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At least 19 recordsLinked to original sources
PubMed1978

Costs and benefits of measles vaccination in Finland.

Measles vaccination is fairly beneficial. During the third year after launching of the vaccination programme, cumulative benefits accuring from vaccination outweigh the cumulative costs of vaccination. This conclusion is based on a study of the vaccination programme in Finland. According to the vaccination programme, all 1-year-old infants in Finland are vaccinated. The duration of the period under survey has been set at 25 years, the measuring unit is the Finnish mark and the price level is that of the year 1975. When comparing costs and benefits, these are converted to present day monetary values. Vaccination costs per vaccinated infant amount to 32 marks, and in total during the period 1975--1999 they will amount to about 34 million marks according to an interest rate of 9% and to about 41 million marks according to an interest rate of 6% in current monetary value. Benefits gained by vaccination, compared with costs, are manifold. The benefits of one vaccination have been estimated at 230 marks. In total, benefits during the period 1975--99 constitute ca 117 million marks at an interest rate of 9%, and ca 159 million marks at an interest rate of 6% in current monetary value, without any deduction for vaccination costs. The net gain of vaccination--with a deduction of vaccination costs--is ca 84 million marks at an interest rate of 9%, and ca 118 million marks at an interest rate of 6% in current monetary value.

Child, Preschool↗
PubMed1992

Cholera vaccination: a decision analysis.

OBJECTIVE: To examine the clinical impact and financial cost of a vaccination program for the prevention of cholera in North Americans travelling to endemic and epidemic regions by means of the principles of decision analysis and a decision tree as well as to illustrate the effect of case attack rates on the cost per case prevented by vaccination. DESIGN: Review of the scientific literature to establish the probabilities of each significant outcome as well as a decision analysis and partial economic evaluation. OUTCOME MEASURES: Clinical impact (attack rates for cholera among vaccinated and nonvaccinated travellers), rates of death associated with cholera and vaccine-associated adverse events (VAAEs), and the number of VAAEs and the vaccine cost per case prevented. MAIN RESULTS: On the basis of our assumptions (including a rate of one case of cholera per 500,000 journeys to endemic regions), to prevent one case of cholera a vaccination program would cost $28.67 million and be associated with 105 VAAEs. CONCLUSION: Routine vaccination of travellers to endemic areas cannot be recommended; however, for people travelling to regions with a high transmission rate vaccination should be considered.

Cholera↗
PubMed1992

Low-cost hepatitis B vaccine improves uptake among self-paying health-care students.

Advisory committees recommend hepatitis B (HBV) immunization for professional and student health-care workers. However, the currently licensed vaccines are expensive, and previous surveys have shown that few students (14%) have been immunized in Canada. A low-cost immunization program was offered to health-care students in order to determine whether the effectiveness of HBV immunization could be improved by substantially reducing the vaccine cost to recipients. The immunogenicity, side effects, and 3-dose completion rate of a low-cost Korean HBV vaccine were compared with a similar U.S.-made vaccine. A total of 922 postsecondary students enrolled in 6 health-care disciplines in Ottawa, Canada were surveyed for hepatitis-B immunization status. Nonimmunized students were subsequently offered HBV vaccine at total cost of $15 (Canadian), randomly allocated to receive 3 intramuscular doses of either Korean or U.S.-made plasma-derived HBV vaccine in a double-blind fashion, surveyed about side effects, and tested for hepatitis B surface antibody seroconversion. Only 12% of the 922 surveyed students had been previously immunized when vaccine was obtainable only at high cost. However, 66% of those not immunized participated in the vaccine trial and paid the $15 fee. Hepatitis-B surface antibody seroconversion (greater than or equal to 10 sample ratio units by radioimmunoassay) occurred in 291/311 (93.6%) and 299/310 (96.5%) of recipients of 3 doses of the Korean and U.S. vaccines, respectively (P = 0.10). There were no meaningful differences in vaccine adverse effects, and 92.6% of recipients of either vaccine completed 3 doses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Immunogenicity of the intradermal route of hepatitis B vaccination with the use of recombinant hepatitis B vaccine.

In March 1987, 32 hospital employees were enrolled in a prospective trial of intradermal recombinant hepatitis B vaccination. Enrollees were given 0.1 ml of vaccine on days 1, 30, and 180. Two weeks after the third intradermal vaccination, 81%, or 26, of the enrollees showed seropositivity (greater than or equal to 10 mIU antibody/ml) for hepatitis B surface antibody. Five of six nonresponders were given a fourth intradermal vaccination. Two additional seroconversions occurred, resulting in an overall conversion rate of 90% for recipients of up to four intradermal vaccine doses. Complications of vaccination were limited primarily to the occasional persistence (less than 6 months) of hyperpigmentation at the injection site. Administration of recombinant hepatitis B vaccine by the intradermal route proved to be a safe and effective method of vaccination. Cost savings of preexposure immunization with the intradermal versus the intramuscular route of vaccination were approximately $90 per enrollee. Efficacy and safety can be maximized by employing a fourth vaccine dose and routinely documenting seroconversion after vaccination.

