A cost-effectiveness analysis of a 10-valent pneumococcal conjugate vaccine in children in six Latin American countries

Background

A recently developed 10-valent pneumococcal non-typeable H influenzae protein D-conjugate vaccine (PHiD-CV) is expected to afford protection against more than two thirds of isolates causing IPD in children in Latin America, and also against acute otitis media caused by both Spn and NTHi. The objective of this study is to assess the cost-effectiveness of PHiD-CV in comparison to non-vaccination in children under 10 years of age in Argentina, Brazil, Chile, Colombia, Mexico and Peru.

Methods

We used a static, deterministic, compartmental simulation model. The dosing regimen considered included three vaccine doses (at 2 months, 4 months and 6 months) and a booster dose (at 13 months) (3?+?1 schedule). Model outcomes included number of cases prevented, deaths averted, quality-adjusted life-years (QALYs) gained and costs. Discount for costs and benefits of long term sequelae was done at 3.5%, and currency reported in 2008-2009 U$S varying between countries.

Results

The largest effect in case prevention was observed in pneumococcal meningitis (from 27% in Peru to 47% in Colombia), neurologic sequelae after meningitis (from 38% in Peru to 65% in Brazil) and bacteremia (from 42% in Argentina to 49% in Colombia). The proportion of predicted deaths averted annually ranged from 18% in Peru to 33% in Brazil. Overall, the health benefits achieved with PHiD-CV vaccination resulted in a lower QALY loss (from 15% lower in Peru to 26% in Brazil). At a cost of USD 20 per vaccine dose, vaccination was cost-effective in all countries, from being cost saving in Chile to a maximum Incremental Cost-effectiveness Ratio of 7,088 US$ Dollars per QALY gained. Results were robust in the sensitivity analysis, and scenarios with indirect costs affected results more than those with herd immunity.

Conclusions

The incorporation of the 10-valent pneumococcal conjugate vaccine into routine infant immunization programs in Latin American countries could be a cost-effective strategy to improve infant population health in the region.

     

Achieving high uptake of human papillomavirus vaccination in Malaysia through school-based vaccination programme

Background

In 2006, 4 years of planning was started by the Ministry of Health, Malaysia (MOH), to implement the HPV (human papillomavirus) vaccination programme. An inter-agency and multi-sectoral collaborations were developed for Malaysia’s HPV school-based immunisation programme. It was approved for nationwide school base implementation for 13-year-old girls or first year secondary students in 2010. This paper examines how the various strategies used in the implementation over the last 7?years (2010–2016) that unique to Malaysia were successful in achieving optimal coverage of the target population.

Methods

Free vaccination was offered to school girls in secondary school (year seven) in Malaysia, which is usually at the age of 13 in the index year. All recipients of the HPV vaccine were identified through school enrolments obtained from education departments from each district in Malaysia. A total of 242,638 girls aged between 12 to 13?years studying in year seven were approached during the launch of the program in 2010. Approximately 230,000 girls in secondary schools were offered HPV vaccine per year by 646 school health teams throughout the country from 2010 to 2016.

Results

Parental consent for their daughters to receive HPV vaccination at school was very high at 96–98% per year of the programme. Of those who provided consent, over 99% received the first dose each year and 98–99% completed the course per year. Estimated population coverage for the full vaccine course, considering also those not in school, is estimated at 83 to 91% per year. Rates of adverse events reports following HPV vaccination were low at around 2 per 100,000 and the majority was injection site reactions.

Conclusion

A multisectoral and integrated collaborative structure and process ensured that the Malaysia school-based HPV immunisation programme was successful and sustained through the programme design, planning, implementation and monitoring and evaluation. This is a critical factor contributing to the success and sustainability of the school-based HPV immunisation programme with very high coverage.

     

Economic evaluation of second generation pneumococcal conjugate vaccines in Norway

Background

A seven valent pneumococcal conjugate vaccine (PCV7) was introduced in the Norwegian childhood immunization programme in 2006, and since then the incidence of invasive pneumococcal disease has declined substantially. Recently, two new second generation pneumococcal conjugate vaccines have become available, and an update of the economic evidence is needed. The aim of this study was to estimate incremental costs, health effects and cost-effectiveness of the pneumococcal conjugate vaccines PCV7, PCV13 and PHiD-CV in Norway.

