Improving the Hospital Quality of Care during Winter Periods by Optimizing Budget Allocation Between Rotavirus Vaccination and Bed Expansion

Abstract

BackgroundDuring each winter the hospital quality of care (QoC) in pediatric wards decreases due to a surge in pediatric infectious diseases leading to overcrowded units. Bed occupancy rates often surpass the good hospital bed management threshold of 85%, which can result in poor conditions in the workplace. This study explores how QoC-scores could be improved by investing in additional beds and/or better vaccination programs against vaccine-preventable infectious diseases.MethodsThe Cobb–Douglas model was selected to define the improvement in QoC (%) as a function of two strategies (rotavirus vaccination coverage [%] and addition of extra hospital beds [% of existing beds]), allowing improvement-isocurves to be produced. Subsequently, budget minimization was applied to determine the combination of the two strategies needed to reach a given QoC improvement at the lowest cost. Data from Jessa Hospital (Hasselt, Belgium) were chosen as an example. The annual population in the catchment area to be vaccinated was 7000 children; the winter period was 90 days with 34 pediatric beds available. Rotavirus vaccination cost per course was €118.26 and the daily cost of a pediatric bed was €436.53. The target QoC increase was fixed at 50%. The model was first built with baseline parameter values.ResultsThe model predicted that a combination of 64% vaccine coverage and 39% extra hospital beds (≈ 13 extra beds) in winter would improve QoC-scores by 50% for the minimum budget allocation.ConclusionThe model allows determination of the most efficient allocation of the healthcare budget between rotavirus vaccination and bed expansion for improving QoC-scores during the annual epidemic winter seasons.

How to assess for the full economic value of vaccines? From past to present, drawing lessons for the future

“…We have been able to provide overviews of full immunization programs developed using portfolio models. Examples include: showing the cost offsets and health gains of different dosing schemes using different vaccines for the same indication under a constrained budget (rotavirus vaccination) [41]; prioritising different intervention types to manage paediatric infections, and malaria [42,44]; demonstrating the benefit of child vaccination for working mothers with evidence of reduced work absenteeism [87]; improving QoC with vaccination and translating this into cost gains while maintaining QoC [50,60]; estimating the best combination of vaccination and screening to maximise cervical cancer reduction under a fixed budget [40]; and showing that extra budget does not guarantee substantial health gain in aging adults from PCV and/or influenza vaccination [43].…”

“…To illustrate all these effects, we have used CO models [40][41][42][43][44], Cobb-Douglas production functions [60], FHM and SAM modelling [45,46], macro-economic computable general equilibrium models (CGE) [88] and impact instead of effectiveness measures [89]. Others have used ECEA [69], distributional CEA [70], BIA [75] and MCDA [72].…”

“…The Cobb-Douglas function has recently been applied to assess quality of care (QoC) improvement in hospitals after introducing rotavirus vaccination, choosing between investing in treatment or prevention to maintain the same QoC [60].…”

“…Poor health conditions are intimately connected with poverty traps in LICs, with devastating long-term consequences for families in populations living in survivaltype economic mode with fragile human capital and relatively high out-of-pocket payments. Preventative interventions in such environments with high coverage bring much broader societal benefits to the population (improved productivity, quality of care, better education, and jobs) than any treatment could achieve [60]. These issues make an impressive list of items to consider in the current economic value assessment of vaccines.…”

Estimating the money flow in the economy attributed to rotavirus disease and vaccination in the Netherlands using a Social Accounting Matrix (SAM) framework

“…As these events often occur during winter periods where young children are most exposed to many different infectious diseases, they cause bottleneck conditions in healthcare delivery of emergency rooms and hospital pediatric wards. Introducing vaccination against pediatric infectious diseases therefore reduces pressure on hospital resources and improves the overall quality of care [5,31]. The cost savings may be used to accomplish a decrease in insurance premiums for households, since HICs are not for profit in the Netherlands.…”