scholarly journals Cost-effectiveness of the next generation of RSV intervention strategies

2019 ◽  
Author(s):  
David Hodgson ◽  
Richard Pebody ◽  
Jasmina Panovska-Griffiths ◽  
Marc Baguelin ◽  
Katherine E. Atkins
Keyword(s):  
Monoclonal Antibody ◽  
Monoclonal Antibodies ◽  
Cost Effective ◽  
The Elderly ◽  
Transmission Model ◽  
School Age Children ◽  
Purchase Price ◽  
Long Acting ◽  
Maternal Protection ◽  
The Impact

ABSTRACTBackgroundWith a suite of promising new RSV prophylactics on the horizon, including long-acting monoclonal antibodies and new vaccines, it is likely that one or more of these will replace the current monoclonal Palivizumab programme. However, choosing the optimal intervention programme will require balancing the costs of the programmes with the health benefits accrued.MethodsTo compare the next generation of RSV prophylactics, we integrated a novel transmission model with an economic analysis. We estimated key epidemiological parameters by calibrating the model to seven years of historical epidemiological data using a Bayesian approach. We determined the cost-effective and affordable maximum purchase price for a comprehensive suite of intervention programmes.FindingsOur transmission model suggests that maternal protection of infants is seasonal, with 2-14% of infants born with protection against RSV. Our economic analysis found that to cost-effectively and affordably replace the current monoclonal antibody Palivizumab programme with long-acting monoclonal antibodies, the purchase price per dose would have to be less than around £4,350 but dropping to £200 for vaccinated heightened risk infants or £90 for all infants. A seasonal maternal vaccine would have to be priced less than £85 to be cost-effective and affordable. While vaccinating pre-school and school-age children is likely not cost-effective relative to elderly vaccination programmes, vaccinating the elderly is not likely to be affordable. Conversely, vaccinating infants at 2 months seasonally would be cost-effective and affordable if priced less than £80.InterpretationsIn a setting with seasonal RSV epidemiology, maternal protection conferred to newborns is also seasonal, an assumption not previously incorporated in transmission models of RSV. For a country with seasonal RSV dynamics like England, seasonal programmes rather than year-round intervention programmes are always optimal.FundingMedical Research Council and National Institute for Health ResearchRESEARCH IN CONTEXTEvidence before this studyA recent systematic review identified RSV prophylactic candidates currently in clinical trials, including a maternal vaccine (RSV F-nanoparticles vaccine), long-acting monoclonal antibodies aimed at neonates (MEDI8897), and an active adenovirus vector-based vaccine aimed at infants and/or the elderly (ChAd155-RSV). Given the significant observed health burden due to RSV in children, these products, which are mainly aimed at children, are likely to be effective at preventing RSV disease. However, uncertainties surrounding i) the dynamics of maternally-derived protection in neonates, ii) the impact of herd immunity, and iii) the purchasing cost of these prophylactics, means it is not clear if these products are cost-effective. Therefore, evaluating the purchasing price required for these prophylactics to remain cost-effective using a dynamic transmission model, in which the herd immunity is included and the dynamics of maternally-derived immunity is determined by calibrating the model to data, is a public health priority.Added-value of this studyOur study finds that in a setting with seasonal RSV epidemiology, maternal protection conferred to newborns is also seasonal. In addition, our study estimates the maximum purchasing price per course for various potential RSV intervention programmes to be cost-effective in England, assuming a cost-effectiveness threshold of £20,000/QALY as recommended by the National Institute of Clinical Excellence (NICE). We find that to cost-effectively and affordably replace the current monoclonal antibody Palivizumab programme with long-acting monoclonal antibodies, the purchase price per dose would have to be less than around £4,350 but dropping to £200 for vaccinated heightened risk infants or £90 for all infants. A seasonal maternal vaccine would have to be priced less than £85 to be cost-effective and affordable. While vaccinating pre-school and school-age children is likely not cost-effective relative to elderly vaccination programmes, and vaccinating the elderly is not likely to be affordable.Implications of all the available evidenceThe seasonal protection conferred to newborns is consistent with empirical immunological data from maternal cord blood and ecological evidence from hospital records. Further, extending a monoclonal antibody programme would be possible if there is a considerable drop in price and maternal vaccination remains the only realistic vaccination strategy in the UK. With further clinical trials planned for RSV F-nanoparticles vaccine to evaluate its efficacy, and with clinical trial completion dates set at the end of 2021 for the other two prophylactic candidates, the results of this study provide a comprehensive overview of the impact of potential RSV intervention programmes both in the present and in the coming years.