Methods

We used a Markov model to estimate costs and epidemiological burden of pneumococcal- and NTHi-related diseases (invasive pneumococcal disease (IPD), Community Acquired Pneumonia (CAP) and acute otitis media (AOM)) for a specific birth cohort. Using the most relevant evidence and assumptions for a Norwegian setting, we calculated incremental costs, health effects and cost-effectiveness for different vaccination strategies. In addition we performed sensitivity analyses for key parameters, tested key assumptions in scenario analyses and explored overall model uncertainty using probabilistic sensitivity analysis.

Results

The model predicts that both PCV13 and PHiD-CV provide more health gains at a lower cost than PCV7. Differences in health gains between the two second generation vaccines are small for invasive pneumococcal disease but larger for acute otitis media and myringotomy procedures. Consequently, PHiD-CV saves more disease treatment costs and indirect costs than PCV13.

Conclusion

This study predicts that, compared to PVC13, PHiD-CV entails lower costs and greater benefits if the latter is measured in terms of quality adjusted life years. PVC13 entails more life years gained than PHiD-CV, but those come at a cost of NOK 3.1 million (∼€0.4 million) per life year. The results indicate that PHiD-CV is cost-effective compared to PCV13 in the Norwegian setting.     

Cost-effectiveness analysis of the national decentralization policy of antiretroviral treatment programme in Zambia

Background

In resource-limited settings with a high prevalence of human immunodeficiency virus (HIV) infection such as Zambia, decentralization of HIV/acquired immunodeficiency syndrome (HIV/AIDS) treatment and care with effective use of resources is a cornerstone of universal treatment and care.

Objectives

This research aims to analyse the cost effectiveness of the National Mobile Antiretroviral Therapy (ART) Services Programme in Zambia as a means of decentralizing ART services.

Methods

Cost-effectiveness analyses were performed using a decision analytic model and Markov model to compare the original ART programme, ‘Hospital-based ART’, with the intervention programme, Hospital-based plus ‘Mobile ART’, from the perspective of the district government health office in Zambia. The total cost of ART services, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) were examined.

Results

The mean annual per-patient costs were 1259.16 USD for the original programme and 2601.02 USD for the intervention programme, while the mean number of QALYs was 6.81 for the original and 7.27 for the intervention programme. The ICER of the intervention programme relative to the original programme was 2965.17 USD/QALY, which was much below the willingness-to-pay (WTP), or three times the GDP per capita (4224 USD), but still over the GDP per capita (1408 USD). In the sensitivity analysis, the ICER of the intervention programme did not substantially change.

Conclusion

The National Mobile ART Services Programme in Zambia could be a cost-effective approach to decentralizing ART services into rural areas in Zambia. This programme could be expanded to more districts where it has not yet been introduced to improve access to ART services and the health of people living with HIV (PLHIV) in rural areas.

     

The effectiveness of a preventive health program and vitamin D status in improving health-related quality of life of older Canadians

Purpose

To assess the effectiveness of a preventive health program and vitamin D status in improving the health-related quality of life (HRQOL) of older residents of Canada.

Design

We analyzed baseline and follow-up data of 2119 volunteers of a community program that promotes healthy lifestyles and encourages vitamin D supplementation. We examined the program effect on each of the five dimensions of the EQ-5D-5L, HRQOL score, and quality-adjusted life years (QALYs) using multivariable regression methods. We further examined the specific contribution of vitamin D status as quantified by serum 25-hydroxyvitamin D (25(OH)D).

Results

Problems with mobility, usual activities, pain/discomfort, and depression/anxiety were reported less during follow-up compared to baseline. On average, participants’ HRQOL had improved by 0.018 units at 6 months and 0.025 units at 1 year of follow-up. Improvements in vitamin D status were independently associated with improvements in HRQOL and in QALYs. As per 25 nmol/L increase in 25(OH)D, there was a 0.002 increase in HRQOL and a 0.001 increase in QALYs.

Conclusions

This study documents the benefits of a real-world preventive health program to HRQOL. It is the first to reveal that improvements in vitamin D status parallel improvements in HRQOL among healthy community dwellers. The study further suggests that the preventive health program and supplementation with vitamin D are cost-effective interventions.

