Constantinos I Michaelidis

University of Pittsburgh, Pittsburgh, Pennsylvania, United States

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Publications (4)11.31 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: There are disparities in influenza and pneumococcal vaccination rates among elderly minority groups and little guidance as to which intervention or combination of interventions to eliminate these disparities is likely to be most cost-effective. Here, we evaluate the cost-effectiveness of four hypothetical vaccination programs designed to eliminate disparities in elderly vaccination rates and differing in the number of interventions.
    BMC Public Health 07/2014; 14(1):718. · 2.08 Impact Factor
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    ABSTRACT: Two clinical trials suggest that procalcitonin-guided antibiotic therapy can safely reduce antibiotic prescribing in outpatient management of acute respiratory tract infections (ARTIs) in adults. Yet, it remains unclear whether procalcitonin testing is cost-effective in this setting. To evaluate the cost-effectiveness of procalcitonin-guided antibiotic therapy in outpatient management of ARTIs in adults. Cost-effectiveness model based on results from two published European clinical trials, with all parameters varied widely in sensitivity analyses. Two hypothetical cohorts were modeled in separate trial-based analyses: adults with ARTIs judged by their physicians to require antibiotics and all adults with ARTIs. Procalcitonin-guided antibiotic therapy protocols versus usual care. Costs and cost per antibiotic prescription safely avoided. We estimated the health care system willingness-to-pay threshold as $43 (range $0-$333) per antibiotic safely avoided, reflecting the estimated cost of antibiotic resistance per outpatient antibiotic prescribed. In the cohort including all adult ARTIs judged to require antibiotics by their physicians, procalcitonin cost $31 per antibiotic prescription safely avoided and the likelihood of procalcitonin use being favored compared to usual care was 58.4 % in a probabilistic sensitivity analysis. In the analysis that included all adult ARTIs, procalcitonin cost $149 per antibiotic prescription safely avoided and the likelihood of procalcitonin use being favored was 2.8 %. Procalcitonin-guided antibiotic therapy for outpatient management of ARTIs in adults would be cost-effective when the costs of antibiotic resistance are considered and procalcitonin testing is limited to adults with ARTIs judged by their physicians to require antibiotics.
    Journal of General Internal Medicine 11/2013; · 3.28 Impact Factor
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    ABSTRACT: Invasive pneumococcal disease is a major cause of preventable morbidity and mortality in the United States, particularly among the elderly (>65 years). There are large racial disparities in pneumococcal vaccination rates in this population. Here, we estimate the cost-effectiveness of a hypothetical national vaccination intervention program designed to eliminate racial disparities in pneumococcal vaccination in the elderly. In an exploratory analysis, a Markov decision-analysis model was developed, taking a societal perspective and assuming a 1-year cycle length, 10-year vaccination program duration, and lifetime time horizon. In the base-case analysis, it was conservatively assumed that vaccination program promotion costs were $10 per targeted minority elder per year, regardless of prior vaccination status and resulted in the elderly African American and Hispanic pneumococcal vaccination rate matching the elderly Caucasian vaccination rate (65%) in year 10 of the program. The incremental cost-effectiveness of the vaccination program relative to no program was $45,161 per quality-adjusted life-year gained in the base-case analysis. In probabilistic sensitivity analyses, the likelihood of the vaccination program being cost-effective at willingness-to-pay thresholds of $50,000 and $100,000 per quality-adjusted life-year gained was 64% and 100%, respectively. In a conservative analysis biased against the vaccination program, a national vaccination intervention program to ameliorate racial disparities in pneumococcal vaccination would be cost-effective.
    Value in Health 01/2013; 16(2):311-7. · 2.19 Impact Factor
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    ABSTRACT: Influenza is a major cause of preventable morbidity and mortality in the United States, particularly among the elderly. Yet, there remain large disparities in influenza vaccination rates across elderly Caucasian (70%), African-American (50%) and Hispanic (55%) populations, with substantial mortality consequences. In this study, we built a decision-analysis model to estimate the cost-effectiveness of a hypothetical national vaccination program designed to eliminate these disparities in influenza vaccination rates. Taking a societal perspective, we developed a Markov model with a one-year cycle length and lifetime time horizon. In the base case, we conservatively assumed that the cost of promoting the vaccination program was $10 per targeted elder per year and that by year 10, the vaccination rate of the elderly African-American and Hispanic populations would equal the vaccination rate of the elderly Caucasian population (70%). The cost-effectiveness of the vaccination program compared to no vaccination program was $48,617 per QALY saved. Probabilistic sensitivity analyses suggested that at willingness-to-pay thresholds of $50,000 and $100,000 per QALY saved, the likelihood of the vaccination program being cost-effective was 38% and 92%, respectively. In an analysis using conservative assumptions, we found that a hypothetical program to ameliorate disparities in influenza vaccination rates has a moderate to high likelihood of being cost-effective.
    Vaccine 03/2011; 29(19):3525-30. · 3.77 Impact Factor

Publication Stats

2 Citations
11.31 Total Impact Points

Institutions

  • 2011–2013
    • University of Pittsburgh
      Pittsburgh, Pennsylvania, United States