Economic analysis for national immunization program planning: A case of rotavirus vaccines in Burundi

BackgroundIn Burundi, diarrhea is the third leading cause of mortality among children under five years of age. This study conducted an economic analysis of rotavirus vaccination program in Burundi.MethodsA Markov model was constructed to simulate clinical and economic outcomes for the 2019 birth cohort for a period of 5 years. Empirical costing data were collected. ICER per episode averted, ICER per death averted, ICER per DALY averted, net present value, and budget impact were estimated for 4 brands of WHO pre-qualified rotavirus vaccines. One-way and probabilistic sensitivity analysis as well as threshold analysis were performed.ResultsFor the base case, while all four WHO pre-qualified rotavirus vaccines were cost-effective (ICER < 3 GDP per capita), three of them (i.e. Rotarix, Rotavac and Rotasiil) were very cost-effective (ICER <1 GDP per capita) from both the provider and societal perspectives. The vaccines were still very cost-effective at a price increase of up to US$ 5.09, US$ 3.16, US$ 3.89, and US$ 2.69 for Rotarix, RotaTeq, Rotavac, and Rotasiil, respectively. Probabilistic sensitivity analysis indicated that vaccination programs with Rotarix, RotaTeq, Rotavac, and Rotasiil are cost-effective at a probability of 93.8%, 27%, 99.1%, and 92.7%, respectively. All vaccination programs were cost-beneficial with a net present value in the range of US$ 5,214,912 and US$ 11,135,997.The budget required to run the vaccination program, estimated with break-even prices, ranged between US$ 42,249,498 and US$ 53,487,935 for a 5-year time period. When compared to the GDP of Burundi in 2019, these are are less than 2%.ConclusionThe rotavirus vaccine is good value for money. Findings from this study offer evidence on potential economic benefits as well as the required budget for different rotavirus vaccination programs, which could be useful for future planning related to rotavirus vaccine coverage in Burundi after graduation from GAVI.     

Economic evaluation methods used in home-visiting interventions: A systematic search and review

Home-visiting interventions are used to improve outcomes for families experiencing disadvantage. As scarce resources must be allocated carefully, appropriate methods are required to provide accurate information on the effect of these programmes. We aimed to investigate: economic evaluation/analysis methods used in home-visiting programmes for children, young people and families, study designs and methods suitable in situations where randomised-controlled-trials are not feasible, and type of costs included in analyses, including any implementation costs stated. A systematic search and review was conducted of existing full economic evaluation/analysis methods in home-visiting programmes for children, young people and/or families. We included studies published in English between January 2000 and mid-November 2020. Of the 4,742 papers sourced, 60 were retained for full-text review, and 21 included. Economic-analysis methods found in the included studies were: within trial economic evaluation, economic evaluation using decision analytic modelling (i.e. cost-utility, cost-benefit analysis), cost comparison and cost-consequence. Studies incorporating return on investment and budget impact analysis were also found. Study designs suitable when randomisation was not feasible included parallel cluster randomised trials and using pre-post intervention data. Costs depended mainly on study context and only one study reported implementation costs. We hope this information will help guide future economic evaluations of home-visiting interventions.     

我国医疗联合体建设现状与发展思考

医疗联合体是我国建设整合型医疗卫生服务体系的具体表现形式之一,具有优化资源配置、提高资源利用率、改善不合理就医秩序、促进医疗机构同质化发展的重要作用。通过梳理医疗联合体构建背景、发展历程、国内外典型经验,结合党的十九届五中全会精神,为完善我国医疗卫生服务体系,提出要构建科学、有效、统一的医疗联合体绩效考核评价体系,充分发挥绩效评估的激励引导作用,开展医疗联合体评估工作,推动医疗联合体高质量发展。     

DRG在深圳市某区临床重点专科评估中的应用

目的评价并遴选深圳市某区临床重点专科,为该区临床重点专科的发展以及我国临床重点专科的评估提供借鉴。方法将DRG相关指标与传统指标相结合作为该区临床重点专科评估指标体系,运用TOPSIS法计算该区11家医院41个临床专科2016—2018年的总排名。结果该区排名前5位的临床重点专科分别是I医院显微外科、J医院产科、K医院鼻科、K医院耳鼻咽喉科以及D医院骨科,排名后5位的专科分别是H医院风湿病科、D医院泌尿外科、C医院儿科、C医院眼耳鼻喉科以及F医院神经外科。结论该区应加快重点专科发展,形成区域专科优势;促进专科均衡发展,满足基本医疗需求;提高专科服务效率,优化医疗资源配置;依托医疗集团做强专科特色品牌,促进专科差异化发展;进一步提高病历首页质量管理水平。     

福建省紧密型县域医共体绩效评价指标体系构建

目的:构建紧密型县域医共体绩效评价指标体系.方法:采用Delphi专家咨询法构建紧密型县域医共体绩效评价指标体系.采用百分权重法和组合权重法计算指标权重.采用综合评分法、加权TOPSIS法和加权秩和比法验证指标体系的有效性与可靠性.结果:构建了由10个一级指标、26个二级指标和45个三级指标的紧密型医共体绩效评价指标体系,涵盖了医共体建设所需的组织结构、资源投入、服务模式、服务产出及效果等方面.相关性分析显示3种综合评价方法显著相关.结论:文章构建的指标体系明确医共体的服务功能定位,能够比较全面评价不同地区紧密型医共体绩效水平,为政府决策提供参考.     

