[Show abstract][Hide abstract] ABSTRACT: Purpose:
Streptococcus pneumoniaeis a leading cause of invasive pneumococcal disease (IPD) in older children and adults, with considerable morbidity and mortality and health system costs in the region of Latin America. The present study aims to fill important gaps in our understanding of the economic burden of IPD in this population.
We developed an Excel-based model to provide estimates of the economic burden of IPD (pneumonia, meningitis) among individuals five years and older in Argentina, Brazil, Chile, Colombia, and Uruguay. We synthesized available data from the published literature, identified national treatment guidelines and conducted physician surveys to establish treatment practices of IPD in three age groups: 5-17 year olds, 18-64 year olds and 65+ year olds.
A total of 15 studies (5 published; 10 unpublished) presenting IPD cost analysis or cost-effectiveness data from 8 countries of the region were identified. Data on IPD economic burden among ≥ 5 year olds in the literature were limited. A total of 153 physicians responded to the surveys. The total direct medical cost per case for treatment of pneumonia ranged from US$993 to US$3,132 in older children (5-17 years), from US$1,274 to US$3,247 in adults (18-64 years) and from US$1,746 to U$3,535 in elderly (65+ years). Higher costs incurred in the elderly due to higher level of resources used for treating pneumonia. Across countries, treating IPD was more expensive in Chile than in Colombia, Argentina, Brazil and Uruguay, due to higher hospital care costs. Overall, the costs of hospital stay accounted for 45% of the total treatment costs in these countries. Across the region, the health care costs of IPD ranged from US$8.2 million to US$14.1 million, with higher costs detected in the elderly. Healthcare spending for IPD in the population age 5 years and above in the region as a percentage of GDP was estimated at 0.1%, compared to the reported 8-10% of GDP spent on healthcare overall in the region.
The present study highlights the important knowledge gap on the economics of IPD for people 5 years of age and older in the region. Findings of the economic burden analysis support the conclusion that IPD poses a sizable burden among individuals aged 5 years and above in the five countries studied.
The 36th Annual Meeting of the Society for Medical Decision Making; 10/2014
[Show abstract][Hide abstract] ABSTRACT: Purpose:
Neisseria meningitidis (NM) is a leading cause of bacterial meningitis and septicemia in infants, young children and adolescents, with considerable morbidity and mortality and outbreaks every two years in certain parts of the world. Public health costs associated with meningococcal outbreaks are not well known in Latin America. The aim of the study is to provide estimates of the economic burden of meningococcal outbreaks in two endemic countries of the region.
We developed an economic model to estimate the cost associated with meningococcal outbreaks in Brazil (Campinas, Sao Paulo) and Colombia (Cartagena and Sincelejo, Cartagena de Indias) from a societal perspective. Structured interviews were conducted by local health authorities to estimate the cost of the outbreaks. The interviews captured information about the use of resources, expenses allocated to case management (e.g. chemoprophylaxis), immunization campaigns and response activities during the outbreak and disease surveillance after the outbreak. Resource utilization and cost data associated with control of the outbreak (response phase) and monitoring of disease (disease surveillance phase) were collected retrospectively.
Costs associated with outbreaks of meningococcal disease were reported from two recent outbreaks: one in Brazil (Vila Brandina in 2011), and one in Colombia (Cartagena de Indias in 2012). The first outbreak that occurred in Vila Brandina, São Paulo, reported 3 cases that were associated with a total investigation and outbreak management cost of US$34,425 (US$11,475 per notified case), compared to US$735.10 (US$122.52 per notified case) for the 2012 outbreak, which reported 6 cases in Cartagena de Indias. These costs correspond to the disease response phase. For the disease surveillance phase, the costs ranged from US$3,935 (Cartagena outbreak) to US$6,667 (outbreak in Vila Brandina). The difference in cost between the two outbreaks was due to the number of cases of an outbreak, the size of the population, the area of exposure, and management practices.
Findings of this study underscore the importance of meningococcal disease in the region. Current study findings will be used to inform national health authorities about the economic burden of meningococcal outbreaks in endemic countries of the region.
