Improvement in hospital Quality of Care (QoC) after the introduction of rotavirus vaccination: An evaluation study in Belgium

Abstract

During each winter period hospital emergency rooms and pediatric wards are often overwhelmed by high patient influx with infectious diseases leading to chaotic conditions with poor quality of care (QoC) delivery as a consequence. The conditions could be improved if we were able to better control the influx by introducing for instance better prevention strategies against some of the most frequent infectious diseases. New prevention strategies using vaccination against rotavirus infection were introduced in Belgium in November 2006. We developed a measure of hospital QoC suitable for assessing the impact of pediatric rotavirus vaccination. The study is retrospective collecting routine data on bed and staff management in one pediatric hospital in Belgium. The data were divided in pre-and post-vaccination periods during rotavirus-epidemic and non-epidemic periods. The scores were constructed using Explanatory Factor Analysis (EFA). All patients enrolled were admitted to the pediatric ward over the period from 1 January 2004 to 31 December 2009. The results of the epidemic period indicated that bed-day occupancy, bed-day turnover and unplanned readmissions for acute gastroenteritis were lower in the post-vaccination compared with the pre-vaccination periods. The QoC scores were therefore significantly lower (indicating improved QoC) after the introduction of rotavirus vaccination, compared with pre-vaccination. The data suggests that the reduction in the winter peak of rotavirus-related hospitalizations after the introduction of the vaccine reduces pressure on hospital resources and improves the quality of hospital care. The findings should be further tested in similar settings.

Towards a more comprehensive approach for a total economic assessment of vaccines?

“…The vaccination impact can also be substantial at the level of overall disease management in the healthcare sector; for example, improvement in hospital quality of care after the introduction of the rotavirus vaccine [34]. A vaccine introduction with an immediate high coverage rate and an instantaneous impact normally introduces an imbalance in healthcare delivery, because resources have to be switched from care to prevention and that has consequences for the existing care delivery [34];the initial investment for introducing a new vaccine may be large for the payer or decision-maker, without much certainty about the short-term benefit. Thus, implementing vaccination is a more risky decision that often needs to be defended at a higher level than the health ministry in a country.…”

“…This occurs especially for disease episodes among children (parents) and the elderly (family members). The vaccination impact can also be substantial at the level of overall disease management in the healthcare sector; for example, improvement in hospital quality of care after the introduction of the rotavirus vaccine [34]. A vaccine introduction with an immediate high coverage rate and an instantaneous impact normally introduces an imbalance in healthcare delivery, because resources have to be switched from care to prevention and that has consequences for the existing care delivery [34];…”

“…Sixth, if the disease burden is high and shows periodic peaks, it is likely that high initial uptake of a vaccine with externalities in the unvaccinated population may avoid many events during a short time period, which may create an imbalance in care delivery and a new externality of improvement in quality of care (QoC) [34]. This type of benefit has also been poorly reported in the value assessment of vaccines [53].…”

3. How comprehensive can we be in the economic assessment of vaccines?

“…However, because of the high herd protection level obtained during the first years after vaccine introduction (with a high coverage rate), we observe two benefits that have been poorly investigated and reported in the literature [43,44]. One is the quality of care improvement in the hospital environment during the winter periods after the introduction of the vaccine, which could be critical for hospital managers and healthcare providers as they improve the quality of care of their institutions [45]. The other is the reduction in work absenteeism, which benefits employers and employees, and potentially also the social security system at the governmental level [46].…”

2. How is the economic assessment of vaccines performed today?

“…Reduced medical visits and hospital admissions during epidemics may allow hospital beds to be re-allocated to people with other diseases, for example people requiring elective surgery who might otherwise be crowded out during an epidemic. In addition, avoiding overcrowding and the staff pressure that can result from a spike in admissions during an epidemic may decrease nosocomial infections and improve the QoC [34]. Conventional health economic analysis has no precise method to include such a benefit, and it is not usually included in economic assessments.…”