Health economic evaluation of a vaccine for the prevention of herpes zoster (shingles) and post-herpetic neuralgia in adults in Belgium

Abstract

Objective:

To determine the cost-effectiveness of vaccination against herpes zoster (HZ) and post-herpetic neuralgia (PHN) in individuals aged 60 years and older in Belgium.

Methods:

A Markov model was developed to compare the cost-effectiveness of vaccination with that of a policy of no vaccination. The model estimated the lifetime incidence and consequences of HZ and PHN using inputs derived from Belgian data, literature sources, and expert opinion. Cost-effectiveness was measured by the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life-year (QALY) gained.

Results:

Vaccination in individuals aged 60 years and older resulted in ICERs of €6,799 (third party payer perspective), €7,168 (healthcare perspective), and €7,137 (societal perspective). The number needed to vaccinate to prevent one case was 12 for HZ, and 35 or 36 for PHN depending on the definition used. Univariate sensitivity analyses produced ICERs of €4,959–19,052/QALY; duration of vaccine efficacy had the greatest impact on cost-effectiveness. Probabilistic sensitivity analysis showed at least a 94% probability of ICERs remaining below the unofficial €30,000 threshold.

Discussion:

Key strengths of the model are the combination of efficacy data from a pivotal clinical trial with country-specific epidemiological data and complete sensitivity analysis performed. Main limitations are the use of non country-specific PHN proportion and non Belgian disease-specific utilities. Results are comparable with those recently published.

Conclusions:

HZ vaccination in individuals aged 60 years and older would represent a cost-effective strategy in Belgium.     

Explaining vaccination decisions: A system dynamics model of the interaction between epidemiological and behavioural factors

The WHO goal of eradicating measles is delayed by widespread scepticism of parents against the recommended MMR vaccination. In this context, a model of the prevalence of measles that incorporates behavioural aspects is desirable. Parental decisions can be influenced by epidemiological and behavioural factors. The former include vaccination coverage and its impact on the prevalence of the disease. The latter include perceptions of the risk to be infected, which affects vaccination decisions, as well as government campaigns to affect vaccination behaviour, vaccination scares or changes in disease control policies. We develop a model that incorporates both kinds of effects. In particular, we illustrate how incorporating parental response to a change in the prevalence of the disease impacts the outcome of governmental policies aiming to increase the vaccination coverage. While calibrated to measles, this model is also applicable to other childhood diseases, such as pertussis or diphtheria. Different scenarios illustrate the long-term consequences of the interaction between health policies (in particular, vaccination campaigns) or the agenda of social institutions (e.g., drawing attention to specific events to create vaccination scares) and parental reactions. Periodic ups and downs of the disease's prevalence, characteristic of epidemiological feedback, are the consequence of the interaction between parental behaviour and events such as vaccination campaigns or vaccination scares. International and national health authorities, pursuing the fight against measles, may be helped by the potential of the model to provide understanding in the way different predictors of vaccination behaviour interact.     

A comparative study of eight COVID-19 protective measures and their impact on Swiss tourists’ travel intentions

A comparative vignette-based experimental survey design incorporating various socio-psychological factors, linked to the Theory of Planned Behavior (TPB), the Health Belief Model (HBM) and the Domain-Specific Risk-Taking scale (DOSPERT) was carried out to test variations in eight travel-related COVID-19 protective measures on Swiss tourists’ travel intentions. Among the tested measures, vaccination passports, surgical masks and quarantining are those that stand out the most, with surgical masks having the greatest acceptance and willingness to adopt while traveling. Quarantining, on the other hand, appears to have a deterrent influence on travel intentions, and vaccination passports have the lowest perceived barriers during travel, but the highest perceived benefits in mitigating the spread of the infection. The discussion of individual differences has specific implications for tourism management against the background of our empirical findings.     

The welfare impact of food pathogen vaccines

Vaccines against several common foodborne pathogens are being developed and could substantially alter the policy tools available to address foodborne illness. However, little analysis is available to suggest how social welfare would be affected by consumer and industry responses to these new vaccines. To address this void, we use stated-preference data to estimate consumer willingness to pay (WTP) for food safety vaccines and then simulate the welfare impacts of subsidizing consumer purchases of the vaccine given two different industry responses: maintaining current levels of food safety vigilance and reducing food safety vigilance due to a moral hazard response that undermines consumer confidence in food safety. To obtain consumer preferences for the vaccine, we simultaneously estimate a three-equation model that recognizes the recursive nature of responses to questions probing respondents’ willingness to purchase vaccines and perceptions of the probability and severity of possible foodborne illness incidents and the joint distribution of unobservable components. Our simulations show large consumer WTP if vaccines are relatively inexpensive while the presence of moral hazard increases respondents’ willingness to pay and voluntary uptake of vaccine.     

People’s willingness to eat meat from animals vaccinated against epidemics

Animal epidemics are associated with significant economic damage and they negatively influence consumers’ meat consumption. Vaccination can be used as a strategy to prevent the outbreak of animal epidemics. The current study examines people’s willingness to eat meat from animals vaccinated against an animal epidemic. We asked people separately about their willingness to eat meat from animals vaccinated against both animal epidemics and against zoonoses. Zoonoses are also animal epidemics, but they might affect human health. A questionnaire was sent out to a representative sample of Swiss people and yielded N = 1033 completed datasets. Although animal vaccinations were highly accepted among those surveyed, compared to a wide range of other animal applications such as antibiotics, only about a quarter of those surveyed indicated that they would eat meat from animals vaccinated against a zoonosis. Some 60% indicated they would eat meat from animals vaccinated against an animal epidemic. We found attitudes about animal vaccination, knowledge about human vaccination, misunderstanding of animal treatments, and average meat consumption to significantly influence people’s willingness to eat meat from animals vaccinated against a zoonosis. Therefore, it is necessary that regulatory bodies provide information on both the safety of meat for human consumption and ways to minimize any potential health risks from the handling or consumption of meat products that might be infected in cases of zoonotic outbreaks.     