The 36th Annual Meeting of the Society for Medical Decision Making; 10/2014
[Show abstract][Hide abstract] ABSTRACT: Financing is becoming increasingly important as the cost of immunizing the world's children continues to rise. By 2015, that cost will likely exceed US$60 per infant as new vaccines are introduced into national immunization programs. In 2006, 51 lower and lower middle income countries reported spending a mean US$12 per surviving infant on routine immunization. By 2012, the figure had risen to $20, a 67% increase. This study tests the hypothesis that lower and lower middle income countries will spend more on their routine immunization programs as their economies grow. A panel data regression approach is used. Expenditures reported by governments annually (2006-12) through the World Health Organization/UNICEF Joint Reporting Form are regressed on lagged annual per capita gross national income (GNI), controlling for prevailing mortality levels, immunization program performance, corruption control efforts, geographical region and correct reporting. Results show the expenditures increased with GNI. Expressed as an elasticity, the countries spent approximately $6.32 on immunization for every $100 in GNI increase from 2006 to 2012. Projecting forward and assuming continued annual GNI growth rates of 10.65%, countries could be spending $60 per infant by 2020 if national investment functions increase 4-fold. Given the political will, this result implies countries could fully finance their routine immunization programs without cutting funding for other programs.
Health Policy and Planning 02/2014; 30(3). DOI:10.1093/heapol/czu002 · 3.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Deployment of oral cholera vaccine (OCV) on the Island of Hispaniola has been considered since the emergence of the disease in October of 2010. At that time, emergency response focused on the time-tested measures of treatment to prevent deaths and sanitation to diminish transmission. Use of the limited amount of vaccine available in the global market was recommended for demonstration activities, which were carried out in 2012. As transmission continues, vaccination was recommended in Haiti as one component of a comprehensive initiative supported by an international coalition to eliminate cholera on the Island of Hispaniola. Leveraging its delivery to strengthen other cholera prevention measures and immunization services, a phased OCV introduction is pursued in accordance with global vaccine supply. Not mutually exclusive or sequential deployment options include routine immunization for children over the age of 1 year and campaigns in vulnerable metropolitan areas or rural areas with limited access to health services.
The American journal of tropical medicine and hygiene 10/2013; 89(4):682-687. DOI:10.4269/ajtmh.13-0200 · 2.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Despite a WHO recommendation in 2009, reaffirmed in 2013, that all countries should consider introducing rotavirus vaccines into their National Immunization Programs, as of June 2013 only 45 have done so. One major consideration appears to have been the costs of the vaccine to countries. Of concern, is that Asian countries have been slow to introduce rotavirus vaccines despite having robust data that could inform the decision-making process. Although decisions on new vaccine introduction are very complex and vary by country and region, economic evaluations are often pivotal once vaccine efficacy and safety has been established, and disease burden documented and communicated. Unfortunately, with private sector list prices of vaccines often used in economic evaluations, rather than a potential public health sector pricing structure, policy-makers may defer decisions on rotavirus vaccine introduction based on the belief that "the vaccine price is too high," even though this might be based on erroneous data. The Pan American Health Organization's Revolving Fund provides one example of how vaccine price can be made more competitive and transparent through a regional tendering process. Other mechanisms, such as tiered pricing and UNICEF procurement, also exist that could help Asian and other countries move forward more quickly with rotavirus vaccine introduction.
[Show abstract][Hide abstract] ABSTRACT: Governments have the authority and responsibility to ensure vaccination for all citizens. The development of vaccination legislation in Latin America and the Caribbean (LAC) parallels the emergence of sustainable, relatively autonomous, and effective national immunization programs. We reviewed vaccination legislation and related legal documents from LAC countries (excluding Canada, Puerto Rico, the United States, and the US Virgin Islands), and described and assessed vaccination legislation provisions. Twenty-seven of the 44 countries and territories in the Region have proposed or enacted vaccination legislation. Provisions vary substantially, but legal frameworks generally protect the sustainability of the immunization program, the individual's right to immunization, and the state's responsibility to provide it as a public good. Of the legislation from countries and territories included in the analysis, 44 per cent protects a budget line for vaccines, 96 per cent mandates immunization, 63 per cent declares immunization a public good, and 78 per cent explicitly defines the national vaccine schedule. We looked for associations between vaccination legislation in LAC and national immunization program performance and financing, and conclude with lessons for governments seeking to craft or enhance vaccination legislation.
