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Results for “Immunization--cost”

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At least 19 recordsLinked to original sources

PubMed1997

Immunity costs and behavioural modulation in male laboratory mice (Mus musculus) exposed to the odours of females.

In a previous study, male laboratory mice experimentally immunodepressed with anti-thymocyte serum (ATS) showed changes in behaviour (aggression, general locomotory activity, and sleeping) and testosterone that are consistent with decision-making being modulated adaptively with respect to immunocompetence. We tested this idea further by repeating the experiment with the addition of female odours (soiled sawdust) to the home cages of males following ATS/control treatment. We predicted that, in the presence of cues suggesting reproductive opportunity, immunodepressed males would trade off potential immunity costs by failing to modulate behaviour. This expectation was borne out in that ATS-treated mice showed no change in aggression, locomotory activity, mounting, or sleeping relative to control animals, and mice overall showed differences in behaviour in the expected direction compared with a previous study in which female odours were not presented. However, despite the lack of difference in behaviour between ATS and control treatments, there was still evidence of a degree of behavioural modulation in relation to measures of immunocompetence.

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

Childhood immunization practices of primary care physicians.

OBJECTIVE: To assess if immunization utilization practices differ between rural and urban primary care physicians in Kentucky. DESIGN: Survey of 200 primary care physicians. PARTICIPANTS: Pediatricians, family physicians, and general practitioners in Kentucky. SELECTION PROCEDURES: Participants completed a 20-item questionnaire that surveyed selected demographics with regard to the physician and practice, immunizations offered to children, and reasons why the responding physicians did not offer immunizations and where they referred patients for this service. RESULTS: Physicians practicing in rural counties offered immunizations to their patients less frequently than did urban physicians (54% vs 77%). Rural and urban physicians cited immunization costs to patients as the chief reason that immunizations were not used more often and referred patients primarily to county health departments. CONCLUSIONS: Rising costs have limited physician use of immunizations in rural areas to a greater extent than that seen in urban areas. This may make access to immunizations more difficult for children living in rural areas.

Child↗

PubMed1999

Clinical and economic impact of a combination Haemophilus influenzae and Hepatitis B vaccine: estimating cost-effectiveness using decision analysis.

BACKGROUND: Compliance with hepatitis B virus (HBV) vaccine remains suboptimal, despite a recommendation by the Advisory Committee on Immunization Practices of the US Public Health Service that all newborns be vaccinated. Although a combined HBV-Haemophilus influenzae type b (Hib) vaccine may improve acceptance of the HBV vaccine, the clinical and economic consequences of this intervention are uncertain. OBJECTIVES: To compare the health impact and cost-effectiveness of the following 2 immunization strategies: current practice of administering HBV vaccine separately (75% compliance) and Hib vaccine alone or as part of a multivalent vaccine (95% compliance); and strategy of delivering a combined HBV-Hib vaccine (95% compliance). DESIGN: A Markov model simulated the natural history of acute and chronic HBV and Hib disease in a cohort of US newborns. Clinical and economic variables were obtained from published reports. RESULTS: The Hib-related outcomes were the same in both strategies, because the efficacy and compliance with Hib vaccine were assumed to be equivalent in both. A 53% reduction in the number of cases of HBV infection with the combination strategy (n = 8541) was estimated when compared with current practice (n = 18 044), along with 205 fewer HBV-related deaths per 1 million infants. Immunization costs of the combination strategy were $11.5 million higher than for current practice ($108.4 million compared with $96.9 million), whereas the cost of HBV-related disease was $4.0 million lower than in current practice. The incremental cost-effectiveness ratio for the combination strategy was $17700 per year of life saved. CONCLUSION: An HBV-Hib vaccine in US infants yields substantial benefits, with a cost-effectiveness ratio that is lower than that of many commonly used medical interventions.

Adolescent↗

PubMed1993

Immune response to simultaneous administration of a combined measles, mumps and rubella vaccine with booster doses of diphtheria-tetanus and poliovirus vaccine.

A combined vaccine against measles (Edmonston-Zagreb 19 strain), mumps (Rubini strain) and rubella (Wistar RA 27/3 strain) was administered to a group of 46 children aged 10-12 months simultaneously with booster doses of compulsory diphtheria-tetanus toxoid and oral poliovirus vaccine. A second group of 53 children aged 15-24 months who had received booster doses of the compulsory vaccines 5 to 12 months before was also vaccinated. The same seroconversion rates (100%) and similar antibody titers for rubella were observed in both groups. The same seroconversion rates for mumps (93%) and similar rates for measles (98 and 94%) were observed in the two groups. Significantly lower antibody titers for measles and mumps were found in the first group, but they were compensated by an earlier protection, a reduction of number of visits for immunization, costs for the community, and improvement in parental compliance. These results confirm that Edmonston-Zagreb 19 and Rubini strains are still immunogenic even when they are combined with Wistar RA 27/3 strain. Moreover, a long term follow-up in order to verify the persistence of protective antibody levels in both groups of children, could suggest that combined measles, mumps and rubella vaccine could be given earlier (at 10-12 months of age), simultaneously with booster doses of diphtheria and tetanus toxoid and of trivalent oral poliovirus vaccine.