The use of Zostavax in Spain: the economic case for vaccination of individuals aged 50 years and older

Background Population aging brings up a number of health issues, one of which is an increased incidence of herpes zoster (HZ) and its complication, post-herpetic neuralgia (PHN). Zostavax vaccine has recently become available to prevent HZ and PHN. This study evaluates the cost-effectiveness of vaccination against HZ in Spain considering a vaccination of the population aged 50 years and older and comparing this to the current situation where no vaccination is being administered.

Methods An existing, validated, and published economic model was adapted to Spain using relevant local input parameters and costs from 2013.

Results Vaccinating 30% of the Spanish population aged 50 years and older resulted in €16,577/QALY gained, €2025/HZ case avoided, and €5594/PHN case avoided under the third-party payer perspective. From a societal perspective, the ICERs increased by 6%, due to the higher price of the vaccine. The number needed to vaccinate to prevent one case was 20 for HZ, and 63 for PHN3. Sensitivity analyses showed that the model was most sensitive to the HZ and PHN epidemiological data, the health state utilities values, and vaccine price used.

Conclusion Considering an acceptable range of cost-effectiveness of €30,000–€50,000 per QALY gained, vaccination of the 50+ population in Spain against HZ with a new vaccine, Zostavax, is cost-effective and makes good use of the valuable healthcare budget.     

Management of vaccinations in Italy: a national survey after healthcare regionalization

Abstract

Objectives:

The main aim of this study was to describe the effects of regional organization and performance in managing vaccinations, in the light of the institutional devolution recently introduced in Italy.

Methods:

We analysed (1) the general organization of regions for vaccination programmes, (2) the management of four vaccination programmes (combined measles-rubella-parotitis, varicella for children, influenza, and pneumococcal 23-valent for adults).

First, we conducted preliminary face-to-face interviews with 16 regional managers of the infective disease prevention departments. Subsequently, we sent them a standardized questionnaire to obtain comparable information on general organization and on the four specific vaccination programmes considered. In all, 14 regions were eventually included.

Results:

The survey showed a widespread lack of regional staff involved in the management of vaccinations and a geographical variation in the availability of computerized data collection. We recorded poor coverage for varicella and pneumococcal 23-valent vaccinations compared to MRP and influenza. Prices of the four vaccines varied widely among regions, with only a weak correlation between prices and volumes.

Limitations and conclusions:

The major limitation of the survey was the lack of information available at regional level. The piecemeal diffusion of computerized systems and the widespread lack of sufficient staff should mainly explain this.

Economic incentives could be offered to regions that achieve national targets. Such incentives should encourage collaboration between central and regional authorities consistent with institutional trends in regional devolution.     

Cost-effectiveness analysis of quadrivalent influenza vaccination in at-risk adults and the elderly: an updated analysis in the UK

Abstract

Objective:

To update an earlier evaluation estimating the cost-effectiveness of quadrivalent influenza vaccination (QIV) compared with trivalent influenza vaccination (TIV) in the adult population currently recommended for influenza vaccination in the UK (all people aged ≥65 years and people aged 18–64 years with clinical risk conditions).     

Partial equilibrium analysis of vaccination as an avian influenza control tool in the U.S. poultry sector

The study addresses the economic effectiveness of vaccination in the case of highly pathogenic avian influenza (HPAI) outbreaks. The effectiveness is evaluated in a U.S. case study comparing the outbreak costs under the currently recommended HPAI control practice versus one which also includes vaccination. An integrated economic‐epidemic partial equilibrium model is used to empirically simulate HPAI outbreaks in three different poultry regions within the State of Texas. The simulation results show that the effectiveness of vaccination depends on flock density in the region and risk aversion preferences of the decision maker. In regions with high flock densities, if the decision maker is less risk averse the currently recommended strategy—which includes depopulation, movement restrictions, and flock testing—is more cost‐effective than the same strategy supplemented with vaccination. Addition of vaccination improves cost effectiveness only if the decision maker is highly risk averse or if surveillance, carcass disposal, and cleaning costs are high. In regions with medium and low flock densities, adding vaccination to the currently recommended strategy is not cost‐effective except in the case of high surveillance, carcass disposal, and cleaning costs.     

An extended picture fuzzy multicriteria group decision analysis with different weights: A case study of COVID-19 vaccine allocation

The high contagion rates of COVID-19 and the limited amounts of vaccines forced public health authorities to develop vaccinations strategies for minimizing mortality, avoiding the collapse of health care infrastructure, and reducing their negative impacts to societies and economies. We propose a Multi Criteria Group Decision Making for prioritizing a set of COVID-19 vaccination alternatives, under a picture fuzzy environment, where the weights for Decisions Experts (DE) and criteria are unknown. A panel of six DEs assess six criteria for prioritizing four groups for vaccination. The weights for DE and criteria are handled in the form of fuzzy sets. Three types of weights are calculated: subjective, objective, and mixture weights.According to our results, three out of the six criteria hold 60% of the strategic importance: 1) allocation and distribution, 2) COVID-19 strains and 3) capabilities and infrastructures. However, persons with comorbidities became the group with the highest priority, followed by essential workers, women, and adults older than 40 years. Governments, decision makers, and policy makers can find rigorous scientific evidence for articulating effective vaccinations campaigns from this work, and contribute to minimize undesired outputs, such as high mortality rates or collapse of hospitals.