     

Impact of HPV vaccination: health gains in the Italian female population

Background

Human papillomavirus (HPV) is the leading cause of cervical cancer and other malignant and benign neoplastic lesions. HPV vaccination has three potential goals: to prevent transmission, infection, and disease. At present, there are no available data about health consequences of HPV immunization in Italy. The aim of this study is to evaluate the effect of current HPV vaccination strategy in Italy.

Methods

A multistate morbidity-mortality model was developed to estimate the infection process in a theoretical cohort of Italian women. The Markov process considered nine health states (health, anogenital warts, grade 1 and grade 2/3 cervical intraepithelial neoplasia, cervical cancer, anal cancer, death due to cervical cancer, anal cancer and other causes), and 26 transition probabilities for each age group. The model was informed with the available data in national and international literature. Effectiveness of immunization was assumed considering a literature review pertaining to models and vaccination coverage rates observed in Italy. Life expectancy (e_x), Quality-Adjusted Life Years (QALYs), Disability-Adjusted Life Years (DALYs), and attributable risk (AR) were estimated for no intervention (cervical cancer screening) and vaccination strategies scenarios.

Results

The model showed that in a cohort of 100,000 Italian women the e₀ is equal to 83.1 years. With current HPV vaccination strategy the e₀ achieves 83.2 (+0.1) years. When HPV-related diseases are considered altogether, the QALYs increase from 82.7 to 82.9 (+0.2 QALYs) with no intervention and vaccination strategies respectively. DALYs decrease by 0.6 due to vaccination. Finally, AR is equal to 93 and 265 cases per 100,000 women in population and not vaccinated, respectively.

Conclusion

When mortality due to cervical cancer is considered, HPV vaccination seems to have a low impact on health unit gains in the Italian female population. Conversely, when several HPV-related and cancer morbidity conditions are included, the effect of vaccination becomes quite remarkable.

     

Economic evaluation of Zepatier for the management of HCV in the Italian scenario

Background

Hepatitis C virus (HCV) is a major health issue worldwide. New generation of direct-active antiviral medications is an epoch-making turning point in the management of HCV infections.

Objective

Conducing a cost-effectiveness analysis comparing the combination of elbasvir/grazoprevir and sofosbuvir?+?pegylated interferon/ribavirin for the management of all HCV patients (even those in the initial stages of fibrosis).

Methods

A Markov model was built on the natural history of the disease to assess the efficacy of the alternatives. The outcomes are expressed in terms of quality adjusted life-years (QALYs) and result in terms of incremental cost-effectiveness ratio).

Results

Elbasvir/grazoprevir implies an expenditure of €21,104,253.74 with a gain of 19,287.90 QALYs and sofosbuvir?+?pegylated interferon/ribavirin implies an expenditure of €31,904,410.11 with a gain of 18,855.96 QALYs. Elbasvir/grazoprevir is thus a dominant strategy.

Conclusion

Consideration should be given to the opportunity cost of not treating patients with a lower degree of fibrosis (F0–F2).

     

Suicide Prevention Among High School Students: Evaluation of a Nonrandomized Trial of a Multi-stage Suicide Screening Program

Background

Suicide is a leading cause of death among youth. Suicide screening programs aim to identify mental health issues and prevent death by suicide.

Objective

The present study evaluated outcomes of a multi-stage screening program implemented over 3 school years in a moderately-sized Midwestern high school.

Methods

One hundred ninety-three 9th-grade students were screened in the program. Students who screened positive were referred to mental health services and followed. Suicide-related thoughts and behaviors among 9th-grade students in the school with screening were compared to those of students in a similar school without screening.

Results

There was a significant increase in utilization of mental health services among students who screened positive and a decrease in rates of suicidal ideation and attempts among 9th-grade students at the school with screening.

Conclusions

This multi-stage screening program shows promise in addressing suicide-related behaviors in schools. Randomized trials are needed to confirm program efficacy.

     

Cost-effectiveness analysis of the nine-valent HPV vaccine in Italy

Background

In Italy HPV vaccination with the quadrivalent vaccine (Gardasil^®) is offered actively and free of charge to girls aged 12 since 2007. A nine-valent vaccine (Gardasil 9^®) received the European market authorization in 2015 to protect, with only 2 doses, against around 90% of all HPV positive cancers, over 80% of high-grade precancerous lesions and 90% of genital warts caused by HPV types 6/11.

