Pub Date : 2024-04-05DOI: 10.1101/2024.04.03.24305296
Shaoying Ma, Qian Yang, Sooa Ahn, Hojin Park, Yanyun He, John F P Bridges, Ce Shang
Background Over 20 states and local jurisdictions in the U.S. have imposed e-cigarette taxes. It is important to evaluate how adult vapers, including those who also smoke respond to e-cigarette taxation. The purpose of this study is to examine factors associated with adult vapers’ cost perception of e-cigarettes relative to cigarettes and budget allocations between two products.
{"title":"Cost Comparison and Spending on Tobacco Products: Evidence from A Nationally Representative Sample of Adult E-Cigarette Users","authors":"Shaoying Ma, Qian Yang, Sooa Ahn, Hojin Park, Yanyun He, John F P Bridges, Ce Shang","doi":"10.1101/2024.04.03.24305296","DOIUrl":"https://doi.org/10.1101/2024.04.03.24305296","url":null,"abstract":"<strong>Background</strong> Over 20 states and local jurisdictions in the U.S. have imposed e-cigarette taxes. It is important to evaluate how adult vapers, including those who also smoke respond to e-cigarette taxation. The purpose of this study is to examine factors associated with adult vapers’ cost perception of e-cigarettes relative to cigarettes and budget allocations between two products.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"114 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140561156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28DOI: 10.1101/2024.03.28.24305020
Thomas Shin, Jason K.H. Lee, Alexia Kieffer, Michael Greenberg, Jianhong Wu
Respiratory syncytial virus (RSV) is a highly infectious virus, and infants and young children are particularly vulnerable to its progression to severe lower respiratory tract illness (LRTI). Nirsevimab, an extended half-life monoclonal antibody, was recently approved in Canada as a passive immunization intervention for the prevention of RSV LRTI. A static decision tree model was utilized to determine the cost-effectiveness of nirsevimab in Canadian infants compared to current standard of care (palivizumab for infants born preterm, and with specific chronic conditions) and generate an optimal price per dose (PPD) at accepted willingness-to-pay (WTP) thresholds. Various health outcomes (including hospitalization, ICU, and mechanical ventilation) and healthcare costs were calculated over one RSV season, with any necessary follow-up prophylaxis in the second season for three infant categories (palivizumab-eligible, preterm, and term). All health-related parameters and costs were tailored to the Canadian environment. Compared to scenarios where only at-risk segments of the infant population received nirsevimab, the base case (administering nirsevimab to all infants in their first RSV season) was the most cost-effective versus standard care: the PPD was $692 at a $40,000/QALY WTP threshold, using average costing data assumptions across all scenarios. Compared to standard care, the base case scenario could avoid 18,249 RSV-related health outcomes (reduction of 9.96%). Variations in discount rate, distribution of monthly RSV infections, nirsevimab coverage rate for infants born at term, and palivizumab cost had the most significant model impact. Passive immunization of all infants with nirsevimab can significantly reduce RSV-related health and economic burden across Canada.
{"title":"A Health Economic Evaluation for Implementing an Extended Half-life Monoclonal Antibody for All Infants vs. Standard Care for Respiratory Syncytial Virus Prophylaxis in Canada","authors":"Thomas Shin, Jason K.H. Lee, Alexia Kieffer, Michael Greenberg, Jianhong Wu","doi":"10.1101/2024.03.28.24305020","DOIUrl":"https://doi.org/10.1101/2024.03.28.24305020","url":null,"abstract":"Respiratory syncytial virus (RSV) is a highly infectious virus, and infants and young children are particularly vulnerable to its progression to severe lower respiratory tract illness (LRTI). Nirsevimab, an extended half-life monoclonal antibody, was recently approved in Canada as a passive immunization intervention for the prevention of RSV LRTI. A static decision tree model was utilized to determine the cost-effectiveness of nirsevimab in Canadian infants compared to current standard of care (palivizumab for infants born preterm, and with specific chronic conditions) and generate an optimal price per dose (PPD) at accepted willingness-to-pay (WTP) thresholds. Various health outcomes (including hospitalization, ICU, and mechanical ventilation) and healthcare costs were calculated over one RSV season, with any necessary follow-up prophylaxis in the second season for three infant categories (palivizumab-eligible, preterm, and term). All health-related parameters and costs were tailored to the Canadian environment. Compared to scenarios where only at-risk segments of the infant population received nirsevimab, the base case (administering nirsevimab to all infants in their first RSV season) was the most cost-effective versus standard care: the PPD was $692 at a $40,000/QALY WTP threshold, using average costing data assumptions across all scenarios. Compared to standard care, the base case scenario could avoid 18,249 RSV-related health outcomes (reduction of 9.96%). Variations in discount rate, distribution of monthly RSV infections, nirsevimab coverage rate for infants born at term, and palivizumab cost had the most significant model impact. Passive immunization of all infants with nirsevimab can significantly reduce RSV-related health and economic burden across Canada.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140323708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-22DOI: 10.1101/2024.03.20.24304630
