RESUMO
OBJECTIVES: To evaluate cost implications of a hexavalent vaccine (diphtheria, tetanus, and acellular pertussis [DTaP]-inactivated polio vaccine [IPV]-hepatitis B [HB]-Haemophilus influenzae type B [Hib] polysaccharide conjugated to T protein [PRPâ¼T]) as an alternative to DT-whole-cell pertussis (wP)-HB//Hib, DTwP, IPV, and oral polio vaccines in the Expanded Program on Immunization schedule in Colombia. METHODS: Primary vaccination (DTaP-IPV-HB-PRPâ¼T or DTwP-HB-Hib + IPV [2, 4, 6 months]) and booster (DTaP-IPV-HB-PRPâ¼T or DTwP + oral polio vaccine [18 months]) (scenario 1) and primary vaccination only (DTaP-IPV-HB-PRPâ¼T or DTwP-HB-Hib + IPV) (scenario 2) were evaluated. An estimated cost-minimization analysis was based on a micro costing technique for vaccination-associated activities. Adverse event (AE)-associated costs, out-of-pocket costs, and productivity losses for caregivers were included. A budget impact (12-month temporal horizon) was estimated according to the distribution of full-term and premature infants. A 5% annual discount rate was used. A 2-way univariate (tornado) analysis evaluated which variables had the greatest impact on the overall cost. RESULTS: DTaP-IPV-HB-PRPâ¼T resulted in a cost increase of 29.38% (scenario 1) and 22.19% (scenario 2) for full-term infants and a decrease of 0.99% (scenario 1) and 18.88% (scenario 2) for premature infants, probably because of the higher incidence of wP-related AEs and associated costs in premature infants. With a 100% replacement rate, the budget impact for full-term infants and full-term plus premature infants was 23.73% and 21.80% (scenario 1), respectively, and 13.02% and 11.14% (scenario 2), respectively, of the national immunization program budget. The variables with most impact were the hexavalent vaccine price and costs associated with the pentavalent safety profile. CONCLUSIONS: Incorporation of the hexavalent vaccine in the Expanded Program on Immunization schedule would lead to an increase in spending largely mitigated by reduced AE incidence and reduced logistic and social costs.
Assuntos
Vacina contra Difteria, Tétano e Coqueluche/economia , Vacinas Anti-Haemophilus/economia , Vacinas contra Hepatite B/economia , Programas de Imunização , Vacina Antipólio de Vírus Inativado/economia , Colômbia , Humanos , Programas de Imunização/economia , Imunização Secundária , Lactente , Vacinas Combinadas/economiaRESUMO
OBJECTIVE: to compare the direct cost, from the perspective of the Unified Health System, of assessing the post-vaccination serological status with post-exposure management for hepatitis B among health care workers exposed to biological material. METHOD: cross-sectional study and cost-related, based on accident data recorded in the System of Information on Disease Notification between 2006 and 2016, where three post-exposure and one pre-exposure management scenarios were evaluated: A) accidents among vaccinated workers with positive and negative serological status tests for hepatitis B, exposed to known and unknown source-person; B) handling unvaccinated workers exposed to a known and unknown source-person; C) managing vaccinated workers and unknown serological status for hepatitis B and D) cost of the pre-exposure post-vaccination test. Accidents were assessed and the direct cost was calculated using the decision tree model. RESULTS: scenarios where workers did not have protective titles after vaccination or were unaware of the serological status and were exposed to a positive or unknown source-person for hepatitis B. CONCLUSION: the direct cost of hepatitis B prophylaxis, including confirmation of serological status after vaccination would be more economical for the health system.