Methods

A dynamic transmission model simulating the natural history of HPV-infections was calibrated to the Italian setting and used to estimate costs and QALYs associated with vaccination strategies. The analyses compared two strategies with the nine-valent vaccine (cervical cancer screening and vaccination in girls only or vaccination in boys and girls) to four alternative strategies (cervical cancer screening and vaccination with quadrialent vaccine in girls only, in both boys and girls, with bivalent vaccine in girls and screening strategy only). The National Health Service perspective was considered.

Conclusion

The switch to the nine-valent vaccine in Italy can further reduce the burden associated to cervical cancer and HPV-related diseases and is highly cost-effective.

Results

Compared to the current vaccination program with quadrivalent vaccine, the nine-valent vaccine in a programme including girls and boys shows further reductions of 17% in the incidence of cervical cancer, 35 and 14% in anal cancer for males and females, as well as over a million cases of genital warts avoided after 100 years. The new technology is associated with an ICER of 10,463€ per QALY gained in universal vaccination, decreasing to 4483€ when considering the vaccine switch for girls-only.

     

Cost-Effectiveness Analyses of Lung Cancer Screening Strategies Using Low-Dose Computed Tomography: a Systematic Review

Background

Lung cancer screening with low-dose computed tomography (LDCT) has been shown to deliver appreciable reductions in mortality in high-risk patients. However, in an era of constrained medical resources, the cost-effectiveness of such a program needs to be demonstrated.

Objective

The aim of this study was to systematically review the literature analyzing the cost-effectiveness of lung cancer screening using LDCT.

Methods

We searched MEDLINE, EMBASE, EBM Reviews—Health Technology Assessment, the National Health Service Economic Evaluation Database (NHS-EED), and the Cochrane Database of Systematic Reviews. Due to technological progress in CT, we limited our search to studies published between January 2000 and December 2014. Our search returned 393 unique results. After removing studies that did not meet our inclusion criteria, 13 studies remained. Costs are presented in 2014 US dollars (US$).

Results

The results from the economic evaluations identified in this review were varied. All identified studies reported outcomes using either additional survival (life-years gained) or quality-adjusted life-years (QALYs gained). Results ranged from US$18,452 to US$66,480 per LYG and US$27,756 to US$243,077 per QALY gained for repeated screening. The results of cost-effectiveness analyses were sensitive to several key model parameters, including the prevalence of lung cancer, cost of LDCT for screening, the proportion of lung cancer detected as localized disease, lead time bias, and, if included, the characteristics of a smoking cessation program.

Conclusions

The cost-effectiveness of a lung cancer screening program using LDCT remains to be conclusively resolved. It is expected that its cost-effectiveness will largely depend on identifying an appropriate group of high-risk subjects.

     

WTP for a QALY and health states: More money for severer health states?

Background

In economic evaluation, cost per quality-adjusted life year (QALY) is generally used as an indicator for cost-effectiveness. Although JPY 5 million to 6 million (USD 60, 000 to 75,000) per QALY is frequently referred to as a threshold in Japan, do all QALYs have the same monetary value?

Methods

To examine the relationship between severity of health status and monetary value of a QALY, we obtained willingness to pay (WTP) values for one additional QALY in eight patterns of health states. We randomly sampled approximately 2,400 respondents from an online panel. To avoid misunderstanding, we randomly allocated respondents to one of 16 questionnaires, with 250 responses expected for each pattern. After respondents were asked whether they wanted to purchase the treatment, double-bounded dichotomous choice method was used to obtain WTP values.

Results

The results clearly show that the WTP per QALY is higher for worse health states than for better health states. The slope was about JPY ?1 million per 0.1 utility score increase. The mean and median WTP values per QALY for 16 health states were JPY 5 million, consistent with our previous survey. For respondents who wanted to purchase the treatment, WTP values were significantly correlated with household income.

Conclusion

This survey shows that QALY based on the EQ-5D does not necessarily have the same monetary value. The WTP per QALY should range from JPY 2 million (USD 20,000) to JPY 8 million (USD 80,000), corresponding to the severity of health states.

     

Cost-effectiveness of different strategies to prevent breast and ovarian cancer in German women with a BRCA 1 or 2 mutation

Background

Women with a BRCA1 or BRCA2 mutation are at increased risk of developing breast and/or ovarian cancer. This economic modeling study evaluated different preventive interventions for 30-year-old women with a confirmed BRCA (1 or 2) mutation.

