Andrew J. Leidner

• PhD
• Economist at Centers for Disease Control and Prevention

Demand for adequate provision of drinking-water and sanitation facilities to promote public health and economic growth is increasing in the rapidly urbanizing countries of the developing world. With a panel of data on Asia and Africa from 1990 to 2008, associations are estimated between the occurrence of cholera outbreaks, the case rates in given o...

Objective This paper investigates the change through time in the perception of smoking-related health harm and smoking behaviour from 1949 to 1981.Background and contextA variety of common behaviours can be linked to chronic disease risk—smoking, over-eating, and excessive sitting, to name a few. Changing behaviours to reduce exposure to such risks...

This paper provides a demonstration of propensity-score matching estimation methods to evaluate the effectiveness of health-risk communication efforts. This study develops a two-stage regression model to investigate household and respondent characteristics as they contribute to aversion behavior to reduce exposure to arsenic-contaminated groundwate...

Background: Coverage levels for many recommended adult vaccinations are low. The cost-effectiveness research literature on adult vaccinations has not been synthesized in recent years, which may contribute to low awareness of the value of adult vaccinations and to their under-utilization. We assessed research literature since 1980 to summarize econ...

Concern has been expressed that human papillomavirus (HPV) vaccination programs might promote risky sexual behavior through mechanisms such as risk compensation, behavioral disinhibition, or perceived endorsement of sexual activity. This study assesses whether HPV vaccination status is associated with any differences in selected sexual behaviors am...

Before October 2024, the Advisory Committee on Immunization Practices (ACIP) recommended use of a pneumococcal conjugate vaccine (PCV) for all adults aged ≥65 years, as well as for those aged 19-64 years with risk conditions for pneumococcal disease who have not received a PCV or whose vaccination history is unknown. Options included either 20-vale...

BACKGROUND AND OBJECTIVES Respiratory syncytial virus (RSV) causes substantial hospitalization in US infants. The Advisory Committee on Immunization Practices recommended nirsevimab in infants younger than 8 months born during or entering their first RSV season and for children aged 8 to 19 months at increased risk of RSV hospitalization in their s...

BACKGROUND AND OBJECTIVES Respiratory syncytial virus (RSV) commonly causes hospitalization among US infants. A maternal vaccine preventing RSV in infants, RSV bivalent prefusion F maternal vaccine (RSVpreF), was approved by the US Food and Drug Administration and recommended by the Advisory Committee on Immunization Practices. Our objective was to...

On June 17, 2024, the Food and Drug Administration approved 21-valent pneumococcal conjugate vaccine (PCV) (PCV21; CAPVAXIVE; Merck Sharp & Dohme, LLC) for adults aged ≥18 years. PCV21 does not contain certain serotypes that are included in other licensed pneumococcal vaccines but adds eight new serotypes. The Advisory Committee on Immunization Pra...

Since 1994, the U.S. Vaccines for Children (VFC) program has covered the cost of vaccines for children whose families might not otherwise be able to afford vaccines. This report assessed and quantified the health benefits and economic impact of routine U.S. childhood immunizations among both VFC-eligible and non-VFC-eligible children born during 19...

Objective The Federated States of Micronesia (FSM) experience periodic outbreaks of vaccine-preventable diseases. Our objective was to assess the cost-effectiveness of routine outreach and catch-up campaign strategies for increasing vaccination coverage for the measles, mumps, and rubella (MMR) vaccine among children aged 12 months through 6 years...

Background: Although use of the 13-valent pneumococcal conjugate vaccine (PCV13) among children has reduced incidence of pneumococcal disease, a considerable burden of disease remains. PCV15 is a new vaccine that contains pneumococcal serotypes 22F and 33F in addition to serotypes contained in PCV13. To inform deliberations by the Advisory Committ...

Objectives: This study aimed to estimate the cost-effectiveness of the use of recombinant zoster vaccine (RZV) (Shingrix), which protects against herpes zoster (HZ), among immunocompromised adults aged 19 to 49 years, as a contribution to deliberations of the Advisory Committee on Immunization Practices. Methods: Hematopoietic cell transplant (H...

The 13-valent pneumococcal conjugate vaccine (PCV13 [Prevnar 13, Wyeth Pharmaceuticals, Inc, a subsidiary of Pfizer, Inc]) and the 23-valent pneumococcal polysaccharide vaccine (PPSV23 [Merck Sharp & Dohme LLC]) have been recommended for U.S. children, and the recommendations vary by age group and risk group (1,2). In 2021, 15-valent pneumococcal c...

