsy is very common. Large epidemiological surveys have only been carried out in Togo and Benin, where the prevalence of human cysticercosis was 2.4 and 1.3%, respectively. In Central Africa, porcine and human cysticercosis are (hyper)-endemic in Rwanda, Burundi, the Democratic Republic of Congo and Cameroon. The parasite also has been reported in pigs in Chad and Angola. Cysticercosis has been shown to be one of the major causes of epilepsy in Cameroon with figures as high as 44.6%. Cameroon is one of the few countries where the taeniosis-cysticercosis complex has been examined more in detail. In the Western province of Cameroon large scale surveys have shown that active cysticercosis is present in 0.4-3% of the local population and in 11% of the village pigs. However, the prevalence of adult T. solium was only 0.1%, which underscores the frequency of the T. solium paradox. Based on the available information, a very conservative economic estimate indicates that the annual losses due to porcine cysticercosis in 10 West and Central African countries amount to about 25 million Euro. The financial losses due to human cysticercosis are very difficult to estimate, but are certainly exceeded by the social impact of the disease, especially because of the particular perception of epilepsy in many African communities. It is concluded that the true prevalence of T. solium cysticercosis in pigs and humans in Central and West Africa remains underestimated because of unreliable slaughterhouse data and the lack of awareness and diagnostic facilities in the public health sector.     

Cost‐Effectiveness of a Biopsy‐Based 8‐Protein Prostate Cancer Prognostic Assay to Optimize Treatment Decision Making in Gleason 3 + 3 and 3 + 4 Early Stage Prostate Cancer

Background.

Many patients with Gleason 3 + 3 and 3 + 4 early stage prostate cancer receive invasive treatment but likely derive little or no benefit. A novel 8-protein prognostic assay generates a risk score at time of biopsy that is predictive of prostate cancer aggressiveness and can inform treatment decisions. The objective of this study was to evaluate the cost-effectiveness of using the assay to inform treatment decisions compared with usual care.

Patients and Methods.

We developed a simulation model to estimate quality-adjusted life-year (QALY) and cost outcomes for the 8-protein assay and usual care strategies. Risk classification outcomes, treatment distributions, costs, health state utilities, and mortality rates were derived from the assay’s validation study and the peer-reviewed literature. Outcomes included incremental QALYs, costs, and cost-effectiveness ratios. We conducted one-way and probabilistic sensitivity analyses to evaluate the most influential inputs and to explore joint uncertainty in outcomes, respectively.

Results.

The 8-protein assay strategy resulted in 0.04 more QALY and $700 less in costs compared with usual care (and thus was “dominant”). The cost-effectiveness of the assay strategy was most sensitive to the assay cost, the active surveillance health state utility, and the proportion of low-risk patients receiving active surveillance (vs. treatment) in usual care. In the probabilistic sensitivity analyses, the assay strategy decreased cost and increased QALYs in 86.9% and 58.3% of simulations, respectively.

Conclusion.

Assuming that ongoing prospective studies support the results of retrospective validation studies, the 8-protein prognostic assay strategy for prostate cancer is likely to be a cost-effective alternative to usual guideline-based care in biopsy Gleason 3 + 3 and 3 + 4 early stage prostate cancer.

Implications for Practice:

Prostate cancer prognostic assays such as the 8-protein assay can provide information about disease aggressiveness that may improve decisions about use of active surveillance versus invasive treatment in Gleason 3 + 3 and 3 + 4 disease. This study, the first cost-effectiveness evaluation of this type of assay reported in the peer-reviewed literature, found that the assay strategy is expected to result in increased quality-adjusted survival and decreased cost compared with usual care. The findings demonstrate the potential for prognostic assays to be dominant strategies in this clinical setting, in which many patients currently receive invasive treatment but derive limited clinical benefit.     

手术部位医院感染的危险因素及其所致经济损失的探索

目的了解胃肠外科发生外科手术部位感染(SSI)的危险因素,及其所致的直接经济损失,为医疗机构制定决策提供依据。 方法调取某院普外科2018年1月至5月实施胃、结肠和直肠手术的335例患者资料进行回顾性病例对照研究。根据配对条件比较发生SSI的患者(SSI组)与同期进行相同手术但未发生SSI的患者(对照组),分析SSI的危险致病因素以及住院总费用、各项费用的详细差异以及住院时间的差异。 结果本研究335例实施胃、结肠和直肠手术患者的SSI发病率为3.88%(13/335)。普通外科住院患者入院时的年龄、基础疾病数量、手术时间、术前合并其他感染、泌尿道插管等为发生SSI的危险因素。SSI组患者住院总费用高于对照组[20 912.8±2 772.8)元和(10 798.3±2 393.4)元],是对照组总费用的1.94倍,差异有统计学意义(P<0.05)。 结论患者年龄、基础疾病数量、手术时间、术前合并其他感染、泌尿道插管等为其发生SSI的危险因素,此外,SSI延长患者的住院天数,增加医疗费用,影响经济收入和医疗质量。     

Personalisation and the disability sector: What can health economics contribute to inform decision-making?

Consistent with policy reforms originating in the US, and subsequently adopted in the UK and Europe, the Australian disability sector is currently experiencing an era of unprecedented and transformative policy change towards personalisation and self-directed care. The National Disability Insurance Scheme (NDIS) introduces the use of personalised budgets, the main objective of which is to support the social and economic participation of people with disabilities. Against this background, this article discusses the potential for health economic techniques to be usefully applied in the disability sector from two main perspectives. Firstly, to apply an economic evaluation framework to generate an evidence base of the cost effectiveness of new and existing services and supports. Secondly, through the development and application of discrete choice experiments, a choice based method for building the knowledge and capacity of consumers to make informed preferences between alternative services and supports.     

