http://repub.eur.nl/res/aut/14281/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/34704/ 2012-05-01T00:00:00Z Objectives: Discounting has long been a matter of controversy in the field of health economic evaluations. How to weigh future health effects has resulted in ongoing discussions. These discussions are imminently relevant for health care interventions with current costs but future benefits. Different approaches to discount health effects have been proposed. In this study, we estimated the impact of different approaches for discounting health benefits of human papillomavirus (HPV) vaccination. Methods: An HPV model was used to estimate the impact of different discounting approaches on the present value of health effects. For the constant discount approaches, we varied the discount rate for health effects ranging from 0% to 4%. Next, the impact of relevant alternative discounting approaches was estimated, including hyperbolic, proportional, stepwise, and time-shifted discounting. Results: The present value of health effects gained through HPV vaccination varied strongly when varying discount rates and approaches. The application of the current Dutch guidelines resulted in a present value of health effects that was eight or two times higher than that produced when using the proportional discounting approach or when using the internationally more common 4% discount rate for health effects, respectively. Obviously, such differences translate into large variations in corresponding incremental cost-effectiveness ratios. Conclusion: The exact discount rate and approach chosen in an economic evaluation importantly impact the projected value of health benefits of HPV vaccination. Investigating alternative discounting approaches in health-economic analysis is important, especially for vaccination programs yielding health effects far into the future. Our study underlines the relevance of ongoing discussions on how and at what rates to discount. http://repub.eur.nl/res/pub/24786/ 2009-11-09T00:00:00Z Objective To document the impact of the severe acute respiratory syndrome (SARS) outbreak in Beijing on indicators of social and economic activity. Methods Associations between time series of daily and monthly SARS cases and deaths and volume of public train, airplane and cargo transport, tourism, household consumption patterns and gross domestic product growth in Beijing were investigated using the cross-correlation function. Results Significant correlation coefficients were found for all indicators except wholesale accounts and expenditures on necessities, with the most significant correlations occurring with a delay of 1 day to 1 month. Conclusions Especially leisure activities, local and international transport and tourism were affected by SARS particularly in May 2003. Much of this consumption was merely postponed; but irrecoverable losses to the tourist sector alone were estimated at about US$ 1.4 bn, or 300 times the cost of treatment for SARS cases in Beijing. http://repub.eur.nl/res/pub/11359/ 2004-01-01T00:00:00Z The article explains that if decision makers are willing to adopt the recommended societal perspective, universal infant varicella vaccination is very desirable since large savings are expected to occur in all economic evaluations adopting this perspective. By contrast, if decision makers do not wish to consider the time lost by parents or caregivers and prefer to adopt the more narrow healthcare payer's perspective, then, the results of the studies taking such a perspective all indicate that universal infant varicella vaccination results in high net costs, whilst showing a low efficiency in saving life-years and averting deaths, in comparison with other programmes. http://repub.eur.nl/res/pub/11433/ 2003-10-01T00:00:00Z The application of economic evaluation in healthcare, including vaccination programs, has increased exponentially since the 1980s. There are a number of aspects of economic evaluation of vaccine programs that present particular challenges to the analyst. These include the development of the appropriate epidemiological models from which to estimate the costs and benefits; the accurate prediction of uptake rates; the incorporation of quality adjusted survival gains; and the inclusion of intangible but nonetheless important benefits and costs associated with infectious disease and vaccination. The estimation of marginal intervention costs presents specific difficulties, especially for multivalent vaccines and valuing costs and benefits over time is heavily influenced by the choice of discount rate, which is still a controversial topic. Developments in the next 5 years are likely to address all of these issues and result in more sophisticated and accurate models of vaccination programs. http://repub.eur.nl/res/pub/11367/ 2003-01-01T00:00:00Z Chickenpox infections are generally mild but due to their very high incidence among healthy children they give rise to considerable morbidity and occasional mortality. With the development of a varicella vaccine in the early 1970s and its progressive licensing in many countries, interest in the efficiency of varicella immunisation