Assuntos
Anticorpos Antivirais/sangue , Pessoal de Saúde/estatística & dados numéricos , Antígenos de Superfície da Hepatite B/sangue , Vacinas contra Hepatite B/economia , Vírus da Hepatite B/imunologia , Hepatite B/prevenção & controle , Exposição Ocupacional/economia , Adulto , Estudos Transversais , Feminino , Pessoal de Saúde/economia , Hepatite B/economia , Humanos , Masculino , Vacinação/economiaRESUMO
BACKGROUND: The phased withdrawal of oral polio vaccine (OPV) and the introduction of inactivated poliovirus vaccine (IPV) is central to the polio 'end-game' strategy. METHODS: We analyzed the cost implications in Chile of a switch from the vaccination scheme consisting of a pentavalent vaccine with whole-cell pertussis component (wP) plus IPV/OPV vaccines to a scheme with a hexavalent vaccine with acellular pertussis component (aP) and IPV (Hexaxim®) from a societal perspective. Cost data were collected from a variety of sources including national estimates and previous vaccine studies. All costs were expressed in 2017 prices (US$ 1.00 = $Ch 666.26). RESULTS: The overall costs associated with the vaccination scheme (4 doses of pentavalent vaccine plus 1 dose IPV and 3 doses OPV) from a societal perspective was estimated to be US$ 12.70 million, of which US$ 8.84 million were associated with the management of adverse events related to wP. In comparison, the cost associated with the 4-dose scheme with a hexavalent vaccine (based upon the PAHO reference price) was US$ 19.76 million. The cost of switching to the hexavalent vaccine would be an additional US$ 6.45 million. Overall, depending on the scenario, the costs of switching to the hexavalent scheme would range from an additional US$ 2.62 million to US$ 6.45 million compared with the current vaccination scheme. CONCLUSIONS: The switch to the hexavalent vaccine schedule in Chile would lead to additional acquisition costs, which would be partially offset by improved logistics, and a reduction in adverse events associated with the current vaccines.
Assuntos
Vacina contra Difteria, Tétano e Coqueluche/administração & dosagem , Vacina contra Difteria, Tétano e Coqueluche/economia , Substituição de Medicamentos/economia , Vacinas Anti-Haemophilus/administração & dosagem , Vacinas Anti-Haemophilus/economia , Vacinas contra Hepatite B/administração & dosagem , Vacinas contra Hepatite B/economia , Poliomielite/prevenção & controle , Vacina Antipólio de Vírus Inativado/administração & dosagem , Vacina Antipólio de Vírus Inativado/economia , Vacina Antipólio Oral/administração & dosagem , Vacina Antipólio Oral/economia , Vacinação/economia , Chile , Custos e Análise de Custo , Humanos , Esquemas de Imunização , Lactente , Vacinas Combinadas/administração & dosagem , Vacinas Combinadas/economiaRESUMO
OBJECTIVES: A combination vaccine against hepatitis A and B provides the opportunity for simultaneous protection against both diseases with a single vaccine. This clinical study investigated the reactogenicity and immunogenicity of a combined hepatitis A and B vaccine (Twinrix, GlaxoSmithKline Biologicals, Rixensart, Belgium) in healthy Chilean adults between 18 and 40 years of age. METHODS: In total, 345 healthy, seronegative health care workers were enrolled and randomized to three groups who received one of three lots of Twinrix on a 0-, 1- and 6-month schedules. Blood samples were screened 1 month after each dose for anti-HAV and anti-HBs antibodies. Reactogenicity after each dose was assessed using diary cards. RESULTS: The nature and incidence of symptoms were similar to those reported for other Twinrix studies. Very few symptoms were scored as severe. Upon completion of the vaccination, all subjects had anti-HAV antibodies with titers $6000 mIU/mL, and all but one were protected against hepatitis B, with titers $4000 mIU/mL. CONCLUSIONS: We have demonstrated the high immunogenicity and tolerance of the combined hepatitis A and B vaccine. Combined vaccination has the advantage of offering dual protection with a reduction in the number of injections needed, lower associated costs, and a positive impact on compliance.
Assuntos
Vacinas contra Hepatite A/efeitos adversos , Vacinas contra Hepatite A/imunologia , Vírus da Hepatite A/imunologia , Vacinas contra Hepatite B/efeitos adversos , Vacinas contra Hepatite B/imunologia , Vírus da Hepatite B/imunologia , Vacinas Combinadas/efeitos adversos , Vacinas Combinadas/imunologia , Adolescente , Adulto , Chile , Método Duplo-Cego , Feminino , Saúde , Anticorpos Anti-Hepatite A , Vacinas contra Hepatite A/economia , Anticorpos Anti-Hepatite/sangue , Anticorpos Anti-Hepatite B/sangue , Vacinas contra Hepatite B/economia , Humanos , Esquemas de Imunização , Masculino , Pessoa de Meia-Idade , Vacinas Combinadas/economiaRESUMO
OBJECTIVE: To analyze factors associated with hepatitis B immunization adherence among adolescents attending a sexually transmitted disease (STD) clinic in El Paso, a city in Texas that is on the border between Mexico and the United States of America. METHODS: In this cohort study with 248 adolescents we obtained data on demographics and health beliefs through personal interviews and medical record abstraction. We monitored each of the individuals for 8 months to determine whether the adolescents received a first, second, and third dose of the hepatitis B vaccine. RESULTS: Overall, 32% of the adolescents received the first immunization, 9% the second, and 2% the third. The strongest predictor of receiving either one or two doses was providing the vaccine at the STD clinic as opposed to referring adolescents to a separate vaccination clinic (relative risk (RR) for receiving the first immunization = 7.3; RR for receiving the second immunization = 3.8). Several health beliefs were also associated with receiving vaccinations. CONCLUSIONS: The results of our study indicate that hepatitis B vaccination programs can be improved through such steps as providing vaccinations at a convenient site, educating adolescents about hepatitis B risk factors, and emphasizing the difficulty of treating hepatitis B infection.