Methods

A Markov model was developed to estimate the costs and benefits [i.e., quality-adjusted life years (QALYs), and life years gained (LYG)] associated with prophylactic bilateral mastectomy (BM), prophylactic bilateral salpingo-oophorectomy (BSO), BM plus BSO, BM plus BSO at age 40, and intensified surveillance. Relevant input data was obtained from a large German database including 5902 women with BRCA 1 or 2, and from the literature. The analysis was performed from the German Statutory Health Insurance (SHI) perspective. In order to assess the robustness of the results, deterministic and probabilistic sensitivity analyses were performed.

Results

With costs of €29,434 and a gain in QALYs of 17.7 (LYG 19.9), BM plus BSO at age 30 was less expensive and more effective than the other strategies, followed by BM plus BSO at age 40. Women who were offered the surveillance strategy had the highest costs at the lowest gain in QALYs/LYS. In the probabilistic sensitivity analysis, the probability of cost-saving was 57% for BM plus BSO. At a WTP of 10,000 € per QALY, the probability of the intervention being cost-effective was 80%.

Conclusions

From the SHI perspective, undergoing BM plus immediate BSO should be recommended to BRCA 1 or 2 mutation carriers due to its favorable comparative cost-effectiveness.

     

Making use of equity sensitive QALYs: a case study on identifying the worse off across diseases

Background

Resource allocation decisions currently lack standard quantitative methods for incorporating concerns about the worse off when analysing the cost-effectiveness of medical interventions.

Objective

To explore and demonstrate how to identify who are the worse off without a new intervention by measuring lifetime Quality-Adjusted Life Years (QALYs) for patients across different conditions, and compare the results to using proportional shortfall of QALYs.

Methods

Case study of eight condition-intervention pairs that are relevant to priority setting in Norway; childhood deafness (unilateral cochlear implant), unruptured cerebral aneurysm (coiling), morbid obesity (RY gastric bypass), adult deafness (unilateral cochlear implant), atrial fibrillation (catheter ablation), hip osteoarthritis (hip replacement), rheumatoid arthritis (TNF inhibitor) and acute stroke (stroke unit). We extracted prospective QALYs without and with new interventions from published health technology assessments and economic evaluations.

Results

Among the eight cases, the lifetime QALY method and the proportional shortfall method yielded conflicting worse-off rank orders. Particularly two conditions had a substantial shift in ranking across the applications of the two methods: childhood deafness and acute stroke. Deaf children had the lowest expected lifetime QALYs (38.5 without a cochlear implant) and were worst off according to the lifetime approach, while patients with acute stroke had the second-highest lifetime QALYs (76.4 without stroke units). According to proportional shortfall of QALYs, patients with acute stroke were ranked as worse off than deaf children, which seems counterintuitive.

Conclusion

This study shows that it is feasible to identify who are the worse off empirically by the application of lifetime QALYs and proportional shortfalls. These methods ease further examination of whether there is a true conflict between maximization and equity or whether these two concerns actually coincide in real world cases. It is yet to be solved whether proportional prospective health losses are more important than absolute shortfalls in expected lifetime health in judgements about who are worse off.

     

Cost-Effectiveness Analysis of a Pharmacy Asthma Care Program in Australia

Objectives

A pharmacy asthma care program in Australia, which included specific education on asthma and asthma medication, trigger factors, use of inhalers, and medication adherence, as well as goal setting and patient review aspects, assessed the impact of a community pharmacy asthma service on the severity of patients’ asthma over 6 months. Data from this study were used to estimate the cost effectiveness of the program.

Methods

The intervention population was compared with a control population and results at 6 months were included in a Markov model in order to estimate the cost effectiveness over 5 years from the perspective of the Australian healthcare system. The model had a cycle length of 6 months and included transition probabilities for switching between classes of severity of asthma, the costs of asthma treatment and program delivery, and utility values for a patient’s quality of life with asthma. Costs were Australian dollars ($A), year 2006 values, and both costs and benefits were discounted at a rate of 5% per annum.

Results

Over the 5 years following an initial review, the program generated 0.131 additional quality-adjusted life-years (QALYs), at an additional net cost of $A623 if annual reviews were required to maintain asthma improvements (annual review scenario) or $A376 if annual reviews were not required (no annual review scenario), resulting in costs per QALY gained of $A4753 and $A2869, respectively.