scholarly journals Evaluating the next generation of RSV intervention strategies: a mathematical modelling study and cost-effectiveness analysis

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
David Hodgson ◽  
Richard Pebody ◽  
Jasmina Panovska-Griffiths ◽  
Marc Baguelin ◽  
Katherine E. Atkins
Keyword(s):  
Monoclonal Antibodies ◽  
Economic Analysis ◽  
Cost Effective ◽  
Transmission Model ◽  
School Age Children ◽  
Purchase Price ◽  
Next Generation ◽  
Intervention Programme ◽  
Long Acting ◽  
Maternal Protection

Abstract Background With a suite of promising new RSV prophylactics on the horizon, including long-acting monoclonal antibodies and new vaccines, it is likely that one or more of these will replace the current monoclonal Palivizumab programme. However, choosing the optimal intervention programme will require balancing the costs of the programmes with the health benefits accrued. Methods To compare the next generation of RSV prophylactics, we integrated a novel transmission model with an economic analysis. We estimated key epidemiological parameters by calibrating the model to 7 years of historical epidemiological data using a Bayesian approach. We determined the cost-effective and affordable maximum purchase price for a comprehensive suite of intervention programmes. Findings Our transmission model suggests that maternal protection of infants is seasonal, with 38–62% of infants born with protection against RSV. Our economic analysis found that to cost-effectively and affordably replace the current monoclonal antibody Palivizumab programme with long-acting monoclonal antibodies, the purchase price per dose would have to be less than around £4350 but dropping to £200 for vaccinated heightened risk infants or £90 for all infants. A seasonal maternal vaccine would have to be priced less than £85 to be cost-effective and affordable. While vaccinating pre-school and school-age children is likely not cost-effective relative to elderly vaccination programmes, vaccinating the elderly is not likely to be affordable. Conversely, vaccinating infants at 2 months seasonally would be cost-effective and affordable if priced less than £80. Conclusions In a setting with seasonal RSV epidemiology, maternal protection conferred to newborns is also seasonal, an assumption not previously incorporated in transmission models of RSV. For a country with seasonal RSV dynamics like England, seasonal programmes rather than year-round intervention programmes are always optimal.

Forecasting Paratransit Ridership Using Discrete Choice Models with Explicit Consideration of Availability

1998 ◽  
Vol 1618 (1) ◽  
pp. 60-65 ◽  
Author(s):  
Julian Benjamin ◽  
Shinya Kurauchi ◽  
Takayuki Morikawa ◽  
Amalia Polydoropoulou ◽  
Kuniaki Sasaki ◽  
...  
Keyword(s):  
Choice Model ◽  
Mode Choice ◽  
Cost Effective ◽  
The Elderly ◽  
Developed Countries ◽  
Discrete Choice Models ◽  
Mode Share ◽  
Bus Service ◽  
Reservation System ◽  
The Impact

In most developed countries, the population of the elderly and disabled is growing rapidly. These individuals require transportation service suited to their needs. Such service may be provided by applying emerging technologies to dial-a-ride transit. This research develops a methodology to quantitatively evaluate the impact of paratransit services on a traveler’s mode choice behavior. The mode choice model explicitly considers availability of alternative modes and includes latent factors to account for taste heterogeneity. Stated preferences are also used to elicit preferences for new paratransit services. The methodology is empirically tested with data collected in Winston-Salem, North Carolina. The model system developed is applied to evaluate the effect of improving service attributes and the impact of the introduction of new cost-effective modes on modal shares. Results of the policy analysis indicate that ( a) transit policy changes, such as fare reduction, would have little effect on automobile driver and automobile passenger shares; ( b) an improved reservation system for dial-a-ride services would produce shifts in mode share; ( c) the proposed new bus deviation service was favored; ( d) free bus service reduces dial-a-ride share; and ( e) an increase in awareness of a dial-a-ride system would significantly increase its share.