Assuntos
Vacinas contra Hepatite B/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Criança , Estudos de Coortes , Custos e Análise de Custo , Feminino , Humanos , Masculino , México , Análise Multivariada , Fatores de Risco , Estados UnidosRESUMO
BACKGROUND: Hepatitis B virus (HBV) infection is one of the infectious diseases whose elimination or eradication is possible. However, it is still a serious problem among health workers who are an important risk group to acquire this infection. OBJECTIVE: To focus the problem of the HBV infection among health workers in terms of the risks and prevention alternatives, showing effective strategies to this effect. DATA SOURCE: Analysis of related publications through the MEDLINE system and the review of scientific journals, both in English and Spanish. SYNTHESIS OF INFORMATION: An available and effective vaccine against HBV exist more than 10 years ago. Some national hospitals have demonstrated the prevalence of HBV infection in apparently healthy staff, which evidences that it is an occupational problem. The vaccination of this risk group has proved to reduce the HBV infection in several centers in different countries, in addition to the cost-effectiveness of this measure. CONCLUSION: HBV infection constitutes a significant problem in our country considering its intermediate high endemic rate. No effective measures for its control have been taken, despite the availability of effective vaccines and strategies for the control and prevention of this disease, not to mention their economic benefits.
Assuntos
Pessoal de Saúde , Hepatite B/epidemiologia , Doenças Profissionais , Idoso , Análise Custo-Benefício , Feminino , Hepatite B/prevenção & controle , Hepatite B/transmissão , Vacinas contra Hepatite B/administração & dosagem , Vacinas contra Hepatite B/economia , Humanos , Masculino , Doenças Profissionais/epidemiologia , Doenças Profissionais/prevenção & controle , Peru , Fatores de RiscoRESUMO
In order to optimize the employment of financial resources to be allocated for hepatitis B vaccination programs involving health care workers, two different aspects were studied: the need of a pre-vaccination screening and the efficacy of low-doses schedules of HBV vaccine by the intradermal (ID) route. The economical analysis (a cost-minimization study) showed that when the prevalence of immune individuals is higher than 11 per cent it is more cost-effective to perform pre-vaccination screening. This situation was observed in the employees group. For students and doctors vaccination without screening was the best approach. Regarding the schedules, 3 doses of HBV vaccine by the intramuscular (IM) route (group A) were compared to first dose by the ID route and second and third doses by the IM route (group B) and to first and second doses by the ID route and the last dose by the IM route (group C). After the third dose, soroconversion rates in groups A and B (92 per cent and 93 per cent, respectively) and geometric mean titers of antiHBs (1278 UI/L and 789.6 UI/L) were similar, and both were different from group A (p < 0.05), showing that alternative vaccination schedules may be cost-effective.
Assuntos
Humanos , Pessoal de Saúde , Vacinas contra Hepatite B/imunologia , Hepatite B/economia , Recursos em Saúde/economia , Brasil , Análise Custo-Benefício , Relação Dose-Resposta Imunológica , Anticorpos Anti-Hepatite B/sangue , Vacinas contra Hepatite B/administração & dosagem , Vacinas contra Hepatite B/economia , Hepatite B/imunologia , Hepatite B/prevenção & controle , Pessoal de Saúde/economia , Recursos em SaúdeRESUMO
In order to optimize the employment of financial resources to be allocated for hepatitis B vaccination programs involving health care workers, two different aspects were studied: the need of a pre-vaccination screening and the efficacy of low-doses schedules of HBV vaccine by the intradermal (ID) route. The economical analysis (a cost-minimization study) showed that when the prevalence of immune individuals is higher than 11% it is more cost-effective to perform pre-vaccination screening. This situation was observed in the employees group. For students and doctors vaccination without screening was the best approach. Regarding the schedules, 3 doses of HBV vaccine by the intramuscular (IM) route (group A) were compared to first dose by the ID route and second and third doses by the IM route (group B) and to first and second doses by the ID route and the last dose by the IM route (group C). After the third dose, soroconversion rates in groups A and B (92% and 93%, respectively) and geometric mean titers of antiHBs (1278 UI/L and 789.6 UI/L) were similar, and both were different from group A (p < 0.05), showing that alternative vaccination schedules may be cost-effective.
