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Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. t r a c tIntroduction: Respiratory syncytial virus (RSV) infection is one of the major causes of respiratory illness in infants, infecting virtually every child before the age of 2 years. Currently, several Phase 1 trials with RSV vaccines in infants are ongoing or have been completed. As yet, no efficacy estimates are available for these vaccine candidates. Nevertheless, cost-effectiveness estimates might be informative to enable preliminary positioning of an RSV vaccine. Methods: A decision analysis model was developed in which a Dutch birth cohort was followed for 12 months. A number of potential vaccination strategies were reviewed such as vaccination at specific ages, a two-or three-dosing scheme and seasonal vaccination versus year-round vaccination. The impact of the assumptions made was explored in various sensitivity analyses, including probabilistic analysis. Outcome measures included the number of GP visits, hospitalizations and deaths, costs, quality-adjusted life years and incremental cost-effectiveness ratios (ICERs). Results: Currently, without vaccination, an annual number of 28,738 of RSV-related GP visits, 1623 hospitalizations, and 4.5 deaths are estimated in children in the age of 0-1 year. The total annual cost to society of RSV in the non-vaccination scenario is D 7.7 million (95%CI: 1.7-16.7) and the annual disease burden is estimated at 597 QALYs (95%CI: 133-1319). In case all infants would be offered a potentially safe and effective 3-dose RSV vaccination scheme at the age of 0, 1 and 3 months, the total annual net costs were estimated to increase to D 21.2 million, but 544 hospitalizations and 1.5 deaths would be averted. The ICER was estimated at D 34,142 (95%CI: D 21,652-D 87,766) per QALY gained. A reduced dose schedule, seasonal vaccination, and consideration of out-of-pocket expenses all resulted in more favorable ICER values, whereas a reduced vaccine efficacy or a delay in the timing of vaccination resulted in less favorable ICERs. Discussion: Our model used recently updated estimates on the burden of RSV disease in children and it included plausible utilities. However, due to the absence of clinical trial data, a number of crucial assumptions had to be made related to the characteristics of potential RSV vaccine. The outcomes of our modeling exercise show that vaccination of infants against RSV might be cost-effective. However, clinical trial data are warranted.

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versus DRV/r. CONCLUSIONS: The value of initiation with ATV/r in terms of durable viral suppression and favourable side-effect profile was most prominent in Spain. In general, starting with ATV/r is suggested to be a cost-effective treatment strategy for HIV-1 treatment-naïve patients in most of the country-specific comparisons made.OBJECTIVES: Streptococcus pneumoniae is a leading cause of life-threatening pneumococcal diseases (PDs). In Germany, PPV23 has been recommended in the elderly (aged 60 and over) since 1998. In 2006, the pneumococcal conjugate vaccine (PCV) was introduced in children. The US experience showed that PCV vaccination of children led, ten years after its introduction, to a decrease in IPD incidence caused by the PCV serotypes not only in vaccinated children but also in unvaccinated adults. This study aimed to re-assess the good cost-effectiveness profile of PPV23 vs. no vaccination (NoVac) in the elderly in Germany, accounting for epidemiological changes in adults due to PCV vaccination of children. METHODS: A populationbased Markov model was developed, consisting of five health states: no PD, IPD (invasive PD), NBPP (non-bacteraemic pneumococcal pneumonia), post-meningitis sequelae (PMS) and death. A cohort of individuals was followed until death assuming vaccination or no vaccination. IPD and NBPP incidence were retrieved from German sources, while the changes in IPD incidence were estimated based on US data. IPD and NBPP case-fatality rates, probability of developing PMS, vaccine effectiveness, vaccine waning function and utilities were retrieved from the published literature. A discount rate of 3% was applied to costs and effects. RESULTS: PPV23 was associated with a discounted increment of 1,587 QALYs. From the third party payer's (TPP) perspective, incremental costs were estimated at €28 million and the ICER was €17,700/QALY gained. From the societal perspective, PPV23 was associated with an increment of €14 million, and the ICER was €8579/QALY gained. Results were sensitive to vaccine effectiveness and epidemiological trends assumptions. CONCLUSIONS: The model suggests that vaccinating the elderly with PPV23 is cost-effective in Germany. As PPV23 covers 80%-90% of all serotypes causing IPD, it is still cost-effective despite the reduction in IPD incidence in adults due to PCV vaccination of children.

Prevalence of Johne's on US dairy farms is estimated at one-fifth of all herds, and is higher for the population of large herds. Of the animals which test positive for MAP, high levels of bacterial shedding are noted in only a small proportion. Despite this low prevalence of high-shedding animals, elimination of MAP from herds has proven exceptionally challenging, with few published reports of successful eradication of MAP from infected farms. Mathematical modeling may aid us in the understanding of this apparent contradiction.