School Health and Nutrition: Policy and Programs

2005 ◽  
Vol 26 (2_suppl2) ◽  
pp. S186-S192 ◽  
Author(s):  
Donald Bundy
Keyword(s):  
School Health ◽  
Low Cost ◽  
Cost Effective ◽  
School Age Children ◽  
Nutrition Interventions ◽  
Middle Income ◽  
Health And Nutrition ◽  
Nutrition Programs ◽  
The World ◽  
The Impact

This paper argues that there is now reliable evidence that ill health and malnutrition affect education access, participation, completion, and achievement, and that school-based health and nutrition programs can provide a cost-effective and low-cost solution. International coordination around this issue has been helped by a consensus framework to “Focus Resources on Effective School Health (FRESH),” developed jointly by UNESCO, WHO, UNICEF, Education International, and the World Bank, and launched at the World Education Forum in Dakar in April 2000 as part of the global effort to achieve the goal of Education for All (EFA). The need for school health and nutrition programs as part of EFA actions is now recognized by both countries and development partners, and examples of successful practical sector programs that have gone to scale are presented for both low- and middle-income countries. This paper argues that, despite this progress, there are two key unresolved issues related to the targeting of nutrition interventions toward school-age children. The first concerns the role of food as an incentive for participation in education, and the second concerns the appropriate target age group for nutrition interventions. It is suggested that finding clear answers to these key policy questions in nutrition could profoundly influence the impact of future school health and nutrition programs.

scholarly journals Could Sotrovimab, a monoclonal antibody, be helpful in COVID-19 symptoms in cats and ferrets?

2021 ◽  
Author(s):  
Sayıner Serkan
Keyword(s):  
Monoclonal Antibody ◽  
Monoclonal Antibodies ◽  
Intensive Care ◽  
Chronic Disease ◽  
Chronic Diseases ◽  
Early Stages ◽  
Different Types ◽  
The Impact

Although the types of coronaviruses seen in animals differ, recent studies have also shown that they are affected by COVID-19, known as SARS-CoV-2. The impact of COVID-19 on animals is a factor that should be followed carefully, especially since different variants appear in humans every day and this disease is transmitted from human to animal. Thanks to vaccination, animals are less affected by different types of coronaviruses. Cats and ferrets are especially affected much more in COVID-19, causing damage to the lungs and other organs. Recently, it has been shown that the use of monoclonal antibodies, especially in the early stages of COVID-19, by people with chronic diseases, positively affects the course of the disease, reduces the frequency of hospitalization and the possibility of falling into intensive care. Sotrovimab is a pan-sarbecovirus monoclonal antibody, and 12-13 studies to date have shown that individuals with chronic disease are less affected when given in the early stages of the disease when the symptoms are mild. We also think that if especially old cats and ferrets are treated with Sotrovimab in the early stages of the disease when they contract COVID-19, it will positively affect the prognosis of the disease.

Live vaccines and immunosuppressive monoclonal antibodies: weighing up the benefit–risk assessment for natalizumab

2020 ◽  
Author(s):  
Jean-Marc Schwob ◽  
Caroline F Samer ◽  
Patrice H Lalive ◽  
Gilles A Eperon
Keyword(s):  
Risk Assessment ◽  
Monoclonal Antibody ◽  
Monoclonal Antibodies ◽  
Mode Of Action ◽  
Live Vaccines ◽  
Specific Mode ◽  
Benefit Risk Assessment ◽  
Long Acting ◽  
Case Basis

Highlight We consider the safety of live vaccines when used in patients on natalizumab, a long-acting immunosuppressive monoclonal antibody. Based on this drug’s specific mode of action we propose a benefit/risk assessment on a case-by-case basis with individual considerations, rather than a generic contra-indication.

scholarly journals Pharmaco Economics Analysis of COVID-19 Vaccines in Ukraine

2021 ◽  
pp. 140-147
Author(s):  
Tsekhmister Yaroslav Volodymyrovych ◽  
Stepanenko Viktor Ivanovich ◽  
Konovalova Tetiana ◽  
Tsekhmister Bogdan Yaroslavovych
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
The Elderly ◽  
Transmission Model ◽  
Sample Population ◽  
Group Model ◽  
Effective Strategy ◽  
Vaccine Strategy ◽  
Cost Effective Strategy ◽  
The Cost

Aims: To evaluate pharmacoeconomics for the vaccination of COVID-19 vaccine and analyze the cost-effectiveness for the vaccine in Ukraine. Study design:  we have analyzed using models for the economics of coronavirus vaccine. Place and duration of study: Sample: population of Ukraine, data used from the official website of Ministry of Health, Ukraine. April - May 2021 Methodology: We have used the transmission model to analyze the vaccine strategy. Data were collected from official sources. We structured an age group model for evaluating high transmitters. Four strategies were organized and analyzed for analyzing the cost-effective strategy vaccination for everyone, no vaccination, and vaccination for old age only, high transmitters’ vaccination. Results: we have analyzed country specific cost-effective strategy for Ukraine depends upon the pandemic and economics of the country. Vaccinating older people was found to be the economically effective for Ukraine. In these study influences of discount rate analysis on QALY in Ukraine was done. When we vaccinate, high transmitters’ ratio was found to be 8.8% higher than for the elderly. This analysis suggests that vaccinating first the elderly group would not be so cost-effective. While doubling the cost for the vaccine, if the vaccine is available early with the scenario of pre-existing immunity has shifted cost-effectiveness for high transmitters than for the elderly in Ukraine Conclusion: we conclude from our pharmacoeconomic research study that cost effective analysis depends on pandemic and vaccinating elderly would be effective economically.

