The economic and health consequences of shared clinical decision-making for hepatitis B birth dose vaccination.

Economic evaluation of alternative PCV13 vaccination strategies in Guangxi, China: a decision tree-Markov model study.

BACKGROUND Pneumococcal disease remains a major cause of morbidity and mortality among children under five years of age, particularly in settings with low vaccine coverage. In China, the 13-valent pneumococcal conjugate vaccine (PCV13) is not included in the National Immunization Program (NIP), resulting in suboptimal uptake. This study evaluated the health and economic impact of including PCV13 in the immunization program in Guangxi Zhuang Autonomous Region. METHODS A decision tree-Markov model was used to simulate a birth cohort of 420,000 children over a 5-year horizon from a societal perspective. The current self-paid vaccination strategy was compared with NIP inclusion. Outcomes included costs, cases, deaths, quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), and benefit-cost ratios (BCRs). Costs and outcomes were discounted at 3%. One-way and probabilistic sensitivity analyses were conducted. RESULTS NIP inclusion increased vaccination coverage from 5900 to 417,019 children and was projected to prevent 77,042 cases and 327 deaths over 5 years. Despite higher vaccination costs, reduced disease burden resulted in a net economic benefit of USD 3.92 million (BCR: 1.03). The program generated an additional 25,702.2 QALYs, with an ICER of USD 6042.75 per QALY gained, below the per capita GDP threshold. Probabilistic sensitivity analysis showed that most simulations were below the willingness-to-pay threshold, with the probability of cost-effectiveness approaching 100%. CONCLUSIONS Including PCV13 in Guangxi's immunization program is highly cost-effective and likely to yield positive economic returns. These findings are robust and support policy decisions on PCV13 inclusion.

Quantifying the societal benefits of adult immunization against respiratory diseases in France: a benefit cost analysis.

BACKGROUND Pneumococcal disease, respiratory syncytial virus (RSV), influenza, and COVID-19 place a significant burden on France's population health, health system, and economy. Older adults and adults in clinical risk groups are recommended to receive vaccination against these illnesses, although RSV is not reimbursed. RESEARCH DESIGN AND METHODS A benefit-cost analysis was conducted to assess the societal return on investment from adult vaccination by estimating benefit-cost ratios (BCRs) and net benefits (NBs). Health outcomes were monetized using established methods. Program costs included all direct vaccination-related expenditures. Scenario and sensitivity analyses assessed alternative program specifications and tested the robustness of the model. RESULTS France's age-based respiratory immunization programs generate a BCR of €2.0 to €8.7 per €1 spent over the lifetime, depending on mortality risk reduction monetization. This corresponds to NBs of €9.7 to €72.6 billion. Introducing adult RSV vaccination with a similar uptake to that in the US could increase NBs by approximately 6%-7% compared to the status quo. Achieving aspirational coverage targets across all programs would increase NBs by 138%-175%. CONCLUSIONS France's adult respiratory vaccination programs generate positive socioeconomic returns. Including adult RSV vaccination and increasing vaccination uptake would further increase their societal benefits. Realizing these gains requires adequate public investment.

Shared clinical decision-making for vaccination: A view through the lens of mid-adult HPV vaccination

ABSTRACT In the summer of 2019, the U.S. Advisory Committee on Immunization Practices (ACIP) updated its recommendations for HPV vaccination. The new recommendation regarding adults ages 27–45y (i.e., mid-adults) indicated that a “shared clinical decision-making” (SCDM) approach, rather than a routine recommendation, should be used. The Morbidity and Mortality Weekly Report (MMWR) publication that described this SCDM recommendation included specific conditional guidance and considerations for SCDM. However, some aspects of the guidance are vague, and others are inconsistent with SCDM, which could lead to confusion for adult health care providers and ultimately lead to under-vaccination of eligible individuals who would benefit from HPV vaccination. More recently, in the U.S. there have been policy proposals to shift additional vaccine recommendations from routine to SCDM. In this commentary, we briefly outline the ACIP recommendations, provide a clear overview of SCDM, and then offer potential implementation challenges for this guideline. For both unvaccinated adult patients and the providers who serve them, clear guidance on effective SCDM practices for HPV vaccination is an essential component for addressing the prevention of HPV-related disease. Using the context of mid-adult HPV vaccination, we also discuss the implications of SCDM recommendations for other vaccines.