Antibody Formation↗
PubMed1991

Pre-exposure rabies prophylaxis for travellers: are the benefits worth the cost?

Pre-exposure rabies prophylaxis is recommended by the Immunization Practices Advisory Committee of the US Public Health Services (PHS) as a safe and effective method for reducing the risk of rabies in international travellers. The United States Peace Corps provides pre-exposure prophylaxis with human diploid cell rabies vaccine (HDCV) to over 2000 new volunteers each year going to rabies-endemic countries. During the year November 1987 through October 1988, 175 rabies exposures (and no deaths) were documented in Peace Corps Volunteers serving in 31 rabies-endemic countries, for an overall postexposure treatment rate of 43.6/1000 volunteers per year. Although PHS treatment protocols were strictly followed, the postexposure prophylaxis rate for these Peace Corps Volunteers was 550 times higher than that for the US general population, and 55 times higher than the average rate for 30 developing countries. The use of pre-exposure prophylaxis in travellers was not cost-effective and will not become so until the price of a dose of vaccine declines substantially to $7.00 for the Peace Corps, and even lower for groups with less rabies exposure. However, despite the high vaccine cost, pre-exposure prophylaxis continues to be recommended in the Peace Corps for important non-economic reasons which may also be applicable to other groups of travellers.

Cost-Benefit Analysis↗
PubMed1987

Cost-benefit analysis of hepatitis-B vaccination.

Since 1983 the Belgian insurance Fund for Occupational Disease (FOD) has refunded the cost of hepatitis-B (HB) vaccination. Vaccination has been carried out by occupational physicians selectively on staff in hospitals and medical-care institutions. At the end of 1986, 40,000 people at high risk of HBV infection had been vaccinated. The vaccination costs are largely offset by the benefits resulting from the striking fall in the number of HB cases. The financial investment has proved economically beneficial for the insurance fund.

Belgium↗
PubMed1991

Cost-effectiveness of hepatitis-B vaccine in Greece. A country of intermediate HBV endemicity.

We evaluated the cost-effectiveness of (a) a vaccination program for the prevention of hepatitis B; and (b) the two commercially available vaccines (Merck Sharp and Dohme; Pasteur Institute) in Greece, a country of intermediate endemicity. We examined cases of hepatitis-B infection prevented and the expected medical costs among the high-risk groups of medical and nursing students, hospital personnel, and the general population. Employing a vaccination program reduces considerably the risk of infection, especially in the high-risk groups, while it increases the total cost. The vaccines are very comparable in terms of both health and economic outcomes. Sensitivity analysis indicated that vaccine cost, incidence of hepatitis B, and compliance were the key factors for the choice of (a) whether to undertake an extensive program to prevent hepatitis-B infection and its chronic sequelae; and (b) which vaccine to administer.

Adult↗
PubMed1979

Administrative costs of the influenza control program of 1976--1977 in Illinois.

In 1976, many resources of state and local agencies were devoted to planning, organizing, implementing and evaluating the influenza immunization program. The costs included salaries and other expenses of specifically employed personnel; diversion of the time of others from their usual responsibilities; and donated resources. They were assessed retrospectively and reported by responsible local agency personnel on a questionnaire. Costs of donated services and other resources were estimated based on assigned unit value. The total cost of the program in Illinois was $3.334 per dose of which $1.733 was accounted for by local agencies, $0.075 by the state agency, and $1.526 by the federal government, including the cost of vaccine doses remaining unused. If the program could have been carried through to include the intended larger numbers of persons, both the administrative costs and the vaccine costs per dose administered would have been much less. The financial cost of the campaign exceeded the federal grant. It must be weighed against the administrative benefits including improved ability to conduct large scale preventive programs and awareness of the importance of both risks of benefits of immunization.

Administrative Personnel↗
PubMed1991

Immunogenicity of low-dose intradermal recombinant DNA hepatitis B vaccine.