Antibodies, Viral↗

PubMed1986

Cost effectiveness of potential immunization interventions against diarrhoeal disease.

Estimates are made of the costs per death averted and the costs per case prevented by three possible immunization interventions against diarrhoeal disease in children. These estimates are based on cost information collected from a number of on-going national immunization programmes and from effectiveness estimates reported in previously published reviews. The first part of the paper reviews the state of current knowledge regarding immunization costs and converts data from 9 different studies into a common set of price equivalents. The second section assesses the composition of typical immunization programme costs and estimates the likely effect on existing costs of introducing new vaccines. Compatibility between existing EPI activity and the administration schedule of the new vaccine is likely to be a major determinant of increments in cost per fully immunized child. The third section brings together the cost information with estimates of the likely impact of measles, rotavirus and new cholera vaccines on mortality and morbidity from diarrhoea.

Adolescent↗

PubMed2001

The utility of serologic testing for varicella in an adolescent population.

The purpose of this study was to determine what proportion of adolescents without a history of varicella are seropositive, and if serologic testing of this adolescent subpopulation is cost-effective. We identified 122 patients with 'no' or 'unknown' histories of chicken pox from our adolescent clinic. Of these, 58 (48%) were found to be Varicella Zoster Virus (VZV) seropositive. Cost to the government for batched serologic testing of all unknowns was $682.65, while each adolescent vaccinated cost $59.60. Serologic testing prior to routine immunization of adolescents with unclear varicella histories saved $2774.15 (38% of routine immunization costs). In this population, serologic testing is more cost effective than routinely immunizing all unknowns.

Adolescent↗

PubMed2002

Vaccinating first-year college students living in dormitories for Meningococcal disease: an economic analysis.

BACKGROUND: Surveillance of meningococcal disease among U.S. college students found an elevated rate of this disease among first-year students living in dormitories. OBJECTIVE: This study examines the economics of routinely vaccinating a cohort of 591,587 incoming first-year students who will live in dormitories for > or =1 years. METHODS: A cost-benefit model (societal perspective) was constructed to measure the net present value (NPV) of various vaccination scenarios, as well as the cost/case and cost/death averted. Input values included hospitalization costs from $10,924 to $24,030 per hospitalization; immunization costs (vaccine plus administration costs) from $54 to $88 per vaccine; 30 nonfatal, vaccine-preventable cases over a 4-year period (includes 3 with sequelae); 3 premature deaths; value of human life from $1.2 million to $4.8 million; and long-run sequelae costs from $1298 to $14,600. Sensitivity analyses were also conducted on vaccine efficacy (80% to 90%); discount rate (0% to 5%); and coverage (60% to 100%). RESULTS: The costs of vaccination outweighed the benefits gained with NPVs ranging from -$11 million to -$49 million. The net cost per case averted ranged from $0.6 million to $1.9 million. The net cost per death averted ranged from $7 million to $20 million. The break-even costs of vaccination (when NPV=$0) at 60% coverage ranged from $23 (90% vaccine efficacy) to $5 (80% efficacy). CONCLUSIONS: The model showed that the vaccination program is not cost-saving. Key variables influencing the results were the low number of vaccine-preventable cases and the high cost of vaccination. However, from the perspective of students and parents, the cost of vaccination might be worth the real or perceived benefit of reducing the risk to an individual student of developing meningococcal disease.

Adolescent↗

PubMed2000

Predicting cost-benefits before programs are started: looking at conjugate vaccine for invasive pneumococcal infections.

This analysis uses existing data to examine how an analysis to predict the net financial impact for an emerging medical program, namely a conjugate vaccine against Streptococcus pneumoniae, and to identify which key variables will have the greatest impact on the program's costs and benefits. Using data available on the prevalence and case fatality rates for invasive diseases caused by S pneumoniae, we examined the theoretical economic impact of vaccinating all newborns versus not vaccinating. Effectiveness estimates for conjugated pneumococcal vaccines and disease incidence and fatality rates were obtained from published sources. Because of scanty or inconclusive data for otitis media and pneumonia, the analysis was limited to cases of meningitis and bacteremia due to S pneumoniae. Based on these two diseases alone, immunization with conjugate pneumococcal vaccine could save an estimated 222 lives per million children vaccinated per year. Analysis of direct costs (projected immunization costs minus savings from reduced illness) show that a pneumococcal vaccine program will result in net direct costs between $0.08 and $2.42 per child. When indirect costs are included in the analysis, the vaccine is cost savings for all cases except when the two year incidence of disease and death rates are lowest and the cost of the vaccine series is $150. Further research should focus on these key issues as the vaccine is introduced into use, as expected in the next few years.