Ashleigh R Tuite, Alison E Simmons, Monica Rudd, Alexandra Cernat, Gebremedhin B Gebretekle, Man Wah Yeung, April Killikelly, Winnie Siu, Sarah A Buchan, Nicholas Brousseau, Matthew Tunis
Background: Vaccines against respiratory syncytial virus (RSV) have the potential to reduce disease burden and costs in Canadians, but the cost-effectiveness of RSV vaccination programs for older adults is unknown. We evaluated the cost-effectiveness of different adult age cutoffs for RSV vaccination programs, with or without a focus on people with higher disease risk due to chronic medical conditions (CMCs). Methods: We developed a static individual-based model of medically-attended RSV disease to evaluate the cost-utility of alternate age-, medical risk-, and age- plus medical risk-based vaccination policies. The model followed a multi-age cohort of 100,000 people aged 50 years and older over a three-year period. Vaccine characteristics were based on RSV vaccines authorized in Canada as of March 2024. We calculated incremental cost-effectiveness ratios (ICERs) in 2023 Canadian dollars per quality-adjust life year (QALY) from the health system and societal perspectives, discounted at 1.5%. Results: Although all vaccination strategies averted medically-attended RSV disease, strategies focused on adults with CMCs were more likely to be cost-effective than age-based strategies. A program focused on vaccinating adults aged 70 years and older with one or more CMCs was optimal for a cost-effectiveness threshold of $50,000 per QALY. Results were sensitive to assumptions about vaccine price, but approaches based on medical risk remained optimal compared to age-based strategies even when vaccine prices were low. Findings were robust to a range of alternate assumptions. Interpretation: Based on available data, RSV vaccination programs in some groups of older Canadians with underlying medical conditions are expected to be cost-effective.
{"title":"Respiratory syncytial virus vaccination strategies for older Canadian adults: a cost-utility analysis","authors":"Ashleigh R Tuite, Alison E Simmons, Monica Rudd, Alexandra Cernat, Gebremedhin B Gebretekle, Man Wah Yeung, April Killikelly, Winnie Siu, Sarah A Buchan, Nicholas Brousseau, Matthew Tunis","doi":"10.1101/2024.03.20.24304630","DOIUrl":"https://doi.org/10.1101/2024.03.20.24304630","url":null,"abstract":"Background: Vaccines against respiratory syncytial virus (RSV) have the potential to reduce disease burden and costs in Canadians, but the cost-effectiveness of RSV vaccination programs for older adults is unknown. We evaluated the cost-effectiveness of different adult age cutoffs for RSV vaccination programs, with or without a focus on people with higher disease risk due to chronic medical conditions (CMCs). Methods: We developed a static individual-based model of medically-attended RSV disease to evaluate the cost-utility of alternate age-, medical risk-, and age- plus medical risk-based vaccination policies. The model followed a multi-age cohort of 100,000 people aged 50 years and older over a three-year period. Vaccine characteristics were based on RSV vaccines authorized in Canada as of March 2024. We calculated incremental cost-effectiveness ratios (ICERs) in 2023 Canadian dollars per quality-adjust life year (QALY) from the health system and societal perspectives, discounted at 1.5%. Results: Although all vaccination strategies averted medically-attended RSV disease, strategies focused on adults with CMCs were more likely to be cost-effective than age-based strategies. A program focused on vaccinating adults aged 70 years and older with one or more CMCs was optimal for a cost-effectiveness threshold of $50,000 per QALY. Results were sensitive to assumptions about vaccine price, but approaches based on medical risk remained optimal compared to age-based strategies even when vaccine prices were low. Findings were robust to a range of alternate assumptions. Interpretation: Based on available data, RSV vaccination programs in some groups of older Canadians with underlying medical conditions are expected to be cost-effective.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140202320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-19DOI: 10.1101/2024.03.18.24304483
Julia Dvorkin, Clint Pecenka, Emiliano Sosa, Andrea Sancilio, Karina Duenas, Andrea Rodriguez, Carlos Rojas Roque, Patricia B. Carruteiro, Ranju Baral, Elisabeth Vodicka, Fernando Pedro Polack, Romina Libster, Mauricio T. Caballero
