BACKGROUND:Respiratory syncytial virus (RSV) can cause substantial morbidity and mortality in adults aged 50-59 years at increased risk of severe RSV disease due to specific underlying conditions (i.e. '50-59 years at-increased-risk [AIR] population'), and in older adults aged ≥60 years (i.e. '≥60 years population'). RESEARCH DESIGN AND METHODS:A static multi-cohort Markov model estimated cost-effectiveness of adjuvanted RSVPreF3 vaccination versus no vaccination among the 50-59 years AIR and ≥60 years populations in Japan, over a five-year time horizon from a healthcare payer perspective. Japan-specific RSV epidemiology and healthcare resource utilization parameters were used; vaccine efficacy was derived from the phase 3 AReSVi-006 trial (NCT04886596). RESULTS:Adjuvanted RSVPreF3 vaccination was cost-effective: in the 50-59 years AIR population, 49,280 RSV cases were prevented and 4333 quality-adjusted life years (QALYs) gained, at an incremental cost-effectiveness ratio (ICER) of Japanese yen (JPY) 2,770,558/QALY; in the ≥60 years population, 2,111,080 RSV cases were prevented and 205,543 QALYs gained, at an ICER of JPY 2,613,241/QALY. Vaccination was more cost-effective when including productivity losses from RSV-ARI. Scenario and sensitivity analyses results were robust. CONCLUSIONS:RSV vaccination may provide substantial health benefits and be a cost-effective intervention to reduce RSV burden in adults in Japan.

Invasive meningococcal disease (IMD) caused by Neisseria meningitidis is a rapidly progressing, rare disease that often presents as meningitis or sepsis. It mostly affects infants and adolescents, with high fatality rates or long-term sequelae. In the Netherlands, serogroup B (MenB) is most prevalent. We aimed to estimate the economic burden of MenB-related IMD between 2015 and 2019, including direct and indirect medical costs from short- and long-term sequelae, from a societal perspective. IMD incidence was based on laboratory-based case numbers from the Netherlands Reference Laboratory for Bacterial Meningitis (Amsterdam UMC, Amsterdam, the Netherlands); there were 74 MenB cases on average per year in the study period 2015–2019. Case-fatality rate (3.8

Injectable antiretroviral treatment (ART) represents a new effective and potentially more convenient alternative to oral ART for people living with HIV (PLWH). This study assessed preferences of PLWH for long-acting injectable compared with oral ART in the Netherlands. A labelled discrete choice experiment presented 12 choice sets of long-acting injectable and oral ART. PLWH were asked to select their preferred ART, described by six attributes: location of administration, dosing frequency, risk of short-term side effects, drug-drug interaction, forgivability, and food and mealtime restrictions. Random parameters logit and latent class models were used to estimate preferences of PLWH. 98.6% of 76 respondents were experienced oral ART users that had taken ART for a median of 12 years (Q1-Q3: 7.0-20.0). 30 (39.5%) respondents chose long-acting injectable ART in all choice tasks and 22 (28.9%) always chose oral ART. The random parameter model showed that, on average, respondents significantly favoured long-acting injectable ART over oral ART, preferred administration of the long-acting injectable ART at home, and a less frequent regimen. The latent class model confirmed one class strongly preferring long-acting injectable ART and one class slightly preferring oral ART. This study highlights the value for both long-acting injectable and oral ART.

Introduction Vaccination against human papillomavirus (HPV) is considered the most effective strategy to protect women from cervical cancer. Three HPV vaccines are currently licensed in Europe and, although they are generally supported by favorable health economic outcomes, current models fall short in predicting vaccination benefits. Here, we aim to re-evaluate the health benefits of HPV vaccination, using updated long-term effectiveness data and emphasizing quality of life losses related to pre-cancer disease and treatment.Methods We used a static Markov model that compared "only screening" (includes unvaccinated girls) and "vaccination" (assumes 100% vaccination coverage with the bivalent HPV vaccine). A lifetime cohort of 100,000 uninfected 12-year-old girls was included, in which the number of cases with cervical intraepithelial neoplasia grade 2 or higher/3 (CIN2+, CIN3), cervical cancer, and cervical cancer deaths per scenario were determined. Furthermore, the reduction in major excisional procedures, the preterm deliveries averted, and the related gain in quality-adjusted life years (QALYs) due to vaccination were estimated.Results The bivalent vaccine showed larger reductions in CIN2+, CIN3, cervical cancer cases, cervical cancer deaths, and major excisional treatments, after including long-term efficacy and effectiveness data, compared to previous data. Moreover, we observed an increased amount of QALYs gained due to prevention of major excisional treatment and the negative side effects related to it.Conclusions Updated health economic models for HPV vaccination, using updated and long-term effectiveness data and including prevention of treatment-related side effects, demonstrate a substantial additional positive effect on vaccination outcomes. Indeed, extrapolation of the bivalent HPV vaccine's updated long-term effectiveness data against HPV-related cervical diseases shows that the positive effects of vaccination may be more substantial than previously estimated.There is a graphical abstract available for this article.