Conclusions

The program appears to be cost effective compared with no program, whether or not annual reviews were required to maintain improvements and under a range of other assumptions. Current evidence suggests that the pharmacy asthma care program should be implemented and funded for the treatment of adults with asthma in Australia.

     

Effect of the conditional cash transfer program <Emphasis Type="Italic">Oportunidades</Emphasis> on vaccination coverage in older Mexican people

Background

Immunization is one of the most effective ways of preventing illness, disability and death from infectious diseases for older people. However, worldwide immunization rates are still low, particularly for the most vulnerable groups within the elderly population. The objective of this study was to estimate the effect of the Oportunidades -an incentive-based poverty alleviation program- on vaccination coverage for poor and rural older people in Mexico.

Methods

Cross-sectional study, based on 2007 Oportunidades Evaluation Survey, conducted in low-income households from 741 rural communities (localities with <2,500 inhabitants) of 13 Mexican states. Vaccination coverage was defined according to three individual vaccines: tetanus, influenza and pneumococcal, and for complete vaccination schedule. Propensity score matching and linear probability model were used in order to estimate the Oportunidades effect.

Results

12,146 older people were interviewed, and 7% presented cognitive impairment. Among remaining, 4,628 were matched. Low coverage rates were observed for the vaccines analyzed. For Oportunidades and non-Oportunidades populations were 46% and 41% for influenza, 52% and 45% for pneumococcal disease, and 79% and 71% for tetanus, respectively. Oportunidades effect was significant in increasing the proportion of older people vaccinated: for complete schedule 5.5% (CI_95% 2.8-8.3), for influenza 6.9% (CI_95% 3.8-9.6), for pneumococcal 7.2% (CI_95% 4.3-10.2), and for tetanus 6.6% (CI_95% 4.1-9.2).

Conclusions

The results of this study extend the evidence on the effect that conditional transfer programs exert on health indicators. In particular, Oportunidades increased vaccination rates in the population of older people. There is a need to continue raising vaccination rates, however, particularly for the most vulnerable older people.

     

Perceptions of healthcare professionals on the usage of percutaneous endoscopic gastrostomy in a teaching hospital from a middle-income South East Asian country

Objective

To explore the perceptions of healthcare professionals’ (HCPs) in a South East Asian nation towards percutaneous endoscopic gastrostomy (PEG) feeding.

Design

Semi-structured, qualitative interviews.

Settings

A teaching hospital in Kuala Lumpur, Malaysia.

Participants

A total of 17 healthcare professionals aged 23-43 years, 82% women.

Results

Thematic analysis revealed five themes that represent HCPs’ perceptions in relation to the usage of PEG feeding: 1) knowledge of HCPs, 2) communication, 3) understanding among patients, and 4) financial and affordability.

Conclusion

The rationale for reluctance towards PEG feeding observed in this regions was explained by lack of education, knowledge, communication, team work, and financial support. Future studies should assess the effects of educational programmes among HCPs and changes in policies to promote affordability on the utilization of PEG feeding in this region.

     

Assessing long-term QALYs gain from averting and reversing overweight and obesity in childhood

Background

Interventions to tackle childhood obesity have been devised in response to the rising prevalence of childhood obesity. However, efficiency of these interventions remains a concern. Cost-utility analysis, representing health benefits in terms of quality-adjusted life years (QALYs), is a type of economic evaluation that has widely been recommended in assessing efficiency of health interventions. However, certain limitations in using QALYs remain specifically difficult in QALYs estimation. This study estimates the long-term QALYs gain from reversing childhood obesity in Thailand.

Methods

An economic model was developed to estimate long-term QALYs of the youth aged 3–18 for the BMI status in childhood, which were categorized into three groups: normal weight, overweight, and obese. Long-term QALYs were estimated between ages 35 and 100, according to children’s age, sex, and BMI status. Differences in QALYs between BMI status groups were calculated to represent the QALYs gain for youth from reversing obesity and overweight. The future outcomes were discounted at 3 % per annum in the base-case analysis; the discount rates of 0, 1.5, 3.5, and 5 % were also applied in the sensitivity analyses.

Results

QALYs gained from reversing childhood obesity increase with age, starting from 0.040 and 0.083 QALYs at age 3 to 0.590 and 0.553 QALYs at age 18 in boys and girls, respectively. Reversing overweight and obesity in girls produces more QALYs than in boys between ages 3 and 17.