Introduction. There is a lack of available data on the economic burden of wheezing episodes resulting from prior severe respiratory syncytial virus (RSV) infections in resource constrained settings. This study aimed to assess the cost incurred for wheezing episodes during five years after a severe RSV infection in children from Argentina, considering both the public health system and societal perspectives. Methods. A prospective cohort was conducted to assess the cost-of-illness (COI) linked to wheezing episodes after severe RSV disease in children from Buenos Aires, Argentina. Direct medical and non-medical costs were estimated, along with indirect costs per episode and patient. Data pertaining to healthcare resource utilization, indirect expenses, and parental out of pocket costs were obtained from research forms. The overall cost per hospitalization and health visits were calculated from the perspectives of the healthcare system and society. Costs were quantified in US dollars. Results. Overall, 150 children aged between 12 and 60 months presented a total of 429 wheezing episodes. The median number of wheezing episodes per patient was 5 (IQR 3 to 7). The mean cost per wheezing episode was US$ 191.01 (95% confidence interval [CI] $166.37 to $215.64). The total cost per episode of wheezing was significantly higher (p<0.001) in infants under 12 months of age (207.43, 95%CI 154.3-260.6) compared to older toddler subgroups. The average cumulative cost associated to wheezing per patient was US$ 415.99 (95%CI $313.35 to $518.63). Considering both acute RSV disease and long-term wheezing outcomes the cumulative mean cost per patient was US$ 959.56 (95%CI $832.01 to $1087.10). Conclusions. This study reveals the economic impact of prolonged wheezing resulting from severe acute RSV infection on Argentina's public health system and society. The estimates obtained serve as valuable inputs for informing cost effectiveness analyses of upcoming RSV preventive interventions.
{"title":"Assessing the Long-Term Economic Impact of Wheezing Episodes After Severe RSV Disease in Children from Argentina: A Cost of Illness Analysis","authors":"Julia Dvorkin, Clint Pecenka, Emiliano Sosa, Andrea Sancilio, Karina Duenas, Andrea Rodriguez, Carlos Rojas Roque, Patricia B. Carruteiro, Ranju Baral, Elisabeth Vodicka, Fernando Pedro Polack, Romina Libster, Mauricio T. Caballero","doi":"10.1101/2024.03.18.24304483","DOIUrl":"https://doi.org/10.1101/2024.03.18.24304483","url":null,"abstract":"Introduction. There is a lack of available data on the economic burden of wheezing episodes resulting from prior severe respiratory syncytial virus (RSV) infections in resource constrained settings. This study aimed to assess the cost incurred for wheezing episodes during five years after a severe RSV infection in children from Argentina, considering both the public health system and societal perspectives.\u0000Methods. A prospective cohort was conducted to assess the cost-of-illness (COI) linked to wheezing episodes after severe RSV disease in children from Buenos Aires, Argentina. Direct medical and non-medical costs were estimated, along with indirect costs per episode and patient. Data pertaining to healthcare resource utilization, indirect expenses, and parental out of pocket costs were obtained from research forms. The overall cost per hospitalization and health visits were calculated from the perspectives of the healthcare system and society. Costs were quantified in US dollars.\u0000Results. Overall, 150 children aged between 12 and 60 months presented a total of 429 wheezing episodes. The median number of wheezing episodes per patient was 5 (IQR 3 to 7). The mean cost per wheezing episode was US$ 191.01 (95% confidence interval [CI] $166.37 to $215.64). The total cost per episode of wheezing was significantly higher (p<0.001) in infants under 12 months of age (207.43, 95%CI 154.3-260.6) compared to older toddler subgroups. The average cumulative cost associated to wheezing per patient was US$ 415.99 (95%CI $313.35 to $518.63). Considering both acute RSV disease and long-term wheezing outcomes the cumulative mean cost per patient was US$ 959.56 (95%CI $832.01 to $1087.10). Conclusions. This study reveals the economic impact of prolonged wheezing resulting from severe acute RSV infection on Argentina's public health system and society. The estimates obtained serve as valuable inputs for informing cost effectiveness analyses of upcoming RSV preventive interventions.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140173167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-16DOI: 10.1101/2024.03.13.24304250
Gunjan K, Ramendra Pati Pandey, Himanshu K, Riya Mukherjee, Chung-Ming Chang
Poultry eggs are a critical source of protein, vitamins, and minerals for people worldwide; facing the current global egg shortage is a significant concern. The shortage results from various factors, including avian flu outbreaks, changes in consumer demand, and supply chain disruptions caused by the COVID-19 pandemic. The economic crisis caused by the pandemic has also impacted the availability and affordability of eggs, particularly in low-income countries. The global egg shortage has implications for public health, particularly for vulnerable populations who rely on eggs for essential nutrients. One Health, an approach that recognizes the interconnectedness of human, animal, and environmental health, provides a useful framework for understanding and addressing the egg shortage. One Health approach to the egg shortage involves collaboration between agriculture and environmental sectors to address the root causes of the lack and ensure the sustainable production and distribution of eggs. Addressing the global egg shortage requires a multifaceted approach considering the complex social, economic, and environmental factors. One Health perspective offers a way to understand and address the interconnected factors contributing to the shortage to ensure access to affordable, nutritious eggs for all in a healthy way.