Introduction:Immunocompromised patients (ICP) have an increased risk for infectious diseases. Vaccines could help reduce this risk. However, ICP do not always receive or are reimbursed for the specific vaccinations on which they are dependent in the Netherlands. This research aims to gain insights into the current challenges in the vaccination process of ICP in the Netherlands. Moreover, it aims to explore potential solutions for these challenges and the ideal vaccination process.Methods:Twelve semi-structured interviews with relevant stakeholders were conducted. Partly based on the challenges found by the Council for Health and Society (RVS) and the Dutch National Health Care Institute (ZIN) an interview guide was developed.Results:Several newly emerged challenges were identified: fair reimbursement for the efforts of stakeholders; circular reasoning of vaccine reimbursement and guidelines; suboptimal translation from guidelines to practice and no smooth-running infrastructure. Most challenges corresponded with those stated by the RVS and ZIN. Affordability and knowledge deficit in healthcare providers and patients were the most important challenges. Rarely the same solutions were mentioned, and no ideal vaccination process emerged.Conclusions:The various challenges in the vaccination process of ICP in the Netherlands implies the difficulty to solve the problem. It is recommended to focus on solving the most important challenges. A potential solution is to adjust the GVS registration process to make it easier for the pharmaceutical industry to apply for reimbursement towards various high-risk groups. Additionally, vaccination should have a more prominent role in the education of healthcare providers. Furthermore, stakeholders need to cooperate more to solve the reimbursement and guidelines issue.

In the Netherlands, the Health Council has advised that the human papillomavirus (HPV) vaccination should be offered to both boys and girls. Additionally, boys and men up to the age of 26 years should be included in a catch-up program. In this study, we examine the cost-effectiveness of this HPV catch-up program.We used a static Markov model to estimate the amount of cancers prevented and the incremental cost-effectiveness ratio (ICER) for different scenarios.Vaccinating men from 12 until the age of 26 years would result in an average of 48 cancer cases prevented in every cohort (an estimated total of 720 cases), with an average ICER of €32,256.We found that the catch-up vaccination program results in a relevant number prevented cases against an acceptable cost-effectiveness ratio. Policymakers should take these findings into account when evaluating a gender-neutral HPV vaccination program in the Netherlands.

Background: Vaccinating girls against human papillomavirus (HPV) infection is a highly effective and cost-effective intervention to provide protection against HPV-induced cancers. Since vaccination coverage rates among girls is modest in the Netherlands, additional strategies should be implemented to improve the protection against HPV-related cancer. Here we assessed the benefits and cost-effectiveness of gender-neutral vaccination. Methods: We designed a static Markov model with a lifelong time horizon to simulate a cohort of 100,000 12-year-old Dutch boys. The model compares health and economic effects of HPV vaccination taking the current female vaccination coverage into consideration. HPV prevalence in boys was corrected for the predicted herd effects of the female programme in 2017. We extracted transition probabilities from peer-reviewed literature and previously constructed models. The robustness of the model was tested with multiple sensitivity analyses. Results: Vaccinating 30% of 100,000 12-year-old boys prevents 18, 13 and 25 cases of anal, penile, and oropharyngeal cancers in men, respectively. A total of 205 quality-adjusted life-years (QALYs) are saved by preventing cancer-related morbidity and mortality. Assuming a vaccine price of (sic)50 per dose, the incremental cost-effectiveness ratio (ICER) is (sic)17,907 per QALY. In addition, due to vaccine-induced herd effects, we estimated that 110 cases of cancer in females would be additionally prevented and 246 QALYs would be gained in the female cohort, bringing the total to 166 cancers prevented and 451 QALYs gained. Taking these additional benefits of boys' vaccination into account, the overall ICER was estimated at (sic)7310 per QALY gained. The model outcomes are most sensitive to variation in vaccine price, herd immunity from females and vaccine efficacy. Conclusions: Vaccination of boys, additional to girls, will prevent a relevant number of cancers in both boys and girls. Based on the current Dutch situation vaccination of HPV in boys is likely cost-effective. GSK Study identifier: HO-18-19169. (C) 2020 GlaxoSmithKline Biologicals S.A. Published by Elsevier Ltd.