Solutions to tackle the mental health consequences of the economic recession: A qualitative study integrating primary health care users and professionals’ perspectives

This qualitative study explores solutions proposed by primary health care users and professionals to address the consequences of the economic recession and austerity measures on populations' mental health and delivery of care in Portugal. Qualitative data were collected in three primary health care centres in the Lisbon Metropolitan Area. Five focus groups with 26 users and semistructured interviews with 27 health professionals were conducted. Interviews were audio-recorded, transcribed verbatim and underwent thematic analysis.Solutions proposed by users focused on improvements in accessibility and management of services, socioeconomic and living conditions, human resources for health, and investment in mental health. Health professionals focused on improvements in integration and articulation of services, infrastructure and structural barriers to primary care, recruitment and retention of human resources, and socioeconomic and living conditions. The themes from both groups were integrated and organized into three axes for action: 1) increasing investment and reversing austerity measures in health and social sectors; 2) coordination and integration of mental health care; and 3) tackling the social determinants of mental health.The findings provide an assessment of the needs and priorities set by primary health care users and professionals, reflecting their contextspecific experiences. These complementary perspectives highlight the need for inter-sectoral efforts in policy-making to improve delivery of care and to mitigate social inequalities in health across the Portuguese population.     

全球肺癌筛查卫生经济学研究的系统评价

目的 了解全球肺癌筛查的卫生经济学评价研究进展,为我国相关研究和筛查工作开展提供参考。方法 系统检索PubMed、EMbase、The Cochrane Library、中国知网及万方数据知识服务平台自建库至2018年6月30日间肺癌筛查卫生经济学研究相关文献,摘录其经济学评价方法及结果等信息,并进行质量评价。成本统一货币单位后计算增量成本效果比（ICER）后计算与当年当地人均GDP比值。结果 共纳入23项研究（1项基于人群随机对照试验,20项完全基于模型评价）,整体质量较好;22项来自发达国家,11项筛查起始年龄为55岁,18项目标人群考虑了吸烟史;评价的筛查技术全部涉及低剂量螺旋CT（LDCT）,筛查频率以每年1次（17项）和终生1次（7项）居多。22项研究可获得与未筛查相比的ICER,其中17项研究报道的ICER低于3倍当年当地人均GDP。各有15项和7项研究可获得每年1次和终生1次的ICER,其中各有12项和7项支持其经济有效,且终生1次略优于每年1次;不同筛查起始年龄和吸烟包年的经济有效性优劣差异不明显。结论 发达国家多开展基于模型LDCT肺癌筛查卫生经济学评价,并结合年龄和吸烟史进行高危人群选择,初步提示该方案经济有效;可为证据有限的欠发达地区提供参考,但实施需结合当地卫生资源现状;预算有限时低频次LDCT筛查更佳,而筛查起始年龄和吸烟史等细节确定需结合人群特征进行精准评价。     

Cost-effectiveness of Recombinant Zoster Vaccine (RZV) and Varicella Vaccine Live (VVL) against herpes zoster and post-herpetic neuralgia among adults aged 65 and over in Japan

BackgroundThe approval of the extended use of 1-dose varicella vaccine (VVL) in adults aged 50 and older against herpes zoster (HZ) in 2016 and the 2-dose recombinant zoster vaccine (RZV) in 2018 raised the need to evaluate the value for money between these two vaccines.MethodsWe conducted a cost-effectiveness analysis with Markov modelling to evaluate the efficiency of the immunisation programmes from payer’s perspective. Eight strategies with different ages to receive VVL or RZV were set, namely: 65–84 year old (y.o.), 70–84 y.o., 75–84 y.o., and 80–84 y.o. VVL- or RZV-strategy. Incremental cost-effectiveness ratios (ICERs) compared with curative care scenario were calculated. The health statuses following the target cohort were as follows: acute HZ followed by recovery, post-herpetic neuralgia followed by recovery, post HZ/PHN, recurrence of HZ, and general death.ResultsAt the vaccination cost ¥8000 (US$73) for 1-dose ZVL and ¥30,000 (US$273) for 2-dose RZV, ICERs ranged from ¥2,633,587/US$23,942 (age 80–84 y.o.) to ¥3,434,267 or US$31,221 (age 65–84 y.o.)/QALY gained for VVL-strategies; from ¥5,262,227 or US$47,838 (age 80–84 y.o.) to ¥6,278,557 or US$57,078/QALY gained (age 65–84 y.o.) for RZV-strategies. Cost-effectiveness acceptability curves derived from probabilistic sensitivity analyses showed that if the cost-effective threshold was at ¥3,000,000 or US$27,273/QALY, the acceptability was 90.7% and 8.8% for 65–84 VVL-strategy and 65–84 RZV-strategy, respectively; if at ¥5,000,000 or US$45,455/QALY, 56.2% and 43.8%, and if at ¥10,000,000 or US$90,909/QALY 11.9% and 88.1%, respectively.ConclusionVaccinating individuals aged 65–84 y.o., 70–84 y.o., 75–84 y.o., 80–84 y.o. with VVL or RZV to prevent HZ-associated disease in Japan can be cost-effective from payer’s perspective, with vaccination costs at ¥8,000 per shot for VVL, ¥30,000 for 2-dose RZV. While the results suggesting that only 65–84 VVL-strategy and 65–84 RZV strategy should be considered when introducing HZ immunisation programme. The optimal strategy varies depending on the willingness-to-pay threshold.