{"title":"Navigating the global egg shortage: a comprehensive study of interconnected challenges","authors":"Gunjan K, Ramendra Pati Pandey, Himanshu K, Riya Mukherjee, Chung-Ming Chang","doi":"10.1101/2024.03.13.24304250","DOIUrl":"https://doi.org/10.1101/2024.03.13.24304250","url":null,"abstract":"Poultry eggs are a critical source of protein, vitamins, and minerals for people worldwide; facing the current global egg shortage is a significant concern. The shortage results from various factors, including avian flu outbreaks, changes in consumer demand, and supply chain disruptions caused by the COVID-19 pandemic. The economic crisis caused by the pandemic has also impacted the availability and affordability of eggs, particularly in low-income countries. The global egg shortage has implications for public health, particularly for vulnerable populations who rely on eggs for essential nutrients. One Health, an approach that recognizes the interconnectedness of human, animal, and environmental health, provides a useful framework for understanding and addressing the egg shortage. One Health approach to the egg shortage involves collaboration between agriculture and environmental sectors to address the root causes of the lack and ensure the sustainable production and distribution of eggs. Addressing the global egg shortage requires a multifaceted approach considering the complex social, economic, and environmental factors. One Health perspective offers a way to understand and address the interconnected factors contributing to the shortage to ensure access to affordable, nutritious eggs for all in a healthy way.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140150033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-15DOI: 10.1101/2024.03.13.24304238
Estela Barbosa, Niels Blom, Annie Bunce
Violence as a phenomena has been analysed in silo due to difficulties in accessing data and concerns for the safety of those exposed. While there is some literature on violence and its associations using individual datasets, analyses using combined sources of data are very limited. Ideally data from the same individuals would enable linkage and a longitudinal understanding of experiences of violence and their (health) impacts and consequences. However, in the absence of directly linked data, look-alike modelling may provide an innovative and cost-effective approach to exploring patterns and associations in violence-related research in a multi-sectorial setting. We approached the problem of data integration as a missing data problem to create a synthetic combined dataset. We combined data from the Crime Survey of England and Wales with administrative data from Rape Crisis, focussing on victim-survivors of sexual violence in adulthood. Multiple imputation with chained equations were employed to collate/impute data from different sources. To test whether this procedure was effective, we compared regressions analyses for the individual and combined synthetic datasets on a binary, continuous and categorical variables. Our results show that the effect sizes for the combined dataset reflect those from the dataset used for imputation. The variance is higher, resulting in fewer statistically significant estimates. We extended our testing to an outcome measures and finally applied the technique to a variable fully missing in one data source. Our approach reinforces the possibility to combine administrative with survey datasets using look-alike methods to overcome existing barriers to data linkage.