Bacterial Vaccines↗

PubMed1999

Economics of theileriosis control in Zambia.

For an economic analysis of theileriosis control, we adopted the total economic cost (TEC) method, which calculates the sum of output losses from tick damage, theileriosis mortality and morbidity, and expenditures for treatment or prevention of the disease. At farm level, the TEC can be minimized by a specific combination of vector control and/or immunization and an acceptable level of losses. Expenditures for vector control include acaricides, construction of dipping or spraying facilities and their maintenance, and variable costs such as those for water and labour. Economics of vector control depend on the herd size and the method of application of the acaricide. Morbidity, mortality and tick damage losses are effectively reduced by correct and intensive vector control programmes. Expenditures for vector control are estimated at US$ 8. 43, 13.62 and 21.09 per animal per year for plunge dipping, hand spraying and pour-on, respectively. Immunization costs comprise production of parasite stabilates, storage and application, delivery and treatment. At US$ 9.5 per animal, immunization limits losses caused by Theileria parva, but ticks still may reduce the productivity of the animals. Expenditures for treatment after natural infection involve drugs, transport, veterinary fees and farm labour costs. Treatment has a moderate success rate, hence both morbidity and mortality remain important factors. Equally, it does not affect the vector, which may continue to reduce overall productivity of cattle. Expenditures for treatment range between US$ 9.04 and US$ 27.31 per animal. To compare different TECs in relation to different control strategies, assumptions have to be made on disease occurrence, case fatality, value and productivity of the cattle, reductions in productivity due to morbidity and number of animals under a specific control regime. Calculations based on data from Southern Province, Zambia show that large-scale immunization reduces the TEC by 90% compared to no intervention. Treatment, which is the second-best option, reduces the TEC by 60%. Appendix 1 Summary of factors influencing total economic cost

Animals↗

PubMed2001

Improving immunization coverage in rural areas of Ecuador: a cost-effectiveness analysis.

This study describes the costs and outcomes of two different immunization strategies used by the district level of the Ministry of Health carried out between 1993 and 1995 in Low-Napo area, Napo, Ecuador. One was centrally planned and managed by the District Hospital (DH) and the other planned and implemented together with community health workers (CHW). Immunization costs were estimated directly from survey records and communication of the Ministry of Health. Outcomes information was abstracted from the vaccination statistics of the Napo Province Health Department for 1993/1995. Community health workers strategy immunized 113 children with an average cost of US $32 per child. District Hospital strategy had an average cost of US $777.6 per immunized child.Thus, CHWs strategy is more effective and less costly than the DH strategy. This study shows that in order to maximize the cost-effectiveness of immunization, it is important to involve community participation in both planning and implementation. Continuous follow-up and evaluation of the immunization programme and further research on vaccine efficacy are necessary in order to maintain these results.

Child↗

PubMedDate not supplied

Hepatitis B immunization in a low-incidence province of Canada: comparing alternative strategies.

This study provides a comparative cost-effectiveness analysis of three universal immunization programs for hepatitis B virus (HBV). Using three theoretical cohorts of infants, 10-year-olds, and 12-year-olds, a universal immunization program was compared with a prenatal screening/newborn immunization program involving testing of prepartum women and immunization of newborns of HBsAg-positive mothers. A Markov long-term outcome model used Manitoba data to estimate costs and health outcomes across the lifespan. The model was based on an HBV incidence rate of 19/100,000 and a discount rate of 5% and incorporated the most recent treatment advances (interferon therapy). Cost-effectiveness was calculated as the ratio of dollars spent per year of life saved, with costs determined from the perspective of a third-party payer. The universal infant-immunization program, although not cost-saving, was associated with a low, economically attractive cost-effectiveness ratio of $15,900 (Canadian) per year of life saved, a figure substantially lower than the ratios of $97,600 and $184,800 (Canadian) associated with the universal programs for 10- and 12-year-olds, respectively. Cost-effectiveness ratios were found to be sensitive to changes in immunization costs, HBV incidence rates, and the rate at which protective antibody levels are lost over time: If these variables move in the directions suggested by current trends, the authors anticipate an increasing economic appeal of universal programs well into the future. A universal program of HBV immunization for infants appears to be economically practical in regions where HBV infection rates are low and stable.