Assuntos
Pessoal de Saúde , Recursos em Saúde/estatística & dados numéricos , Vacinas contra Hepatite B/imunologia , Hepatite B/prevenção & controle , Brasil , Análise Custo-Benefício , Relação Dose-Resposta Imunológica , Pessoal de Saúde/economia , Recursos em Saúde/economia , Hepatite B/economia , Hepatite B/imunologia , Anticorpos Anti-Hepatite B/sangue , Vacinas contra Hepatite B/administração & dosagem , Vacinas contra Hepatite B/economia , HumanosRESUMO
A seroprevalence survey of hepatitis B virus (HBV) markers was conducted among health care workers in Belize to help determine the epidemiology of hepatitis B and to determine if screening before immunization might lower vaccine costs. Of the 330 workers tested, 94 (29%) were positive for antibody to HBV core antigen (anti-HBc) and three (1%) had HBV surface antigen. The presence of anti-HBc increased significantly with age from 12% in those 18-24 years old to 52% in those > or = 50 years old. The rate was 17% of 48 men compared with 30% of 282 women (P = 0.05). Rates increased with years of medical service and were higher among nurses (69 of 228; 30%) and nonprofessional staff (15 of 44; 34%) than among physicians (0 of 20). The presence of anti-HBc also differed significantly among ethnic groups: Mestizo, 4%; Creole, 33% and Garifuna, 57%. Rates differed by district ranging from 3% in a northern district (mostly Mestizo) to 67% in a southern district (mostly Garifuna). Parental exposure to hepatitis B through needle stick injuries and blood transfusions was not associated with anti-HBc. Multiple logistic regression analysis confirmed ethnicity, district of residence, and age as the best predictors of anti-HBc in health care workers. Cost analysis suggests that because of regional differences in exposure, testing of health care workers for anti-HBc in the Belize and Stann Creek districts in southern Belize before hepatitis B immunization would result in vaccine program cost savings.
Assuntos
Pessoal de Saúde , Vírus da Hepatite B/imunologia , Hepatite B/epidemiologia , Doenças Profissionais/epidemiologia , Adolescente , Adulto , Idoso , Anticorpos Antivirais/análise , Belize/epidemiologia , Ensaio de Imunoadsorção Enzimática , Etnicidade , Feminino , Hepatite B/imunologia , Hepatite B/prevenção & controle , Antígenos do Núcleo do Vírus da Hepatite B/imunologia , Antígenos de Superfície da Hepatite B/imunologia , Vacinas contra Hepatite B/economia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/imunologia , Doenças Profissionais/prevenção & controle , Prevalência , VacinaçãoRESUMO
A seroprevalence survey of hepatitis B virus (HBV) markers was conducted among health care workers in Belize to help determine the epidemiology of hepatitis B and to determine if screening before immunization might lower vaccine costs. Of the 330 workers tested, 94 (29 percent) were positive for antibody to HBV core antigen (anti-HBc) and three (1 percent) had HBV surface antigen. The presence of anti-HBc increased significantly with age from 12 percent in those 18-24 years old to 52 percent in those o 50 years old. The rate was 17 percent of 48 men compared with 30 percent of 282 women (P = 0.05). Rates increased with years of medical service and were higher among nurses (69 of 228; 30 percent) and nonprofessional staff (15 of 44; 34 percent) than among physicians (0 of 20). The presence of anti-HBc also differed significantly among ethnic groups: Mestizo, 4 percent; Creole, 33 percent and Garifuna, 57 percent. Rates differed by district ranging from 3 percent in a northern district (mostly Mestizo) to 67 percent in a southern district (mostly Garifuna). Parenteral exposure to hepatitis B through needle stick injuries and blood transfusions was not associated with anti-HBc. Multiple logistic regression analysis confirmed ethnicity, district of residence, and age as the best predictors of anti-HBc in health care workers. Cost analysis suggests that because of regional differences in exposure, testing of health care workers for anti-HBc in the Belize and Stann Creek districts in southern Belize before hepatitis B immunization would result in vaccine program cost savings (AU)