{"title":"Look-alike modelling in violence-related research: a missing data approach","authors":"Estela Barbosa, Niels Blom, Annie Bunce","doi":"10.1101/2024.03.13.24304238","DOIUrl":"https://doi.org/10.1101/2024.03.13.24304238","url":null,"abstract":"Violence as a phenomena has been analysed in silo due to difficulties in accessing data and concerns for the safety of those exposed. While there is some literature on violence and its associations using individual datasets, analyses using combined sources of data are very limited. Ideally data from the same individuals would enable linkage and a longitudinal understanding of experiences of violence and their (health) impacts and consequences. However, in the absence of directly linked data, look-alike modelling may provide an innovative and cost-effective approach to exploring patterns and associations in violence-related research in a multi-sectorial setting.\u0000We approached the problem of data integration as a missing data problem to create a synthetic combined dataset. We combined data from the Crime Survey of England and Wales with administrative data from Rape Crisis, focussing on victim-survivors of sexual violence in adulthood. Multiple imputation with chained equations were employed to collate/impute data from different sources. To test whether this procedure was effective, we compared regressions analyses for the individual and combined synthetic datasets on a binary, continuous and categorical variables. Our results show that the effect sizes for the combined dataset reflect those from the dataset used for imputation. The variance is higher, resulting in fewer statistically significant estimates. We extended our testing to an outcome measures and finally applied the technique to a variable fully missing in one data source. Our approach reinforces the possibility to combine administrative with survey datasets using look-alike methods to overcome existing barriers to data linkage.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140150055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-15DOI: 10.1101/2024.03.13.24304170
Amy Lee, Benjamin Davido, Ekkehard Beck, Clarisse Demont, Keya Joshi, Michele Kohli, Michael Maschio, Mathieu Uhart, Nadia El Mouaddin
An economic evaluation was conducted to predict the economic and clinical burden of vaccinating immunocompromised (IC) individuals aged ≥30 years with mRNA-1273 variant-adapted COVID-19 vaccines in Fall 2023 and Spring 2024 versus BNT162b2 variant-adapted vaccines in France. The number of symptomatic COVID-19 infections, hospitalizations, deaths, and long COVID cases, costs and quality-adjusted life years (QALYs) was estimated using a static decision-analytic model. Predicted vaccine effectiveness (VE) were based on real-world data from prior versions, suggesting higher protection against infection and hospitalization with mRNA-1273 vaccines. VE estimates were combined with COVID-19 incidence and probability of COVID-19 severe outcomes. Uncertainty surrounding VE, vaccine coverage, infection incidence, hospitalization and mortality rates, costs and QALYs were tested in sensitivity analyses. The mRNA-1273 variant-adapted vaccine is predicted to prevent an additional 3,882 infections, 357 hospitalizations, 81 deaths, and 326 long COVID cases when compared to BNT162b2 variant-adapted vaccines in 230,000 IC individuals. This translates to €10.1 million cost-savings from a societal perspective and 645 QALYs saved. Results were consistent across all analyses and most sensitive to variations surrounding VE and coverage. These findings highlight the importance of increasing vaccine coverage, and ability to induce higher levels of protection with mRNA-1273 formulations in this vulnerable population.
{"title":"Substantial reduction in the clinical and economic burden of disease following variant-adapted mRNA COVID-19 vaccines in immunocompromised patients in France","authors":"Amy Lee, Benjamin Davido, Ekkehard Beck, Clarisse Demont, Keya Joshi, Michele Kohli, Michael Maschio, Mathieu Uhart, Nadia El Mouaddin","doi":"10.1101/2024.03.13.24304170","DOIUrl":"https://doi.org/10.1101/2024.03.13.24304170","url":null,"abstract":"An economic evaluation was conducted to predict the economic and clinical burden of vaccinating immunocompromised (IC) individuals aged ≥30 years with mRNA-1273 variant-adapted COVID-19 vaccines in Fall 2023 and Spring 2024 versus BNT162b2 variant-adapted vaccines in France. The number of symptomatic COVID-19 infections, hospitalizations, deaths, and long COVID cases, costs and quality-adjusted life years (QALYs) was estimated using a static decision-analytic model. Predicted vaccine effectiveness (VE) were based on real-world data from prior versions, suggesting higher protection against infection and hospitalization with mRNA-1273 vaccines. VE estimates were combined with COVID-19 incidence and probability of COVID-19 severe outcomes. Uncertainty surrounding VE, vaccine coverage, infection incidence, hospitalization and mortality rates, costs and QALYs were tested in sensitivity analyses. The mRNA-1273 variant-adapted vaccine is predicted to prevent an additional 3,882 infections, 357 hospitalizations, 81 deaths, and 326 long COVID cases when compared to BNT162b2 variant-adapted vaccines in 230,000 IC individuals. This translates to €10.1 million cost-savings from a societal perspective and 645 QALYs saved. Results were consistent across all analyses and most sensitive to variations surrounding VE and coverage. These findings highlight the importance of increasing vaccine coverage, and ability to induce higher levels of protection with mRNA-1273 formulations in this vulnerable population.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140150058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-07DOI: 10.1101/2024.03.04.24303762
Silas Bukuno Bujitie, Yusuf Haji Daud