The Advisory Committee on Immunization Practices (ACIP) recommends recombinant zoster vaccine (RZV) to prevent against herpes zoster (HZ) and related complications in immunocompetent adults ≥50 y and immunocompromised adults ≥19 y. In 2019, a statistical safety signal for Guillain-Barré syndrome (GBS) following RZV was identified using data from th...

This article describes new recommendations from the Advisory Committee on Immunization Practices (ACIP) in which they recommend two doses of Zoster Vaccine Recombinant, Adjuvanted (Shingrix, GlaxoSmithKline [GSK]) (RZV) for the prevention of herpes zoster and related complications in adults who are or will be immunosuppressed. RZV is the first herp...

Cost-effectiveness analyses (CEAs) are often prepared to quantify the expected economic value of potential vaccination strategies. Estimated outcomes and costs of vaccination strategies depend on numerous data inputs or assumptions, including estimates of vaccine efficacy and disease incidence in the absence of vaccination. Limitations in epidemiol...

In 2021, 20-valent pneumococcal conjugate vaccine (PCV) (PCV20) (Wyeth Pharmaceuticals LLC, a subsidiary of Pfizer Inc.) and 15-valent PCV (PCV15) (Merck Sharp & Dohme Corp.) were licensed by the Food and Drug Administration for adults aged ≥18 years, based on studies that compared antibody responses to PCV20 and PCV15 with those to 13-valent PCV (...

Zoster Vaccine Recombinant, Adjuvanted (Shingrix, GlaxoSmithKline [GSK]) is a 2-dose (0.5 mL each) subunit vaccine containing recombinant glycoprotein E in combination with adjuvant (AS01B) that was licensed in the United States for prevention of herpes zoster for adults aged ≥50 years by the Food and Drug Administration (FDA) and recommended for i...

Objectives Evaluate different non-continuous temperature-monitoring practices for detection of out-of-range temperatures (above or below the recommended temperature range of 2–8 °C for refrigeration units), which are called excursions, within vaccine storage units.Methods Simulations based on temperature data collected by 243 digital data loggers o...

A two-dose series of the recombinant zoster vaccine (RZV, Shingrix) was licensed by the Food and Drug Administration in 2017 and recommended by the Advisory Committee on Immunization Practices in 2018 for adults in the United States age 50 years and older. Despite the health benefits of shingles vaccination, coverage has remained low, with financia...

An effective and widely used vaccine could reduce the burden of dengue virus (DENV) around the world. DENV is endemic in Puerto Rico, where the dengue vaccine CYD-TDV is currently under consideration as a control measure. CYD-TDV has demonstrated efficacy in clinical trials in vaccinees who had prior dengue virus infection. However, in vaccinees wh...

Background: Ghana introduced 13-valent pneumococcal conjugate vaccine (PCV13) into the routine infant immunization program in 2012, using a three-dose primary series without a booster. Despite ≥ 88% reported three-dose vaccination coverage since 2013, PCV13-type pneumococcal meningitis outbreaks have occurred. We estimated the ongoing economic bur...

Background Estimates in the research literature on the health-related quality of life (QOL) associated with pneumococcal disease exhibit variation. It complicates the selection of estimates in modeling projects that evaluate the health impact and economic value of the prevention and treatment. This study reviewed the literature and developed pooled...

Background The Community Preventive Services Task Force (CPSTF) has recommended several interventions that have been demonstrated to be effective at increasing vaccination coverage. Objective Conduct a systematic review to examine the costs of interventions designed to increase vaccination coverage among children and adolescents in the United Stat...

Background and objectives: Between December 31, 2018, and April 26, 2019, 72 confirmed cases of measles were identified in Clark County. Our objective was to estimate the economic burden of the measles outbreak from a societal perspective, including public health response costs as well as direct medical costs and productivity losses of affected in...

During early August 2020, county-level incidence of coronavirus disease 2019 (COVID-19) generally decreased across the United States, compared with incidence earlier in the summer (1); however, among young adults aged 18-22 years, incidence increased (2). Increases in incidence among adults aged ≥60 years, who might be more susceptible to severe CO...

Introduction Improving the utilization of preventive care among adolescents is important for achieving individual-level and population-level health goals. The Healthcare Effectiveness Data and Information Set reports data submitted by managed care health plans, capturing a large number of individuals in the U.S. Methods Using Healthcare Effectiven...

