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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AF is a serious disease with a high clinical and economic burden, especially due to hospitalisations as a result of cardiovascular events. The number of patients with AF in the Netherlands is considerable and will increase with the ageing population in the future.

To optimally develop or adjust national contingency plans to respond to the next influenza pandemic, we developed a decision type model and estimated the total health burden and direct medical costs during the next possible influenza pandemic in the Netherlands on the basis of health care burden during a regular epidemic. Using an arithmetic decision tree-type model we took into account population characteristics, varying influenza attack rates, health care consumption according to the Dutch health care model and all-cause mortality. Actual direct medical cost estimates were based on the Dutch guidelines for pharmaco-economic evaluation. In the base-case scenario with no preventive measure available and an average influenza attack rate of 30%, 4,958,188 influenza infections, 1,552,687 GP consultations, 83,515 hospitalizations and 173,396 deaths will take place in The Netherlands. The burden is highest in adults aged 20 to 64 years. If minimizing the total mortality and sustaining highest net economic returns is the objective, this group needs to be targeted in interventions.

BackgroundDespite the clinical evidence, influenza vaccination coverage of healthcare workers remains low. To assess the health economic value of implementing an influenza immunization program among healthcare workers (HCW) in University Medical Centers (UMCs) in the Netherlands, a cost‐benefit model was developed using a societal perspective.Methods/PatientsThe model was based on a trial performed among all UMCs in the Netherlands that included both hospital staff and patients admitted to the pediatrics and internal medicine departments. The model structure and parameters estimates were based on the trial and complemented with literature research, and the impact of uncertainty explored with sensitivity analyses.ResultsIn a base‐case scenario without vaccine coverage, influenza‐related annual costs were estimated at € 410 815 for an average UMC with 8000 HCWs and an average occupancy during the influenza period of 6000 hospitalized patients. Of these costs, 82% attributed to the HCWs and 18% were patient‐related. With a vaccination coverage of 15.47%, the societal program’s savings were € 2861 which corresponds to a saving of € 270.53 per extended hospitalization. Univariate sensitivity analyses show that the results are most sensitive to changes in the model parameters vaccine effectiveness in reducing influenza‐like illness (ILI) and the vaccination‐related costs.ConclusionIn addition to the decreased burden of patient morbidity among hospitalized patients, the effects of the hospital immunization program slightly outweigh the economic investments. These outcomes may support healthcare policymakers’ recommendations about the influenza vaccination program for healthcare workers.

BackgroundThe use of zoledronic acid (ZOL) has recently been shown to significantly reduce the risk of new skeletal-related events (SREs) in renal cell carcinoma (RCC) patients with bone metastases. The present exploratory study assessed the cost-effectiveness of ZOL in this population, adopting a French, German, and United Kingdom (UK) government payer perspective.Materials and methodsThis cost-effectiveness model was based on a post hoc retrospective analysis of a subset of patients with RCC who were included in a larger randomized clinical trial of patients with bone metastases secondary to a variety of cancers. In the trial, patients were randomized to receive ZOL (n = 27) or placebo (n = 19) with concomitant antineoplastic therapy every 3 weeks for 9 months (core study) plus 12 months during a study extension. Since the trial did not collect costs or data on the quality-adjusted life years (QALYs) of the patients, these outcomes had to be assumed via modeling exercises. The costs of SREs were estimated using hospital DRG tariffs. These estimates were supplemented with literature-based costs where possible. Drug, administration, and supply costs were obtained from published and internet sources. Consistent with similar economic analyses, patients were assumed to experience quality of life decrements lasting 1 month for each SRE. Uncertainty surrounding outcomes was addressed via multivariate sensitivity analyses.ResultsPatients receiving ZOL experienced 1.07 fewer SREs than patients on placebo. Patients on ZOL experienced a gain in discounted QALYs of approximately 0.1563 in France and Germany and 0.1575 in the UK. Discounted SRE-related costs were substantially lower among ZOL than placebo patients (−€ 4,196 in France, −€ 3,880 in Germany, and −€ 3,355 in the UK). After taking into consideration the drug therapy costs, ZOL saved € 1,358, € 1,223, and € 719 in France, Germany, and the UK, respectively. In the multivariate sensitivity analyses, therapy with ZOL saved costs in 67–77% of simulations, depending on the country. The cost per QALY gained for ZOL versus placebo was below € 30,000 per QALY gained threshold in approximately 93–94% of multivariate sensitivity analyses simulations.ConclusionsThe present analysis suggests that ZOL saves costs and increases QALYs compared to placebo in French, German, and UK RCC patients with bone metastases. Additional prospective research may be needed to confirm these results in a larger sample of patients.

In Uganda, mother to child transmission (MTCT) of HIV is responsible for approximately 25,000 infections among newborns annually and is the third leading cause of new infections. This analysis attempts to quantify the financial and disease burden associated with MTCT of HIV in Uganda. METHODS: Whereas HIV-negative infants have a life expectancy at birth ranging from 52.2 years for males and 54.3 years for females, the life expectancy of HIV-positive infants varies from 2 years in the absence of antiretroviral therapy (ART) to about 14.2 years with ART. Approximately 18% of eligible children in Uganda have access to ART, at an annual treatment cost of US$328. Lifetime health-care costs of HIV-positive untreated infants are assumed to be US$495. The model calculates years of life lost (YLL) as the difference in life-expectancy between HIV-positive and HIV-negative newborns and years of life lived with disability (YLD) by applying the relevant disability weights of 0.123 for each year lived with HIV and 0.5 for the last year of life with AIDS. All costs and life years are discounted at 3% annually. RESULTS: The total annual disease burden resulting from mother to child transmission of HIV is estimated at 592,480 disability adjusted life years (DALY's), which is defined as the sum of YLL: 572,662 and YLD: 19,818. The discounted net present value of future health care costs associated with mother to child transmission of HIV is estimated at US$27.3 Million. CONCLUSIONS: Mother to child transmission of HIV is associated with a substantial mortality and morbidity burden in Uganda. The financial burden is also worrisome in a country with annual health expenditures of US$24 per capita (circa US$ 830 Million total). Cost-effective strategies to reduce the incidence of MTCT that can be scaled-up nationally are urgently needed.

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.