Mortality prediction in the elderly by an easily measured metabolic index

2012 ◽  
Vol 9 (3) ◽  
pp. 226-233 ◽  
Author(s):  
Laura Venskutonyte ◽  
Lars Rydén ◽  
Göran Nilsson ◽  
John Öhrvik
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Risk Index ◽  
Density Lipoprotein ◽  
Cost Effective ◽  
The Elderly ◽  
Mortality Prediction ◽  
Elderly Subjects ◽  
Swedish Population ◽  
The Impact

Objective: Hyperglycaemia enhances the risk of cardiovascular events and death, while high-density lipoprotein cholesterol (HDLc) is protective. Information on these associations among the elderly population is scanty. We applied a cardiometabolic risk index (CMRI) based on HDLc and fasting plasma glucose (FPG) in an elderly Swedish population. Methods: In total, 432 75-year-olds were followed for 10-year mortality. The impact of risk factors on survival was analysed using Cox regression. Results: HDLc (mmol/l; median and interquartile range) was 1.6 (1.3–2.0) in women and 1.4 (1.2–1.5) in men, while FPG was 5.9 (5.5–6.6) and 5.9 (5.5–6.5). Some 89 persons were at high risk according to CMRI, and 163 persons died. FPG was related to mortality in women (HR; 95% CI: 1.23; 1.10–1.37) and there was a similar trend in men (1.08; 1.00–1.17; p = 0.061). Increasing HDLc was protective in men (0.38; 0.19–0.77) but not in women (0.77; 0.45–1.29). CMRI was related to mortality in both genders even after adjustment for established risk factors (1.79; 1.14–2.79; p = 0.011). Conclusions: The CMRI helps identify elderly subjects at risk and may serve as a cost-effective risk prediction tool.

scholarly journals Economic evaluation of orphan drug Lutetium-Octreotate vs. Octreotide long-acting release for patients with an advanced midgut neuroendocrine tumour in the Netherlands

2021 ◽  
Author(s):  
Marije E. Hagendijk ◽  
Simon van der Schans ◽  
Cornelis Boersma ◽  
Maarten J. Postma ◽  
Simon van der Pol
Keyword(s):  
Cost Effectiveness ◽  
The Netherlands ◽  
Price Level ◽  
Cost Effective ◽  
List Price ◽  
High Dose ◽  
Positive Effects ◽  
Long Acting ◽  
The Cost ◽  
The Impact

Abstract Objectives Multiple studies showed positive effects of Lutetium-Octreotate (LO) treatment in neuroendocrine tumours. LO has been used in the Netherlands since the 1980s and recently received the orphan status shortly after the acquisition by Novartis. Since then, the official list price has increased sixfold. From a value-based pricing perspective, we analysed the impact of the increase in price on the incremental cost-effectiveness ratio (ICER) of LO treatment compared to optimal best supportive care, a high dose of Octreotide long-acting release (O-LAR), using the clinical data of the NETTER-1 trial. Methods A Markov model was developed to evaluate the costs per quality-adjusted life-year (QALY) for LO treatment compared to O-LAR from the healthcare perspective. A scenario analysis was conducted to compare the cost-effectiveness with the initial and increased price level of the LO-treatment. Results At the increased price level, the cost-effectiveness analysis rendered a deterministic ICER of €53,500 per QALY, while at the initial pricing, the ICER was €19,000 per QALY. The probabilistic sensitivity analysis (PSA) showed that LO had a high probability of being cost-effective at both the increased and initial price level, considering a cost-effectiveness threshold of €80,000. Conclusions Even at the increased price level, LO treatment can still be considered cost-effective using the applicable Dutch willingness-to-pay threshold of 80,000 euro per QALY. Considering the public scrutiny in relation to this price increase, these outcomes raise the question whether traditional cost-effectiveness methods are sufficient in fully capturing the societal acceptance of prices of new medicines.

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