Background Many low-and middle-income countries are affected by catastrophic health expenditures as out-of-pocket payments exceed the World Health Organization’s (WHO) 10% threshold level. The government of Ethiopia has been working to reduce out-of-pocket payments from 37% to less than 15% in its health sector transformation plan II; however, the scheme was marked by a low membership and dropout rate. The aim of the study was to identify determinants of enrolment into a community-based health insurance scheme (CBHIS) in Arba Minch Zuria District of Gamo Zone, Southern Ethiopia. Methods Unmatched case-control study was employed from February 8, 2023, to March 9, 2023, among 327 participants (109 cases and 218 controls to community-based health insurance (CBHI) scheme) in a 1:2 proportions. Multi-stage sampling technique was used to draw the study participants. Data were collected by using structured interviewer administered questionnaire and then entered into Epi-data and exported to SPSS for analysis. Bivariable and multivariable analysis was carried out using binary logistic regression. Significance was declared by using an adjusted odds ratio (AOR) with 95% confidence interval (CIs) and a p value of <0.05. Results A total of 327 participants (109 enrolled and 218 non-enrolled) were interviewed, resulting in a response rate of 100%. Family size (AOR=1.66; 95% CI: 1.00–2.73), wealth index (AOR=2.29; 95% CI: 1.25–4.19), awareness level of the community based health insurance scheme (AOR=3.78; 95% CI: 1.09–13.18), and perceived quality of health care (AOR=1.67; 95% CI: 1.02-2.75) were found to be determinant factors of enrollment in the scheme. Conclusion Strengthening community awareness activities, focusing on families of poor households, and improving the quality of health service delivery are highly recommended to improve enrollment in the scheme.
{"title":"Factors that affect enrollment into a community-based health insurance scheme among households in Arba Minch Zuria District, Gamo Zone, Southern Ethiopia, 2023: A community-based, unmatched case-control Study","authors":"Silas Bukuno Bujitie, Yusuf Haji Daud","doi":"10.1101/2024.03.04.24303762","DOIUrl":"https://doi.org/10.1101/2024.03.04.24303762","url":null,"abstract":"Background Many low-and middle-income countries are affected by catastrophic health expenditures as out-of-pocket payments exceed the World Health Organization’s (WHO) 10% threshold level. The government of Ethiopia has been working to reduce out-of-pocket payments from 37% to less than 15% in its health sector transformation plan II; however, the scheme was marked by a low membership and dropout rate. The aim of the study was to identify determinants of enrolment into a community-based health insurance scheme (CBHIS) in Arba Minch Zuria District of Gamo Zone, Southern Ethiopia. Methods Unmatched case-control study was employed from February 8, 2023, to March 9, 2023, among 327 participants (109 cases and 218 controls to community-based health insurance (CBHI) scheme) in a 1:2 proportions. Multi-stage sampling technique was used to draw the study participants. Data were collected by using structured interviewer administered questionnaire and then entered into Epi-data and exported to SPSS for analysis. Bivariable and multivariable analysis was carried out using binary logistic regression. Significance was declared by using an adjusted odds ratio (AOR) with 95% confidence interval (CIs) and a p value of <0.05. Results A total of 327 participants (109 enrolled and 218 non-enrolled) were interviewed, resulting in a response rate of 100%. Family size (AOR=1.66; 95% CI: 1.00–2.73), wealth index (AOR=2.29; 95% CI: 1.25–4.19), awareness level of the community based health insurance scheme (AOR=3.78; 95% CI: 1.09–13.18), and perceived quality of health care (AOR=1.67; 95% CI: 1.02-2.75) were found to be determinant factors of enrollment in the scheme. Conclusion Strengthening community awareness activities, focusing on families of poor households, and improving the quality of health service delivery are highly recommended to improve enrollment in the scheme.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140071931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction Primary Human Papilloma Virus (HPV) testing offers higher sensitivity and specificity over Visual Inspection using Acetic acid (VIA) in cervical cancer screening. Self-sampling is a promising strategy to boost participation and reduce disparities. However, concerns about the initial costs hinder HPV testing adoption in low and middle-income countries. This study assesses the cost-utility of home-based HPV self-sampling versus VIA for cervical cancer screening in India Methods A cross-sectional study was conducted in East district, Sikkim, India, comparing the costs and utility outcomes of population-based cervical cancer screening through VIA and primary HPV screening through self-sampling. Cost-related data were collected from April 2021 to March 2022 using the bottom-up micro-costing method, while utility measures were collected prospectively using the EuroQoL-5D-5L questionnaire. The utility values were converted into quality-adjusted life days (QALDs) for an 8-day period. The willingness to pay threshold (WTP) was based on per capita GDP for 2022. . If the calculated Incremental Cost-Effectiveness Ratio (ICER) value is lower than the WTP threshold, it signifies that the intervention is cost-effective. Results The study included 95 women in each group of cervical cancer screening with VIA & HPV self-sampling. For eight days, the QALD was found to be 7.977 for the VIA group and 8.0 for the HPV group. The unit cost per woman screened by VIA and HPV self-testing was ?1,597 (US$ 19.2) and ?1,271(US$ 15.3), respectively. The ICER was ?-14,459 (US$ -173.6), which was much below the WTP threshold for eight QALDs, i.e. ? 4,193 (US$ 50.4). Conclusion The findings support HPV self-sampling as a cost-effective alternative to VIA. This informs policymakers and healthcare providers for better resource allocation in cervical cancer screening in Sikkim.