Low-dose intradermal vaccination with plasma-derived hepatitis B vaccine has been shown to give high rates of seroconversion at greatly reduced vaccine cost. We report a study comparing two groups given lower doses (1.0 or 1.5 microgram) of recombinant-derived vaccine intradermally with a control group given the standard intramuscular dose. Of the 132 randomized medical students and hospital employees, 95 completed the study. Rates of seroconversion and peak antibody titers were comparable, though antibody rose more slowly and fell somewhat faster in the intradermal groups. Increasing the intradermal dose did not improve response. Most intradermal vaccinees (80%) developed small (average 2 to 3 mm) areas of local induration, which faded slowly. Low-dose intradermal vaccination with recombinant hepatitis B vaccine results in high rates of seroconversion (greater than 90% in each protocol) at a cost that will allow individual practitioners and program with limited budgets to offer vaccination.

Adult↗
PubMed1990

Cost effectiveness of antenatal hepatitis B screening and vaccination of infants.

Over a 2-year study period 5,858 public antenatal patients were screened with the Welcome hepatitis B surface antigen HA screening kit; 52 (0.89%) were positive (carriers) and 45 (87%) of these were identifiable as high risk patients and would have been diagnosed by selective screening; the remaining 7 (13%) would have been missed. Using a subsample of 1,000 women, it was found that high risk factors were present in 237 (23.7%). Restriction of screening to the high risk group cost an estimated $97 per carrier identified; universal screening cost $354 to identify each carrier. Screening only the high risk group would have missed the 7 carriers in the low risk group, which was estimated to number 4,470 patients (76.3% of the total). Estimated cost of screening the low risk group was $14,036, or $2,005 per carrier identified. The advent of highly effective vaccines enables the almost complete prevention of vertical transmission of hepatitis B. In mid-1988, vaccine costs in terms of hepatitis B prevention per baby were estimated to be $2,432 for vaccination of babies born to mothers in the high risk group, irrespective of maternal serology; and $9,729 for universal vaccination. Carrier rates vary between populations. For our clinic patients, universal screening and vaccination of all babies of high risk group mothers are considered appropriate. Selective screening may be more appropriate in a low risk private practice.

Carrier State↗
PubMed1989

Mumps in the US Army 1980-86: should recruits be immunized?

The US Army's experience with mumps hospitalizations was examined for the years 1980 through 1986. One hundred fifty-two cases among active duty Army soldiers were identified. Mumps rates declined from 3.85 per 100,000 active duty soldiers per year in 1980 to 1.28 in 1985, but an outbreak during 1986 caused rates to jump to 6.65. Attack rates were found to decline dramatically with increasing age or length of military service, with 74 per cent of cases occurring in soldiers with three years or less of service. Rates for Blacks and Whites were similar, but were higher for other minorities. Complications reported were mild. A cost-benefit analysis, assuming all recruits were to be vaccinated, estimated average annual vaccination program costs of $286,789; this figure exceeds average annual reported hospitalized mumps disease costs of $61,525 by a factor of 4.7. Mumps attack rates would have to reach at least 15.0 per 100,000 per year before savings would equal recruit vaccination costs. Failure to show that a vaccine program would be cost-saving may be due to limitations in identifying cases or to the requirement that all recruits be immunized regardless of prior immune status. It is likely that a program to immunize susceptible individuals alone would show benefit.

Adolescent↗
PubMed1979

Cost-benefit analysis of BCG-vaccination in Austria.

BCG-vaccination in Austria is performed generally in newborn, but only partially in school children. A cost-benefit analysis was performed considering age-dependent immunizations, tuberculosis morbidity, protection rate and duration of protection, costs of vaccination, costs of tuberculosis therapy, frequency of complications due to vaccination and costs for treatment of these complications. This analysis shows an economic balance between costs and benefits with regard to immunication of newborn, i. e., costs of vaccination are approximately compensated by the saved costs of prevented diseases. In contrary vaccination of school children reveals a considerable economic gain. General revaccination of schoolchildren would make BCG-vaccination much more effective in an economic respect.

Adolescent↗
PubMed1992

[Immunogenicity of a recombinant vaccine against viral hepatitis B].

The introduction in Italy of recombinant DNA hepatitis B vaccines has allowed to plan out a very important programme of vaccination; in Italy the compulsory vaccination against hepatitis B virus begun from 1991. Because of the reduction of vaccine cost, the screening for serum markers of HBV infection is needless. On the contrary, the test of antiHBs titres after the vaccination is important in order to take into account a booster vaccine dose and to carry out revaccination strategies. In this study, we analyzed 419 subjects vaccinated with Engerix-B; the immune response was correlated with private and behaviour data.

Adult↗
PubMed1990

Financial analysis of pseudorabies control and eradication in swine.