programmes grew. The objective of this review was to discuss the methodological aspects and results of published economic evaluations of varicella vaccination. From this, we attempted to make recommendations. A computerised search was carried out; 17 full economic evaluations of varicella vaccination were retrieved. The review identified the methodological divergences and similarities between the articles in four areas: study design, epidemiological data, economic data and model characteristics. We assessed to what extent the applied methods conform to general guidelines for the economic evaluation of healthcare interventions and compared the studies’ results. The desirability of a universal vaccination programme depends on whose perspective is taken. Despite variability in data and model assumptions, the studies suggest that universal vaccination of infants is attractive to society because large savings occur from averted unproductive days for parents. For the healthcare payer, universal vaccination of infants does not generate savings. Vaccination of susceptible adolescents has been proposed by some authors as a viable alternative; the attractiveness of this is highly dependent on the negative predictive value of anamnestic screening. Targeted vaccination of healthcare workers and immunocompromised individuals appears relatively cost effective. Findings for other target groups are either contradictory or provide insufficient evidence for any unequivocal recommendations to be made. High sensitivity to vaccine price was reported in most studies. This review highlights that some aspects of these studies need to be further... http://repub.eur.nl/res/pub/11370/ 2002-01-01T00:00:00Z The methods that have been used to estimate the clinical and economic impact of vaccination programmes are not always uniform, which makes it difficult to compare results between economic analyses. Furthermore, the relative efficiency of vaccination programmes can be sensitive to some of the more controversial aspects covered by general guidelines for the economic evaluation of healthcare programmes, such as discounting of health gains and the treatment of future unrelated costs. In view of this, we interpret some aspects of these guidelines with respect to vaccination and offer recommendations for future analyses. These recommendations include more transparency and validation, more careful choice of models (tailored to the infection and the target groups), more extensive sensitivity analyses, and for all economic evaluations (also nonvaccine related) to be in better accordance with general guidelines. We use these recommendations to interpret the evidence provided by economic evaluation applied to viral hepatitis vaccination. We conclude that universal hepatitis B vaccination (of neonates, infants or adolescents) seems to be the most optimal strategy worldwide, except in the few areas of very low endemicity, where the evidence to enable a choice between selective and universal vaccination remains inconclusive. While targeted hepatitis A vaccination seems economically unattractive, universal hepatitis A vaccination strategies have not yet been sufficiently investigated to draw general conclusions. http://repub.eur.nl/res/pub/11446/ 1995-01-01T00:00:00Z The World Health Organization (WHO) estimates that about 350 million people in the world are carriers of the hepatitis B virus (HBV), 60 million of whom may die from liver cancer and about 45 million from cirrhosis. In the WHO European Region, which has a total population of 839 million inhabitants, the average number of acute hepatitis B cases reported in 1991 was approximately 160 000, giving an incidence of 19 per 100 000 population. This incidence rate varies from 5 per 100 000 in western Europe to 22 per 100 000 in central Europe and 92 per 100 000 in eastern Europe. Because of under-reporting and the fact that two-thirds of infections are asymptomatic, the reported incidence rate considerably underestimates the true incidence of HBV in Europe. For this reason, we may multiply the number of reported cases by a factor of 6 (by 2 for under-reporting and by 3 for the symptomatic/asymptomatic ratio): an estimated 900 000 to 1 000 000 infections of HBV occur in Europe each year. Approximately 90 000 chronic infections will develop from these new cases. The spread of HBV can be controlled by universal infant or adolescent vaccination. A decision-tree-based analytical model was used to assess the clinical and economic impact of these two interventions. The model took into account incidence and prevalence rates of HBV, natural history of infection, compliance and effectiveness of vaccination, and direct and indirect costs. Data were obtained from the literature and from a WHO European survey. The cost-effectiveness ratio amounts to £6443 and £4745 per infection prevented for neonatal and adolescent vaccination, respectively. The results from these calculations show that neither vaccination of neonates or of adolescents is cost-saving. However, the cost-effectiveness - i.e. the cost incurred to prevent an HBV infection is of an acceptable magnitude for both strategies.