{"title":"Cost-utility analysis of primary HPV testing through home-based self-sampling in comparison to visual inspection using acetic acid for cervical cancer screening in East district, Sikkim, India, 2023","authors":"Roopa Hariprasad, Bhavani Shankara Bagepally, Sajith Kumar, Sangeeta Pradhan, Deepsikka Gurung, Harki Tamang, Arpana Sharma, Tarun Bhatnagar","doi":"10.1101/2024.03.03.24303673","DOIUrl":"https://doi.org/10.1101/2024.03.03.24303673","url":null,"abstract":"Introduction\u0000Primary Human Papilloma Virus (HPV) testing offers higher sensitivity and specificity over Visual Inspection using Acetic acid (VIA) in cervical cancer screening. Self-sampling is a promising strategy to boost participation and reduce disparities. However, concerns about the initial costs hinder HPV testing adoption in low and middle-income countries. This study assesses the cost-utility of home-based HPV self-sampling versus VIA for cervical cancer screening in India Methods\u0000A cross-sectional study was conducted in East district, Sikkim, India, comparing the costs and utility outcomes of population-based cervical cancer screening through VIA and primary HPV screening through self-sampling. Cost-related data were collected from April 2021 to March 2022 using the bottom-up micro-costing method, while utility measures were collected prospectively using the EuroQoL-5D-5L questionnaire. The utility values were converted into quality-adjusted life days (QALDs) for an 8-day period. The willingness to pay threshold (WTP) was based on per capita GDP for 2022. . If the calculated Incremental Cost-Effectiveness Ratio (ICER) value is lower than the WTP threshold, it signifies that the intervention is cost-effective. Results\u0000The study included 95 women in each group of cervical cancer screening with VIA & HPV self-sampling. For eight days, the QALD was found to be 7.977 for the VIA group and 8.0 for the HPV group. The unit cost per woman screened by VIA and HPV self-testing was ?1,597 (US$ 19.2) and ?1,271(US$ 15.3), respectively. The ICER was ?-14,459 (US$ -173.6), which was much below the WTP threshold for eight QALDs, i.e. ? 4,193 (US$ 50.4). Conclusion\u0000The findings support HPV self-sampling as a cost-effective alternative to VIA. This informs policymakers and healthcare providers for better resource allocation in cervical cancer screening in Sikkim.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"266 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140033279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Exploring the impact of national health expenditure and its allocation on neonate and child mortality can help policy makers implement strategies aimed at achieving target 3.2 of Sustainable Development Goals (SDGs). The aim of the current study is to explore the impact of selected indicators of national health accounts on neonate and under-5 mortality across 188 countries from 2000 to 2019. Methods and findings This study has an ecological design. Data on health expenditure was obtained from the Global Health Expenditure Database (GHED) for 188 countries from 2000 to 2019. The Global Burden of Disease study (GBD) 2019 data on neonatal and under 5 mortality rates at national levels from 2000 to 2019 were obtained from the website of the Global Health Data Exchange (GHDx) supported by the Institute for Health Metrics and Evaluation. The income groups were stratified based on the World Bank classification. We employed a mixed-effects regression model to investigate the association of different health account indicators with changes in neonatal and under-5 mortality rates over time across countries. We used the Multiple Change Points model to determine the turning points in the association of health expenditure per capita with mortality across countries in 2019. And finally, we estimated the observed-to-expected ratio of mortality based on the segmented regression model for all 188 countries in 2019. Increase in the current health expenditure in International dollar Purchasing Power Parity (Int$ PPP) per capita was associated with lower mortality among both neonates and children in all strata of countries. Reductions were very minimal among high-income countries and were generally more prominent in low-income countries and decreased along with increase in income. Reductions were more noteworthy for under-5 mortality rates. The percentage of domestic general government health expenditure and the percentage of compulsory financing arrangements out of current health expenditure were inversely associated with mortality, while the association of