Computerized decision-tree analysis and simulation modeling were used to evaluate control and eradication strategies for pseudorabies virus (PRV) in swine. Three alternative actions were considered for a hypothetical 100-sow, farrow-to-finish operation: (1) depopulation-repopulation, (2) test-and-removal of seropositives (T&R), and (3) vaccination (of the entire herd or of sows only). The expected monetary values for the vaccination and T&R alternatives were similar, which was consistent with the long-standing controversy over the best strategy for dealing with PRV. When the prevalence rate of PRV was less than or equal to 57%, T&R was found to be optimal; otherwise, vaccination of sows only was recommended. Sensitivity analysis was performed to determine how modifications in some of the original assumptions affected the expected monetary values of each strategy. When higher gross margins for the producer were assumed, T&R was preferred at all prevalence rates. Vaccination was preferred when lower gross margins, lower vaccination costs, or better protective effect of PRV vaccines on reproductive performance were assumed. The use of gene-deleted vaccines in conjunction with the T&R strategy was also evaluated. When this option was available, T&R was favored at any prevalence rate (T&R alone when the prevalence was less than or equal to 20%, or combined with gene-deleted vaccination at prevalences greater than 20%). Depopulation-repopulation was not the best option under any circumstance. Once formulated, a decision-tree analysis can be adapted to the prevailing economic or epidemiologic conditions; hence, it is a useful tool in the PRV decision-making process.

Animals↗
PubMed1989

The Thai expanded programme on immunization: role of immunization sessions and their cost-effectiveness.

A cost-effectiveness study of the Thai expanded programme on immunization was carried out in district hospitals and health centres in Thailand during early 1987. The total annual spending on immunization was US $3852 in hospitals and US $813 in health centres. The percentage distribution of annual costs was similar in both facilities. Salaries were the largest component, followed by building and vaccine costs. The frequency of immunization sessions was the most important factor in determining total costs--immunization costs increasing with the frequency of sessions. In hospitals the average number of fully immunized children was 184, compared with 49 in health centres. The cost per fully immunized child varied widely from US $5.30 to US $33.20, and the most cost-effective facilities were those that immunized the greatest number of children. With the present number of health facilities in all areas of the country, which correspond to saturation levels, the most likely way for the Thai programme to reduce costs would be to make better use of staff time by decreasing the frequency of the services offered, thereby increasing the efficiency of each session. Hospitals should adjust the frequency of their immunization sessions according to the number of children being served, but health centres should offer sessions only monthly or once every two months.

Community Health Centers↗
PubMed1992

Cost-benefit analysis of a nationwide inoculation programme against viral hepatitis B in an area of intermediate endemicity.

The large decrease in the cost of vaccines against hepatitis virus B prompts a re-examination of nationwide vaccination campaign strategies. The present study estimates the costs and benefits that would result from a viral hepatitis B prevention programme (with no prior screening) targeted at all under-16-year-olds in Israel in 1990 and only neonates in the period 1991-2034. Israel is situated in an area of intermediate endemicity, where the majority of HBsAg carriers are anti-HBe positive. Such a policy would reduce the number of cases of viral hepatitis B in the vaccinated cohort from 654,000 to 270,000 over the period 1990-2059, yielding a benefit-to-cost ratio of 1.88: 1 for the health services only. Inclusion also of the indirect benefits of reduced work absences and mortality would increase the benefit-to-cost ratio to 2.77:1. Even when the benefits arising from the reduction in hepatocellular carcinoma and liver transplants were excluded, the benefit-to-cost ratio for the health services alone would still be 1.41:1. The adoption of such a nationwide inoculation policy appears therefore to be not only medically but also economically justifiable.

Adolescent↗
PubMed1990

Pneumococcal vaccine. Efficacy and associated cost savings.

We evaluated the efficacy and cost savings of the pneumococcal pneumonia vaccine in a retrospective cohort study of 762 vaccinated and 1161 randomly selected unvaccinated age-sex matched persons in Blue Cross/Blue Shield of Minnesota using medical and pharmaceutical claims. The pneumonia incidence and the ratio of incidence in the postvaccination to prevaccination periods (rate ratio) were examined in the vaccine group by sex and risk factors. Vaccination significantly reduced pneumonia incidence, with overall efficacy of 69% and higher efficacy in women (86%) than in men (33%). We assigned persons to risk categories based on disease conditions as recorded in the claims by the ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnostic codes. In the risk categories, efficacy varied from 50% to 75% and was confounded by sex. Immunocompromised and immunocompetent women had high efficacy (83% to 88%), while immunocompetent and immunocompromised men had lower efficacy (33%). Persons with a precondition of pneumonia exhibited similar vaccine efficacy to the overall cohort relative to the comparison group. Projected costs of pneumonia cases are 3.6 times the observed costs of vaccination and postvaccination pneumonia costs. We conclude that the pneumococcal pneumonia vaccine is efficacious in persons having had pneumonia, persons "at risk" of developing pneumonia, or persons over 50 years of age, and it corresponds to overall savings of $141 per person.

Aged↗