Resource impact of managing suspected Middle East respiratory syndrome patients in a UK teaching hospital

Veater, James; Wong, Nicholas; Stephenson, Iain; Kirk-Granger, H; Baxter, Laura; Cannon, R.N.; Wilson, Steven Ray; Atabani, Sowsan; Sahota, Amandip; Bell, Dominic; Wiselka, Martin; Tang, Julian W.

doi:10.1016/j.jhin.2016.12.010

Cited by 8 publications

(7 citation statements)

References 6 publications

(10 reference statements)

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“…Costs per enhanced PPE were based on a previous study on MERS-CoV in 2015, 52 which estimated the additional costs on enhanced PPE equipment (mask, gown, gloves, goggles) at £2.50 per patient visit. Accounting for the additional time of an estimated 15 minutes to put on and take off the PPE as well as disposal plus documentation per patient visit, at 6 visits per patient per day came at additional £29.50 for nurses and £45 for physicians, and the total costs per patient at £119 (uprated to 2019 value at £127.62).…”

Section: Supplementary Materialsmentioning

confidence: 99%

The potential health and economic value of SARS-CoV-2 vaccination alongside physical distancing in the UK: transmission model-based future scenario analysis and economic evaluation

Sandmann

Davies

Vassall

et al. 2020

Preprint

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Background In response to the coronavirus disease 2019 (COVID-19), the UK adopted mandatory physical distancing measures in March 2020. Vaccines against the newly emerged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may become available as early as late 2020. We explored the health and economic value of introducing SARS-CoV-2 immunisation alongside physical distancing scenarios in the UK. Methods We used an age-structured dynamic-transmission and economic model to explore different scenarios of immunisation programmes over ten years. Assuming vaccines are effective in 5-64 year olds, we compared vaccinating 90% of individuals in this age group to no vaccination. We assumed either vaccine effectiveness of 25% and 1-year protection and 90% re-vaccinated annually, or 75% vaccine effectiveness and 10-year protection and 10% re-vaccinated annually. Natural immunity was assumed to last 45 weeks in the base case. We also explored the additional impact of physical distancing. We considered benefits from disease prevented in terms of quality-adjusted life-years (QALYs), and costs to the healthcare payer versus the national economy. We discounted at 3.5% annually and monetised health impact at 20,000 per QALY to obtain the net monetary value, which we explored in sensitivity analyses. Findings Without vaccination and physical distancing, we estimated 147.9 million COVID-19 cases (95% uncertainty interval: 48.5 million, 198.7 million) and 2.8 million (770,000, 4.2 million) deaths in the UK over ten years. Vaccination with 75% vaccine effectiveness and 10-year protection may stop community transmission entirely for several years, whereas SARS-CoV-2 becomes endemic without highly effective vaccines. Introducing vaccination compared to no vaccination leads to economic gains (positive net monetary value) of 0.37 billion to +1.33 billion across all physical distancing and vaccine effectiveness scenarios from the healthcare perspective, but net monetary values of physical distancing scenarios may be negative from societal perspective if the daily national economy losses are persistent and large. Interpretation Our model findings highlight the substantial health and economic value of introducing SARS-CoV-2 vaccination. Given uncertainty around both characteristics of the eventually licensed vaccines and long-term COVID-19 epidemiology, our study provides early insights about possible future scenarios in a post-vaccination era from an economic and epidemiological perspective.

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Section: Supplementary Materialsmentioning

confidence: 99%

The potential health and economic value of SARS-CoV-2 vaccination alongside physical distancing in the UK: transmission model-based future scenario analysis and economic evaluation

Sandmann

Davies

Vassall

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…This second BAL was positive for adenovirus DNA by PCR testing, using an in-house respiratory multiplex PCR screening assay, as described elsewhere [9]. A beta-D-glucan test on the BAL was also positive at 85 pg/ml, having been negative in the peripheral blood.…”

Section: Case Reportmentioning

confidence: 88%

Case report: a fatal case of disseminated adenovirus infection in a non-transplant adult haematology patient

2018

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BackgroundWe report a fatal case of disseminated adenovirus infection in a non-transplant haematology adult patient with chronic lymphocytic leukaemia who had completed combination chemoimmunotherapy a few months before developing respiratory symptoms. In such non-transplant patients, monitoring for adenovirus in the blood is not routine. However, with adenoviruses, when there is a more peripheral (i.e. non-blood) site of infection such as the chest, serial adenovirus monitoring in blood for the duration of that illness may be warranted.Case presentationThis case started with an initial bacterial chest infection that responded to treatment, followed by an adenovirus pneumonitis that disseminated to his blood a week later with levels of up to 92 million adenovirus DNA copies/ml. Despite prompt treatment with cidofovir, his respiratory function continued to deteriorate over the next two weeks and he was moved to intensive care. Intravenous immunoglobulin and ribavirin were subsequently added to his treatment. However, he died soon after this with a final adenovirus load of 20 million copies/ml in his blood.ConclusionsWe recommend that even in non-transplant haematology patients, where such patients present with an acute respiratory adenovirus infection, teams should consider checking the blood for adenovirus to check for signs of disseminated infection. The earlier this can be tested, the earlier treatment can be initiated (if adenovirus positive), which may produce more successful clinical outcomes.

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“…As a result, many were managed as possible MERS patients but were later discovered to have influenza. Although the additional financial costs of this overlap were relatively low, it put significant strain on staff time and isolation room availability (Veater et al, 2017). It is therefore important to plan not only for significant international events over the coming months, but also for the possible complications of overlapping outbreaks of common viruses.…”

Section: Lessons From the Pastmentioning

confidence: 99%

COVID-19 and emergency planning

Winter

2020

Br J Community Nurs

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Resource impact of managing suspected Middle East respiratory syndrome patients in a UK teaching hospital

Cited by 8 publications

References 6 publications

The potential health and economic value of SARS-CoV-2 vaccination alongside physical distancing in the UK: transmission model-based future scenario analysis and economic evaluation

The potential health and economic value of SARS-CoV-2 vaccination alongside physical distancing in the UK: transmission model-based future scenario analysis and economic evaluation

Case report: a fatal case of disseminated adenovirus infection in a non-transplant adult haematology patient

COVID-19 and emergency planning

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