Poverty, crowded housing, and other community attributes associated with social vulnerability increase a community's risk for adverse health outcomes during and following a public health event (1). CDC uses standard criteria to identify U.S. counties with rapidly increasing coronavirus disease 2019 (COVID-19) incidence (hotspot counties) to support...

An effective and widely used vaccine could reduce the burden of dengue virus (DENV) around the world. DENV is endemic in Puerto Rico, where the dengue vaccine CYD-TDV is currently under consideration as a control measure. CYD-TDV has demonstrated efficacy in clinical trials in vaccinees who had prior dengue infection. However, in vaccinees who had...

Currently, the Advisory Committee on Immunization Practices recommends one-time tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination for all adults 19 years and older. This study is designed to evaluate the cost-effectiveness of Tdap vaccination for Tdap-eligible adults aged 19 through 85 in the United States. A cos...

Objective To evaluate the ability of different types of vaccine storage units to maintain appropriate temperatures for the storage of vaccines and to characterize deviations from recommended temperatures. Data sources Continuous temperature monitoring devices, or digital data loggers, from vaccine providers who participated in a continuous tempera...

Despite the elimination of measles in the US in the year 2000, cases continue to occur with measles outbreaks having occurred in various jurisdictions in the US in 2018 and 2019. Understanding the cost associated to measles outbreaks can inform cost-of-illness and cost-effectiveness studies of measles and measles prevention. We performed a literatu...

Two pneumococcal vaccines are currently licensed for use in adults in the United States: a 13-valent pneumococcal conjugate vaccine (PCV13 [Prevnar 13, Pfizer, Inc.]) and a 23-valent pneumococcal polysaccharide vaccine (PPSV23 [Pneumovax 23, Merck and Co., Inc.]). In 2014, the Advisory Committee on Immunization Practices (ACIP)* recommended routine...

Vaccination coverage among adults remains low in the United States. Understanding the barriers to provision of adult vaccination is an important step to increasing vaccination coverage and improving public health. To better understand financial factors that may affect practice decisions about adult vaccination, this study sought to understand how c...

Vaccination coverage among children in kindergarten varies across the country and within states. We surveyed a convenience sample of kindergarten school nurses to investigate self-reported vaccination-related activities conducted at schools nationwide. The majority of the 1,435 kindergarten school nurses responding reported that their schools commu...

The Centers for Disease Control and Prevention recommend annual influenza vaccination of persons ≥6 months old. However, in 2016-17, only 43.3% of U.S. adults reported receiving an influenza vaccination. Limited awareness about the cost-effectiveness (CE) or the economic value of influenza vaccination may contribute to low vaccination coverage. In...

Introduction: Vaccinations are recommended to prevent serious morbidity and mortality. However, providers' concerns regarding costs and payments for providing vaccination services are commonly reported barriers to adult vaccination. Information on the costs of providing vaccination is limited, especially for adults. Methods: We recruited 4 inter...

Amid provider reports of financial barriers as an impediment to adult immunization, this study explores the time and costs of vaccination in adult provider practices. Both a Vaccination Time-Motion Study and Vaccine Practice Management Survey were conducted (March – October 2017) in a convenience sample of 19 family medicine (FM), internal medicine...

We identified 16 Advisory Committee on Immunization Practices (ACIP) presentations from 2012 to 2016 that indicated ‘cost’ or ‘economic’ content. Characteristics were reviewed, abstracted, and tabulated to quantify and assess the transparency and consistency of economic evidence presented to ACIP. To assess transparency, we documented if each study...

Background: Vaccination coverage is typically measured as the proportion of individuals who have received recommended vaccine doses by the date of assessment. This approach does not provide information about receipt of vaccines by the recommended age, which is critical for ensuring optimal protection from vaccine-preventable diseases (VPDs). Obje...

Background: Vaccination Program for US-bound Refugees (VPR) currently provides one or two doses of some age-specific Advisory Committee on Immunization Practices (ACIP)-recommended vaccines to US-bound refugees prior to departure. Methods: We quantified and compared the full vaccination costs for refugees using two scenarios: (1) the baseline of...

Background: Most cost-effectiveness analyses of hepatitis C (HCV) therapy focus on the benefits of reducing liver-related morbidity and mortality. Objectives: Our objective was to assess how cost-effectiveness estimates of HCV therapy can vary depending on assumptions regarding the potential impact of HCV therapy on non-hepatic mortality. Metho...