percentage of domestic private health expenditure and out-of-pocket expenditure out of current health expenditure with mortality was positive. Results showed that the reduction in neonatal mortality associated with each ten-dollar increase in current health expenditure per capita is significantly more prominent for per capita expenditures less that the cut-point of 480 Int$ PPP per capita. The respective figure for under-5 mortality was 386 Int$ PPP per capita. Ultimately, a total of 110 countries had observed versus expected ratio less than one for neonatal mortality and 118 countries for child mortality. Conclusions Increase in health expenditure is significantly associated with decrease in neonate and under-5 mortality especially among low and low-middle income countries. However, the association fades among countries in which health expenditure per capita is higher than the threshold. In all countr
{"title":"Exploring the Impact of Health Expenditure and Its Allocation on Neonatal and Child Mortality at National Level Across 188 Countries from 2000 to 2019: Insights from the Global Burden of Disease Study","authors":"Ali Sheidaei, Negar Rezaei, Maryam Sharafkhah, Hossein Poustchi, Mohammadreza Mobinizadeh, Marita Mohammadshahi, Mohsen Naghavi, Alireza Olyaeemanesh, Reza Malekzadeh, Alireza Delavari, Sadaf G. Sepanlou","doi":"10.1101/2024.02.29.24303584","DOIUrl":"https://doi.org/10.1101/2024.02.29.24303584","url":null,"abstract":"Background Exploring the impact of national health expenditure and its allocation on neonate and child mortality can help policy makers implement strategies aimed at achieving target 3.2 of Sustainable Development Goals (SDGs). The aim of the current study is to explore the impact of selected indicators of national health accounts on neonate and under-5 mortality across 188 countries from 2000 to 2019.\u0000Methods and findings This study has an ecological design. Data on health expenditure was obtained from the Global Health Expenditure Database (GHED) for 188 countries from 2000 to 2019. The Global Burden of Disease study (GBD) 2019 data on neonatal and under 5 mortality rates at national levels from 2000 to 2019 were obtained from the website of the Global Health Data Exchange (GHDx) supported by the Institute for Health Metrics and Evaluation. The income groups were stratified based on the World Bank classification. We employed a mixed-effects regression model to investigate the association of different health account indicators with changes in neonatal and under-5 mortality rates over time across countries. We used the Multiple Change Points model to determine the turning points in the association of health expenditure per capita with mortality across countries in 2019. And finally, we estimated the observed-to-expected ratio of mortality based on the segmented regression model for all 188 countries in 2019. Increase in the current health expenditure in International dollar Purchasing Power Parity (Int$ PPP) per capita was associated with lower mortality among both neonates and children in all strata of countries. Reductions were very minimal among high-income countries and were generally more prominent in low-income countries and decreased along with increase in income. Reductions were more noteworthy for under-5 mortality rates. The percentage of domestic general government health expenditure and the percentage of compulsory financing arrangements out of current health expenditure were inversely associated with mortality, while the association of percentage of domestic private health expenditure and out-of-pocket expenditure out of current health expenditure with mortality was positive. Results showed that the reduction in neonatal mortality associated with each ten-dollar increase in current health expenditure per capita is significantly more prominent for per capita expenditures less that the cut-point of 480 Int$ PPP per capita. The respective figure for under-5 mortality was 386 Int$ PPP per capita. Ultimately, a total of 110 countries had observed versus expected ratio less than one for neonatal mortality and 118 countries for child mortality.\u0000Conclusions Increase in health expenditure is significantly associated with decrease in neonate and under-5 mortality especially among low and low-middle income countries. However, the association fades among countries in which health expenditure per capita is higher than the threshold. In all countr","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140017618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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