BackgroundMutations of the H3N2 vaccine strain during the egg-based vaccine manufacturing process seem to partly explain the suboptimal effectiveness of traditional seasonal influenza vaccine. Cell-based influenza vaccines avoid such egg-adaptation, thereby improving antigenic match and vaccine effectiveness. The objective of this study was to evaluate the public health and economic impact of a cell-based quadrivalent influenza vaccine (QIVc) in adult population (18–64 years) compared to the standard egg-based quadrivalent influenza vaccine (QIVe), in the US.MethodsThe impact of QIVc over QIVe in terms of public health and costs outcomes was estimated using a dynamic SEIR transmission model. The model is age-structured and accounts for 4 circulating influenza strains (A/H1N1pdm9, A/H3N2, B(Victoria), and B(Yamagata)). It was calibrated on US attack rate and strain circulation for the seasons 2013–2018. US specific absolute vaccine effectiveness for QIVe, specific hospitalization rate, mortality rate, Quality-Adjusted Life Years (QALYs) and costs were extracted from published literature. Relative vaccine effectiveness of QIVc over QIVe for subjects 18–64 years of age was obtained from a US retrospective cohort study. Robustness of the results was assessed in univariate and probabilistic sensitivity analyses.ResultsSwitching from QIVe to QIVc in the 18–64 year-old population may prevent 5.7 M symptomatic cases, 1.8 M outpatient visits; 50K hospitalizations and 5,453 deaths annually. The switch could save 128 K QALYs and US$ 845M in direct costs, resulting in a cost-saving alternative in a 3-year time horizon analysis. Probabilistic sensitivity analyses confirmed the robustness of the cost-saving result.ConclusionsThe analysis shows that QIVc is expected to prevent a substantial number of hospitalizations and deaths, and would result in substantial savings in health care costs.
We conducted this study to find out the effectiveness of treatment as well as some prognostic factors when using R-GDP (Rituximab-Gemcitabine, Dexamethasone, and Cisplatin) regimen to treat transplant-ineligible relapsed non-Hodgkin B-cell lymphoma patients. 49 patients diagnosed with relapsed non-Hodgkin B-cell lymphoma treated with R-GDP (Rituximab-Gemcitabine, Dexamethasone, and Cisplatin) regimen were retrospectively analyzed. Patients who subsequently underwent autologous stem cell transplantation were excluded. After 2 cycles, ORR was 71.4%: CR: 12 patients (24.5%), PR: 23 patients (46.9%). 14 patients (28.6%) who did not achieve at least PR would be treated with another regimen. After 6 cycles, CR was 38.8% (19 patients). Median OS and PFS were 36 and 32 months; respectively. The 5-year rates were 36.4 % and 18.1% for OS and PFS; respectively. No serious side effects were reported. Neutrophilia and thrombocytopenia were grade 3, and grade 2; respectively. Univariate and multivariate analysis showed that LDH ≥237 U/L was an independent adverse prognostic factor for OS (
Background Influenza vaccination with quadrivalent egg-based vaccines (QIVe) in adults ≥ 65 years may be less effective due to immunosenescence. An MF59®-adjuvanted trivalent influenza vaccine (aTIV) has been developed to provide stronger, broader and longer protection in older adults. For the younger age groups, lower effectiveness may be associated to the mutagenesis of influenza viruses that are propagated in eggs. A cell- based quadrivalent influenza vaccine (QIVc) was developed to improve the vaccine effectiveness by eliminating egg-adaptation. Objectives The objective of this analysis was to evaluate the potential public health impact on the utilization of both vaccines in Canada. Design/Methods An SEIR dynamic-transmission model was created and adapted to four influenza strains for the 2013-2019 seasons. Strain-specific circulation was obtained from Canada’s national surveillance system. Influenza incidence estimates were calibrated using CDC published data. The model used rVE from peer reviewed publications for QIVc and aTIV showing superiority to QIVe vaccines. Frequency of egg-based genetic changes were estimated from a published review of Crick Institute reports. Estimates of specific vaccines efficacy and economic assumptions were derived from the published literature. Different vaccination scenarios, based on the provincial vaccination programs, were modelled. Results Replacing QIVe with QIVc in subjects 6 months-64 years led to an annual reduction of 462 156 symptomatic cases; 58 122 GP visits; 40,871 emerging consultations; 3 788 hospitalizations and 662 deaths versus a QIVe-for-all scenario. The adoption of QIVc and aTIV will be highly cost effective over the use of QIVe. aTIV would also be more cost effective than QIVHD. Table 1 provides the detailed results for the others scenario. Sensitivity analyses confirmed the robustness of the assumptions used in the analysis. Conclusion The greatest public health impact is obtained by using QIVc and aTIV in influenza vaccine programs in Canada versus other combinations of available vaccine.
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