Algorithms-Based Monitoring of Vaccine Coverage in Chronic-Disease Cohorts: A Population-Based Evaluation of Regional Immunization Policy in Emilia-Romagna, Italy.

OBJECTIVES This study aims at estimating uptake of risk-based recommended adult vaccinations among major chronic-condition subgroups in Emilia-Romagna Region (Italy) and at quantifying sociodemographic and territorial determinants of vaccine uptake. METHODS Retrospective, population-based record-linkage study including all residents aged ≥18 years registered on December 31, 2023 (N = 3 793 475). Chronic conditions (nonmutually exclusive: diabetes, cardiopathies, heart failure, chronic obstructive pulmonary disease [COPD], chronic kidney disease, cancer, and anatomical asplenia) were identified through multisource algorithms applied to regional administrative databases (2020-2024). Vaccination histories were retrieved from the Regional Vaccination Registry-Real Time (2000-2024); uptake was defined as ≥1 recorded dose. Uptake was modeled via subgroup-specific multivariable logistic regression (sex, age group, citizenship, Local Health Authority). RESULTS Pneumococcal uptake ranged from 28.4% in cancer to 40.7% in COPD and was markedly higher in anatomical asplenia (85.1%). Composite uptake mirrored these patterns (32.6% cancer; 42.0% COPD; 85.5% asplenia). Uptake of other risk-indicated vaccines was low in large subgroups, whereas asplenia showed high meningococcal uptake (MenACWY 67.5%; MenB 65.8%). In multivariable models, Italian citizenship was consistently associated with statistically significant higher odds of composite uptake (OR 1.348-2.527), and male sex increased odds in all subgroups (P < .001) except for asplenia. Age effects were substantial but condition specific. Residual territorial heterogeneity persisted after adjustment. CONCLUSIONS Algorithm-based identification of chronic-disease populations linked to immunization registries enables scalable, risk-stratified monitoring applicable to any chronic-condition subgroup definable through administrative codes. This approach detects strong equity gradients and persistent between-Local-Health-Authority variation, supporting regression-based indicators for subregional benchmarking and targeted strengthening of integrated multivaccine delivery pathways.

Cost-Effectiveness Analysis of the mRNA-1345 RSV Vaccine for Older Adults in Italy

Universal screening for measles immunity during pregnancy: a cost-effectiveness analysis.

BACKGROUND Measles is a highly contagious illness capable of causing significant morbidity and mortality, including adverse pregnancy outcomes. Routine screening for measles immunity is not currently recommended during pregnancy. Given the increasing frequency of measles outbreaks nationally and globally, awareness of measles immunity status can influence management of pregnant individuals who incur measles exposures, and offer an opportunity for postpartum or preconception vaccination. OBJECTIVES We sought to evaluate the cost-effectiveness of universal screening for measles immunity during pregnancy in the United States. STUDY DESIGN A decision-analytic model was constructed to evaluate the cost-effectiveness of universal screening for measles immunity during pregnancy compared to usual care (ie, no screening for measles immunity). The outcome of the decision analysis was quality-adjusted life years (QALYs) of the pregnant person. Model inputs were derived from the literature. Our model ran over two pregnancy cycles with a willingness-to-pay threshold of $100,000 per QALY. Total costs and QALYs were used to measure the incremental cost-effectiveness ratio (ICER) of universal measles screening compared with usual care. Sensitivity analyses were conducted to evaluate the robustness of the results. RESULTS Universal screening for measles immunity was the dominant strategy. Using a measles exposure rate of 0.1% to reflect the highest risk areas, the ICER of universal screening versus no screening was $166.46/QALY. Tornado sensitivity analyses demonstrated that the cost of measles screening and the probability of measles exposure had greatest impact on the cost-effectiveness of the screening strategy. When varying the measles exposure rate from 0.001-0.1%, screening remained the dominant strategy. During Monte Carlo simulation, measles screening for immunity during pregnancy was cost-saving and increased QALYs in 99.83% of simulations. CONCLUSIONS Universal screening for measles immunity during pregnancy is a cost-effective strategy. We argue for adoption of universal measles screening during pregnancy in the United States. Until adopted, providers should consider screening their pregnant patients and recommending postpartum vaccination. If implemented, further study will be needed to assess the actual benefit of universal screening.