We estimated the number of people infected with HCV in the United States who would qualify for immediate treatment according to the 2014 guidance. We based fibrosis stage on biopsy results, when available, or on FIB-4 scores. We used laboratory tests and International Classification of Diseases, Ninth Revision, Clinical Modification codes to determ...

New treatments for hepatitis C virus (HCV) may be highly effective but are associated with substantial costs that may compel clinicians and patients to consider delaying treatment. This study investigated the cost-effectiveness of these treatments with a focus on patients in early stages of liver disease. We developed a state-transition (or Markov)...

Disease burden models have predicted worsening morbidity of liver disease caused by hepatitis C in the United States. The aim of this study was to determine the trend in hospitalizations caused by hepatitis C and advanced liver disease. We analyzed data for the period 2004-11 from the Nationwide Inpatient Sample, the largest nationwide all-payer ho...

A major national initiative to generate renewable fuels from plant matter has taken shape in the U.S., primarily to reduce dependency on foreign oil and achieve reduction in greenhouse gases. However, the biofuel policies in the U.S. ignored for the most part, the potential synergies between food and biofuel production. As a result, their productio...

The issue of whether smokers understand the risks from smoking remains controversial, especially when one considers the body of literature by authors outside of the field economics. Many have argued that by eliciting statements of risk perceptions and comparing average perceived risks for smokers and non-smokers, one can determine whether smokers t...

This study develops a two-stage regression model to investigate household and respondent characteristics as they contribute to aversion behavior to reduce exposure to arsenic-contaminated groundwater. The aversion activity under study is the implementation of a household-level point-of-use filtration device. Since the acquisition of arsenic-contami...

Fruit and vegetable consumption is associated with improved health outcomes, yet there is limited understanding of the impact of cost and accessibility on fruit and vegetable intake in rural settings. This study examines the relationship between the consumption of fruits and vegetables and their cost and accessibility among blacks and non-Hispanic...

A critical issue in the cigarette smoking literature has been whether individuals respond to risks of smoking in making decisions to smoke. Evidence has been mixed regarding whether smokers have higher or lower perceptions of risk, as compared to non-smokers. Using Gallup Poll data starting in 1949, and for years where the required data are availab...

This paper examines optimal input allocations in the context of a seawater desalination reverse osmosis (SWRO) system used to produce municipal water. The objective of this research is to better understand the effects on the total costs and the input portfolio of a SWRO system from changes in water quality, daily operations schedule, and input pric...

Leidner, Andrew J., M. Edward Rister, Ronald D. Lacewell, and Allen W. Sturdivant, 2011. The Water Market for the Middle and Lower Portions of the Texas Rio Grande Basin. Journal of the American Water Resources Association (JAWRA) 47(3):597-610. DOI: 10.1111/j.1752-1688.2011.00527.x Abstract: Regional water management on the United States’ side of...

This paper examines the optimal allocation of several inputs in the context of seawater desalination by reverse osmosis (RO) as a source of municipal (or commercial or industrial) water. A cost-minimization model is developed, a production function is estimated, and sensitivity analyses are conducted using the optimization model to investigate the...

In a multi-disciplinary effort directed toward developing a watershed protection plan for the Eagle Mountain Reservoir Watershed in north-central Texas, focus is on minimizing the life-cycle costs associated with the plan. Both the initial construction costs and the annual operating and maintenance costs of watershed management are considered in co...

There is growing evidence that communicable diseases constitute a strong selective force on the evolution of social systems. It has been suggested that infectious diseases may determine upper limits of host sociality by, for example, inducing territoriality or early juvenile dispersal. Here we use game theory to model the evolution of host socialit...

Selected Paper prepared for presentation at the Southern Agricultural Economics Association Annual Meeting, Corpus Christi, TX, February 5-8, 2011 Copyright 2011 by A.J. Leidner et al. All rights reserved. Readers may make verbatim copies of this document for non-commercial purposes by any means, provided that this copyright notice appears on all s...

Seawater desalination project is being actively pursued by the Brownsville Public Utilities Board, municipal power and water supplier to the City of Brownsville located in the Texas Lower Rio Grande Valley. Seawater desalination provides a means to expand the region's water supply and diversify the region's water supply portfolio against water deli...

Demand for adequate provision of drinking-water and sanitation facilities to promote public health and economic growth is increasing in the rapidly urbanizing countries of the developing world. Using panel data and probit estimation, this paper investigates the inter-relationships between the occurrence of cholera outbreaks, urbanization, drinking-...