薄层鉴别结合多成分测定方法评价苓桂术甘颗粒质量

目的:建立苓桂术甘颗粒中肉桂酸、白术内酯Ⅱ、白术内酯Ⅲ的薄层鉴别定性方法及绿原酸类成分、肉桂酸、桂皮醛含量同时测定的定量方法。方法:采用薄层色谱法鉴别制剂中的白术和桂枝;利用高效液相色谱法同时测定新绿原酸、绿原酸、隐绿原酸、桂皮醛和肉桂酸的含量。结果:目标斑点清晰、无阴性干扰,新绿原酸、绿原酸、隐绿原酸、桂皮醛和肉桂酸在线性范围内与峰面积的线性关系良好,平均回收率分别为109.46%、93.46%、97.19%、103.70%、102.41%。结论:该薄层鉴别方法专属性强,含量测定方法准确可靠、操作简便,可以有效控制苓桂术甘颗粒的质量。     

老年心血管病患者健康状况综合评价指标体系的构建

目的应用德尔菲法建立老年心血管病患者健康状况综合评价指标体系,为针对性提高慢性病的综合管理效果提供依据。方法基于前期课题组建立的老年人健康评估量表的框架,通过文献研究,结合心血管病患者特点,初步确立老年心血管病患者健康状况综合评价指标体系。选取专业相关领域的22位专家,采用德尔菲法进行两轮专家咨询,根据咨询结果及专家意见调整指标体系。使用SPSS 20.0软件计算各指标的重要性、可操作性和敏感性评分,并应用Yaahp10.0层次分析软件计算各指标权重。结果本研究中完成两轮咨询的专家共20位,两轮咨询的专家积极系数分别为90.9%和100%;两轮咨询专家总平均权威系数分别为0.808及0.856;第1轮重要性、可操作性和敏感性的专家协调系数分别为0.260、0.218和0.231,第2轮重要性、可操作性和敏感性的专家协调系数分别为0.345、0.377和0.405,均有统计学意义(P<0.01)。通过两轮专家咨询后最终建立包含5个一级指标、25个二级指标、37个三级指标的老年心血管病患者健康状况综合评价指标体系。结论通过德尔菲法构建的老年心血管病患者健康状况综合评价指标体系可靠、客观,可用于老年心血管病患者综合健康评估,有助于对慢性病患者进行精准化健康管理。     

Cost-effectiveness analyses of monovalent mumps vaccination programs for Japanese children

BackgroundThe most common preventative measure against mumps is vaccination with mumps vaccine. Over 122 countries have implemented mumps vaccine routine immunization programs, mostly via Measles-Mumps-Rubella (MMR) vaccine. In Japan, the unexpectedly high incidence of aseptic meningitis caused by mumps vaccine led to the discontinuation of the MMR national vaccination program in 1993, inadvertently resulting in the re-emergence of mumps. Plans of introducing monovalent mumps vaccine into routine vaccination schedule have become one of the emerging topics in health policy that has warranted the need in evaluating its value for money.MethodsWe conducted cost-effectiveness analyses with Markov model and calculated incremental cost-effectiveness ratios (ICERs) of two different vaccination programs (a single-dose program at one-year-old, a two-dose program with second dose uptakes at five) compared to status quo from both payers’ and societal perspectives. Transition probabilities and utility weights in estimating quality-adjusted life-year (QALY), and disease treatment costs were either estimated or obtained from literature. Costs per vaccination were assumed at ¥6140 (US$58;1US$ = ¥106).ResultsBoth programs reduce disease treatment costs compared to status quo, while the reduction cannot offset vaccination cost. ICER of either program is found to be under ¥5,000,000 (US$47,170)/QALY willingness-to-pay (WTP) threshold from either perspective. Results of probabilistic sensitivity analyses expressed by net monetary benefit indicated that at the WTP threshold, the acceptability is at 92.6% for two-dose vaccination program, 0% for single-dose vaccination program, and 7.4% for current no vaccination program. Two-dose program was optimal among the alternatives. One-way sensitivity analyses revealed that proportion of mumps-related hearing loss among mumps cases and vaccine effectiveness (VE) were key variables in changing the ICERs.ConclusionRoutine vaccination program of single- and two-dose programs were cost-effective from both payers’ and societal perspectives. Between the two, the two-dose vaccination program was observed to be more favorable.