BACKGROUND: Rotavirus is among the leading causes of severe gastroenteritis in children. Effective vaccines enable universal mass vaccination (UMV) which incurs high expenditure and therefore economic justification is needed.

OBJECTIVE: This study aimed to evaluate the cost-effectiveness of UMV with Rotarix ® versus no vaccination program in the Philippines.

METHODS: A four-state decision tree model was used to estimate costs and health outcomes subject to annual discount rate of 3.5% Local and international published data and experts opinions were used for epidemiology, efficacy and resource use input parameters. Analyses were reported as estimated total costs, quality adjusted life years (QALYs) gained, and incremental cost-effectiveness ratio (ICER) in Philippines Peso (PHP) per QALY gained between rotavirus UMV and no vaccination.

RESULTS: From a payer (societal) perspective, the ICER is PHP 12, 835/QALY (PHP12,059/QALY). Sensitivity analyses showed the ICERs below PHP 80,000/QALY, well below 1 time 2012 GDP per capita at PHP 103,366 with the main drivers of uncertainty being the probabilities of mild and moderate diarrhoea and vaccine costs

CONCLUSION: Rotavirus UMV reduces both health and economic burden of rotavirus induced gastroenteritis. Based on the WHO's recommended thresholds, Rotarix® vaccination is projected to be very cost-effective in the Philippines in comparison with no vaccination.

Human ; Child Preschool ; Infant ; Cost-Benefit Analysis ; Vaccination ; Rotavirus ; viruses ; Gastroenteritis ; Rotavirus Vaccines ; Viral Vaccines

INTRODUCTIONCervical cancer is the tenth most common cancer and the eighth most frequent cause of death among women in Singapore. As human papillomavirus (HPV) infection is the necessary cause of cervical cancer, the risk of cervical cancer can be substantially reduced through vaccination. This study was conducted to evaluate the cost-effectiveness of two-dose HPV vaccination as part of a national vaccination programme for 12-year-old girls in Singapore, from the perspective of the healthcare payer.

METHODSA lifetime Markov cohort model was used to evaluate the cost-effectiveness of introducing the AS04-adjuvanted HPV-16/18 vaccine (AS04-HPV-16/18v) to the current cervical screening programme in Singapore. Furthermore, the cost-effectiveness of the AS04-HPV-16/18v was compared with the HPV-6/11/16/18 vaccine (4vHPV). Model inputs were derived from local data, where possible, and validated by clinical experts in Singapore.

RESULTSIntroduction of the AS04-HPV-16/18v in Singapore was shown to prevent 137 cervical cancer cases and 48 cervical cancer deaths when compared with screening alone. This resulted in an incremental cost-effectiveness ratio of SGD 12,645 per quality-adjusted life year (QALY) gained, which is cost-effective according to the World Health Organization threshold for Singapore. When discounted at 3%, AS04-HPV-16/18v was dominant over 4vHPV, with cost savings of SGD 80,559 and 28 additional QALYs gained. In the one-way sensitivity analysis, AS04-HPV-16/18v remained cost-effective compared with screening alone and dominant compared with 4vHPV.

CONCLUSIONAS04-HPV-16/18v is the most cost-effective choice for reducing the burden of cervical cancer through universal mass vaccination for 12-year-old girls in Singapore.

INTRODUCTIONSingapore was one of 29 countries worldwide affected by severe acute respiratory syndrome (SARS) in 2003.

MATERIALS AND METHODSThere were 238 cases identified during the outbreak. We performed a retrospective analysis of the clinical and laboratory data of 234 patients admitted to Tan Tock Seng Hospital and Singapore General Hospital.

RESULTSThe mean age of patients was 21 years, 31.6% of patients were males and 41.8% were healthcare workers. At presentation, the common symptoms were fever, myalgia, cough and headache; rhinorrhoea was uncommon. On admission, 21% had leukopenia, 18% had thrombocytopaenia, 29% had hyponatraemia, 31% had hypokalaemia, 21% had transaminitis. Polymerase chain reaction (PCR) testing of respiratory and stool samples provided the best yield at the end of the first week of illness. Thirty-two patients were initially not recognised as probable SARS and were reclassified when the serology test results were available. The chief reasons for not identifying these patients early were persistently normal chest X-rays (68.8%), very mild presentation (43.8%) and the presence of a concomitant illness (12.5%). Overall, 12% of the patients were probable SARS with atypical presentations. Overall mortality was 11.8%.

CONCLUSIONPatients infected with the SARS coronavirus had a wide clinical presentation with non-specific symptoms.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antibodies, Viral ; analysis ; Child ; Child, Preschool ; DNA, Viral ; analysis ; Diagnosis, Differential ; Female ; Humans ; Incidence ; Infant ; Male ; Middle Aged ; Retrospective Studies ; Reverse Transcriptase Polymerase Chain Reaction ; SARS Virus ; genetics ; immunology ; Severe Acute Respiratory Syndrome ; diagnosis ; epidemiology ; virology ; Severity of Illness Index ; Singapore ; epidemiology