Journal of Public Health Policy 02/2013; 34(1):82-99. DOI:10.1057/jphp.2012.66 · 1.78 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Tenth International Rotavirus Symposium Bangkok, Thailand, 19-21 September 2012 Over 350 scientific, public and private sector experts from 47 countries convened at the Tenth International Rotavirus Symposium in Bangkok, Thailand on 19-21 September 2012 to discuss progress in the prevention and control of rotavirus, the leading cause of diarrhea hospitalizations and deaths among young children worldwide. Participants discussed data on the burden and epidemiology of rotavirus disease, results of trials of rotavirus vaccines, postmarketing data on vaccine impact and safety from countries that have implemented rotavirus vaccination programs, new insights in rotavirus pathogenesis, immunity and strain diversity, and key issues related to vaccine policy and introduction.
[Show abstract][Hide abstract] ABSTRACT: The smallpox eradication campaign operated in Ethiopia from 1970 until 1977. During this time Ethiopia had only 84 hospitals, 64 health centres and fewer than 400 physicians in a country of 25 million people. In 1970 smallpox vaccination was relatively unknown in the country, and the government actually contested the fact that smallpox was present in the country. Most of the resources of the Ministry of Health were used for malaria eradication. Initial pessimism from the Ministry of Health and others was eventually overcome as the smallpox eradication campaign continued to pick up steam but many remained unenthusiastic. Ethiopia was the first country in the world to start its smallpox eradication campaign from day one with the strategy of "Surveillance and Containment". Establishing a surveillance system in a country with a limited health infrastructure was a daunting challenge. At the end of the first year of the programme in 1971, 26,000 cases of smallpox had been registered through the growing surveillance system. Throughout revolution of 1974 the smallpox campaign was the only UN program to operate in the country; in fact it expanded with the hire of many locals leading to a "nationalized" program. This development ushered in the most successful final phase of the program. As the program progressed cases were diminishing in most regions, however transmission continued in the Ogaden desert. Over the course of the campaign approximately 14.3 million US dollars was spent. Working conditions were extremely challenging and a variety of chiefs, guerrillas, landowners and governments had to be appeased. The programme was successful due to the dedicated national and international staff on the ground and by having the full support of the WHO HQ in Geneva.
[Show abstract][Hide abstract] ABSTRACT: The Expanded Programme on Immunization (EPI), launched in 1974, has developed and implemented a range of strategies and practices over the last three decades to ensure that children and adults receive the vaccines they need to help protect them against vaccine-preventable diseases. Many of these strategies have been implemented, resulting in immunization coverage exceeding 80% among children one year of age in many countries. Yet millions of infants remain under-immunized or unimmunized, particularly in poorer countries. In November 2009, a panel of external experts met at the United States Centers for Disease Control and Prevention (CDC) to review and identify areas of research required to strengthen routine service delivery in developing countries.
[Show abstract][Hide abstract] ABSTRACT: Vaccines have already saved many lives and they have the potential to save many more as increasingly elaborate technologies deliver new and effective vaccines against both infectious diseases--for which there are currently no effective licensed vaccines--such as malaria, tuberculosis, and HIV and non-infectious diseases such as hypertension and diabetes. However, these new vaccines are likely to be more complex and expensive than those that have been used so effectively in the past, and they could have a multifaceted effect on the disease that they are designed to prevent, as has already been seen with pneumococcal conjugate vaccines. Deciding which new vaccines a country should invest in requires not only sound advice from international organisations such as WHO but also a well informed national immunisation advisory committee with access to appropriate data for local disease burden. Introduction of vaccines might need modification of immunisation schedules and delivery procedures. Novel methods are needed to finance the increasing number of new vaccines that have the potential to save lives in countries that are too poor to afford them. Here, we discuss some options.