Conclusions

Efficiency is an important issue in allocating public healthcare resources to maximize social benefits. The results of this study facilitate long-term QALYs estimation with respect to BMI status in childhood, which could encourage more routine economic evaluation of child obesity interventions and maximize their health benefits.

     

Clinical and Utilization Outcomes for a Pediatric and Adolescent Telephonic Asthma Care Support Program

Objective

To investigate the effect of an asthma care support program for patients under the age of 18 years.

Study design

A 1:1 matched cohort study design was used. The purpose of matching is to find a similar comparison group in terms of observable variables. The propensity score method of matching was used to find a suitable comparison cohort, which is similar at baseline to the treatment cohort. For each treatment cohort member, a comparison cohort member was selected on the basis of having the closest estimated propensity score. Once a comparison cohort was defined, variables were compared at baseline year to ensure the similarity of the two groups. The Kruskal-Wallis test was used for comparison of variables between the treatment and comparison cohorts due to the non-Gaussian distribution of variables. Finally, variables were compared during the program year to estimate the treatment effects of the disease management program.

Patient groups

318 asthma care support program participants and 318 matched non-participants.

Main outcome measures

The rates of medical service utilization including rates of hospitalization, emergency department (ED) visits, and selected clinical indicators including allergen immunotherapy, chest x-rays, influenza vaccinations, and pneumococcal vaccinations.

Results

Baseline matching resulted in no statistically significant difference between the treatment and matched cohorts. However, during the program period the treatment cohort had 35.6% fewer inpatient admissions (p = 0.045), 32.5% fewer ED visits (p = 0.007), 56.7% fewer asthma-related inpatient admissions (p = 0.008), 50.8% fewer asthma-related ED visits (p < 0.0001), 26.8% fewer chest x-rays (p = 0.036), and 51.6% more influenza immunizations (p = 0.046).

Conclusions

Where controlled randomized clinical trials cannot be performed, the use of propensity scores provides an alternative for the purpose of estimating a treatment effect using observational data. The current study employed a propensity score-matching methodology to select a subset of comparison units most comparable to treatment units. It documented the beneficial clinical outcomes of pediatric and adolescent participation in an asthma care support program which suggested a beneficial impact of monitoring, education, and more rigorous adherence to action plans for program participants.

     

Verantwortung des Betriebsmediziners im Rahmen der Gesundheitsförderung

Background

Many adults in Germany do not receive immunizations as recommended. False assumptions about vaccinations and the risk of infectious diseases are important reasons why people fail to receive recommended immunizations.

Aim

Our aim was to provide new possibilities to improve vaccination rates among adults. We directed special attention to some newsworthy infectious diseases (e.g. measles, pertussis).

Results

Owing to their special range of responsibilities and their numerous medical attendances, occupational health physicians are in a position to improve the immunization rates of adults as well as to collect epidemiologic data of this broad age group.

Conclusions

The use of a mobile cart vaccination program in the workplace might increase vaccination rates.

     

A long life in good health: subjective expectations regarding length and future health-related quality of life

Background

Subjective life expectancy is considered relevant in predicting mortality and future demand for health services as well as for explaining peoples’ decisions in several life domains, such as the perceived impact of health behaviour changes on future health outcomes. Such expectations and in particular subjective expectations regarding future health-related quality of life remain understudied. The purpose of this study was to investigate individuals’ subjective quality adjusted life years (QALYs) expectation from age 65 onwards in a representative sample of the Dutch generic public.

Methods

A web-based questionnaire was administered to a sample of the adult population from the Netherlands. Information on subjective expectations regarding length and future health-related quality of life were combined into one single measure of subjective expected QALYs from age 65 onwards. This subjective QALY expectation was related to background, health and lifestyle variables. The implications of using different methods to construct our main outcome measure were addressed.

Results

Mean subjective expected QALYs from age 65 onwards was 11 QALYs (range ?9 to 40 QALYs). Individuals with unhealthier lifestyles, chronic diseases, severe disorders or lower age of death of next of kin reported lower QALY expectations. Indicators were varyingly associated with either subjective life expectancy or future health-related quality of life, or both.

Conclusion

Extending the concept of subjective life expectancy by correcting for expected quality of life appears to generate important additional information contributing to our understanding of people’s perceptions regarding ageing and lifestyle choices.