Carcinoma, Hepatocellular↗

PubMed1997

Differences in the methodology and data of economic evaluations of a health programme. The case of hepatitis B vaccination programmes in Spain.

Economic evaluations of hepatitis B vaccination programmes in Spain or particular regions of Spain were identified and analysed, and their methodologies and data were compared. The results revealed important differences in methodology and the way in which different parameters, such as duration of immunity, costs and sources of cost data, were defined and measured. Some of these variations could be justified by the need to adapt studies to specific contexts, while others appeared arbitrary. Although it is understandable that there should be a substantial amount of heterogeneity between studies, greater efforts need to be made to reduce unnecessary variations in the way in which different parameters are measured. Increasing standardisation in methodology, which nevertheless takes into account inevitable variations due to changing circumstances and perspectives, will help to make economic evaluation a more attractive proposition for decision makers.

Delivery of Health Care↗

PubMed1990

Door-to-door canvassing for immunization program acceleration in Mozambique: achievements and costs.

The Expanded Program on Immunization has made remarkable progress in raising coverage in developing countries. Countries have been urged to accelerate their programs, especially in urban areas. In Mozambique, as part of program acceleration, volunteers from grassroots organizations conducted door-to-door canvassing for the Program. Concurrently, the availability of immunization was increased in health centers and in outreach visits. By 1987, over 90 percent coverage for all vaccines was achieved in the capital, Maputo; two other cities doubled their immunization coverage to over 50 percent fully immunized children, and rural areas of the pilot province achieved 60 percent coverage. Immunization costs were estimated in one city as $6.9 (U.S. dollars) per fully vaccinated child. Door-to-door canvassing accounted for more than 40 percent of personnel costs, and may have diverted attention from the quality of service in the health centers. In this article we outline the achievements and costs of door-to-door canvassing and discuss other strategies to raise coverage. The analysis of the need to balance the mobilization of demand with the capacity to respond is relevant to other countries in their efforts to develop sustainable immunization services.

Cost-Benefit Analysis↗

PubMed1979

Benefits of immunization versus risk factors in tetanus.

The risk of tetanus is universal, but it depends on numerous factors (socio-economic, environmental and biological) which combine to determine the force of infection. Tetanus is a murderous and costly disease. Its morbidity has greatly regressed in industrialized countries (less than 1 case per 100,000, involving mainly aged persons). On the contrary, developing countries are still severely affected (10 to 50 cases per 100,000, involving mainly neonates and children). Tetanus vaccine is one of the most effective, best tolerated and least expensive vaccines. Vaccination is the main weapon for starting disease control in developing countries, and the only way of eradicating tetanus in developed countries. Whatever the socio-economic level may be, some evaluations show that immunization cost is approximately equal to avoided treatment and seroprevention expenditures. The essential benefit of vaccination is the prevention of death, suffering and disability.

Adolescent↗

PubMed1994

The global capacity for manufacturing vaccines. Prospects for competition and collaboration among producers in the next decade.

Can the world respond to the demands of the Children's Vaccine Initiative (CVI) to produce large quantities of affordable vaccines that have never been manufactured previously? Vaccines for the world's birth cohort of 150 million will continue to be produced in the countries that use the greatest part of the global vaccine supply. Thus, the CVI will rely on increased self sufficiency in vaccine production in the developing world and "shared development" of new and improved vaccines. The CVI's goal is to direct product development to meet the needs of immunization programs, but it must not neglect production. Thus, from the start, investment at the front end of the development and production sequence requires attention to the ultimate production capacity.

Child Welfare↗

PubMed1994

The desired field-performance characteristics of new improved vaccines for the developing world.

Although the vaccination initiatives undertaken during the past decade are the cornerstones for protecting the world's children and helping to ensure their survival and development, the vaccines currently being employed may become obstacles for further disease reduction or eradication. Their characteristics complicate or increase the burden on health care infrastructures to maintain or expand vaccine delivery systems. This paper examines an experience with the vaccine technologies that currently are being used by immunization programs in developing countries, illustrating the field problems and obstacles associated with their use. It discusses the advantages and benefits that would accrue if new or improved, heat-stable, multi-antigen vaccines that require only one or two, preferably oral, doses were to become available.

Child Health Services↗

PubMed1979

Immunization against poliomyelitis: risk/benefit/cost in a changing context.

Benefit/risk factors in immunization against poliomyelitis are examined from the viewpoint of the relative risk and efficacy of killed and live poliovirus vaccines in the currently changing contexts of poliomyelitis prevalence in developed and developing countries. Risk factors include virus of vaccine origin gaining access to the CNS, and failure of the vaccine to immunize. Data are presented to illustrate the degree to which the respective risks occur in developed and developing countries. The ultimate elimination of risk by eradication of wild and vaccine virus from the population is discussed.

Adolescent↗