The Lancet 06/2011; 378(9789):439-48. DOI:10.1016/S0140-6736(11)60406-6 · 45.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Immunization programs are important tools for reducing child mortality, and they need to be in place for each new generation. However, most national immunization programs in developing countries are financially and organizationally weak, in part because they depend heavily on funding from foreign sources. Through its Sustainable Immunization Financing Program, launched in 2007, the Sabin Vaccine Institute is working with fifteen African and Asian countries to establish stable internal funding for their immunization programs. The Sabin program advocates strengthening immunization programs through budget reforms, decentralization, and legislation. Six of the fifteen countries have increased their national immunization budgets, and nine are preparing legislation to finance immunization sustainably. Lessons from this work with immunization programs may be applicable in other countries as well as to other health programs.
Health Affairs 06/2011; 30(6):1134-40. DOI:10.1377/hlthaff.2011.0265 · 4.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: By examining the role research has played in eradication or regional elimination initiatives for three viral diseases--smallpox, poliomyelitis, and measles--we derive nine cross-cutting lessons applicable to malaria eradication. In these initiatives, some types of research commenced as the programs began and proceeded in parallel. Basic laboratory, clinical, and field research all contributed notably to progress made in the viral programs. For each program, vaccine was the lynchpin intervention, but as the programs progressed, research was required to improve vaccine formulations, delivery methods, and immunization schedules. Surveillance was fundamental to all three programs, whilst polio eradication also required improved diagnostic methods to identify asymptomatic infections. Molecular characterization of pathogen isolates strengthened surveillance and allowed insights into the geographic source of infections and their spread. Anthropologic, sociologic, and behavioural research were needed to address cultural and religious beliefs to expand community acceptance. The last phases of elimination and eradication became increasingly difficult, as a nil incidence was approached. Any eradication initiative for malaria must incorporate flexible research agendas that can adapt to changing epidemiologic contingencies and allow planning for posteradication scenarios.
PLoS Medicine 01/2011; 8(1):e1000405. DOI:10.1371/journal.pmed.1000405 · 14.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Infectious diseases such as smallpox, pneumonia, rotavirus, malaria and measles have inflicted untold pain, suffering and death on the human population. The fingerprints of these deadly diseases can be found across the pages of history. The harrowing effects of pneumonia on the human body were described by Hippocrates as early as 460 B.C.;1 smallpox scarring can be found on Egyptian mummies dating back more than 3,000 years ago;2 and the Persian philosopher and physician Rhazes detailed the devastation of measles in the 10 century A.D.3 Without the benefits of modern medical interventions, our ancestors had little to no defense against infectious disease, and mortality rates were staggering. In 1531, for example, measles was responsible for the death of half the population of Honduras.4 Furthermore, some historical estimates indicate case fatality rates as high as 90 percent during smallpox epidemics among Native American populations in the early part of the 15th century.5 Yet as science advanced, humanity developed defenses against infectious disease in the form of lifesaving interventions, including vaccines, medical products (e.g., bed nets), therapeutics, and behavioral interventions.6 Across the developed world, these interventions quickly turned the tide against infectious disease. In the United States, infectious disease mortality declined 95 percent during the first 8 decades of the 20th century, from 797 deaths per 100,000 in 1900 to 36 deaths per 100,000 in 1980.7 The success of vaccination programs in the United States and Europe ushered in the 20th-century the concept of "disease eradication"-the idea that a specific disease could be eliminated from the planet. In 1977, after a decade-long campaign involving 33 nations, smallpox was eradicated worldwide-approximately ten years after it had been eradicated from the United States and the rest of the Western Hemisphere.8 But for millions living in the world's poor and developing countries, it is as if these live-saving interventions were never developed. The World Bank defines developing countries as those making less than US $11,905 gross national income per capita per year. People living in developing countries make up more than 80 percent of the world's population.9 A child born in a developing country faces many of the same risks her ancestors did 1,000 years ago. She is 237 times more likely to die of Hib disease than a child born to parents living in a high-income country.10 She's also 118 times more likely to die from rotavirus diarrhea,11 89 times more likely to die from pneumococcal disease,10 57 times more likely to die from HIV/AIDS,12 and 29 times more likely to die from tuberculosis.12 For such children, life-saving medical interventions are few and far between. That is why child mortality rates in the developing world remain as high as 60 times those in developed countries,13 and life expectancies are shorter by almost a quarter century.14.
Human vaccines 11/2010; 6(11):922-5. DOI:10.4161/hv.6.11.13599 · 3.64 Impact Factor