PubMed · 2131447
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K Palmer. 1990. Prescribing.. https://pubmed.ncbi.nlm.nih.gov/2131447/
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In Italy in the 1980s the extent of viral hepatitis B infection was on average about 11,000 symptomatic cases of acute viral hepatitis (AVH) per year (19/100,000 inhabitants). The prevalence of HBsAg carriers in the general population was about 3% and in pregnant women 2.4%. 64,000 people were affected by chronic viral hepatitis (CVH) or cirrhosis (prevalence rate 112/100,000) and 3400 by hepatocellular carcinoma (HCC) (prevalence rate 5.9/100,000). To reduce these HBV related pathologies in the Italian population, universal vaccination of newborn babies, 12-year old adolescents and high risk groups was implemented in 1991. The annual cost of this immunization is about 57 million 544 thousand USD: direct costs: 41 million 34 thousand USD; indirect costs: 16 million 510 thousand USD. Concerning the vaccination impact on HBV endemicity in Italy, we found a significant reduction of acute viral hepatitis incidence (4.2/100,000 in 1996 versus 19/100,000 in the '80s) and HBsAg carrier prevalence (0.9% in 1997 versus 3% in the '80s). As for the assistance and social cost of acute viral hepatitis occurring from 1991 to 1996 (17,608 cases) it was 238 million 908 thousand USD, while the cost for the same pathology in the years from 1985 to 1990 (35,614 cases) was 483 million 216 thousand USD. Thus, the saving during the years of the vaccination was evaluated in 244 million 308 thousand USD. At the moment, we have no information about the reduction in chronic sequelae of HBV pathology as an effect of the vaccination, because the incidence of this pathology generally starts to appear after 15 years (in our case in 2006).
BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is usually diagnosed with overnight polysomnography in a sleep laboratory. Home sleep studies can be performed at lower cost, but results are somewhat less reliable. Bedside diagnosis of OSAS without any testing has also been discussed. OBJECTIVE: To model the costs and utility of laboratory polysomnography, home study, and no testing during the 5 years after initial evaluation for OSAS. DESIGN: Cost-utility analysis. DATA SOURCES: Published data. TARGET POPULATION: Hypothetical cohort of persons suspected of having OSAS. TIME HORIZON: The 5 years after initial evaluation for OSAS. PERSPECTIVE: Societal. INTERVENTION: Nasal continuous positive airway pressure when OSAS was diagnosed. MEASUREMENTS: Quality of life, survival and charges (as proxies for costs) for each diagnostic method. RESULTS OF BASE-CASE ANALYSIS: Under almost all modeled conditions, polysomnography provided maximal quality-adjusted life-years in the 5 years after the initial diagnostic evaluation. The incremental charges for polysomnography over home study or no testing were about $13,400 and $9200, respectively, per quality-adjusted life-year gained during this period. RESULTS OF SENSITIVITY ANALYSIS: Results were sensitive to the utility of treatment in the absence of OSAS. CONCLUSIONS: The cost-utility of polysomnography instead of home study or no testing in the diagnosis of OSAS compares favorably with that of other procedures for which society judges the added utility per dollar spent to be worthwhile. More precise determination of certain key variables in this model should be a goal of future research.