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Extending FLU vaccination in individuals aged 50-64 in Italy.

Extending FLU vaccination in individuals aged 50-64 in Italy. Social savings and budget impact analysis * Lara Gitto CEIS Sanità, Faculty of Economics, University of Rome “Tor Vergata” * The present work has involved two scientific coordinators,

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Extending FLU vaccination in individuals aged 50-64 in Italy.

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  1. Extending FLU vaccination in individuals aged 50-64 in Italy. Social savings and budget impact analysis* Lara Gitto CEIS Sanità, Faculty of Economics, University of Rome “Tor Vergata” *The present work has involved two scientific coordinators, Francesco Saverio Mennini and Americo Cicchetti, and two researchers, Lara Gitto (CEIS Sanità) and Matteo Ruggeri (Università Cattolica del Sacro Cuore)

  2. Study design The present study follows different steps. Firstly, Influsim 2.0 dynamic model was used to simulate the epidemiological course of a FLU infection and to estimate the economic impact of the different strategies for people aged 50-64. Secondly, a mathematical model was used to run the budget impact analysis in order to find the optimal coverage given the financial constraints. Figure 1 presents a flow chart describing every phase of the study.

  3. Figure 1: study design 1st phase: Model specification, identification, measurement and valorization of resource uptake. 2nd phase: Social savings evaluation, sensitivity analysis. 3rd phase: Budget Impact analysis, optimal level of coverage.

  4. The optimization modelThe model applied in this step of the study takes its basis from a work by Weinstein and Zeckhauser (1973), which is currently used to evaluate the efficiency of public spending choices, given alternative programs with different levels of cost and effectiveness.

  5. Elements of originality • Our findings about the course of flu obtained with Influsim 2.0 were used as data for an optimization exercise, aimed at identifying the optimal allocation of vaccine doses and antiviral treatments, i.e. the optimum level of coverage. The latter should maximize social savings. • The solution for the optimization exercise can show to decision makers what extent antiviral treatments and vaccine should be allocated, i.e., the break even population share to be covered.

  6. In the budget impact analysis a third payer perspective was considered. This is due to the reason that in Italy the National Health System provide the resources for vaccination policies. • From this point of view, this work provides issues for further considerations about interactions between health sector decisions and public spending performance.

  7. Data and Methodology The applied methodology is the most appropriate to solve a “competing choice problem” (i.e., the choice between different alternatives, each of them characterized by different levels of cost and effectiveness). Data were, prevalently, extracted from a study by Aballea et al. (2007). Effectiveness of vaccine relates to a reduced probability of work absenteeism, a reduced probability of hospitalization, reduction of mortality and reduction of medical examination.

  8. Data and Methodology The alternatives for which it is possible to estimate costs are: 1) antiviral and antipyretic administration (Oseltamvir, Zanamvir) 2) vaccine. In the first step of the analysis, according to Aballea et al.,the population has been divided in two different age classes: 50-59 years and 60-64 years. In particular, 50-59 years represents the working population (so that it is possible to calculate costs in terms of working days lost).

  9. Effectiveness As a measure of effectiveness, it has been considered an indicator which includes: - reduction of mortality (%), - reduction of hospitalization (%), - reduction in terms of medical examination (%) - reduction of working absenteeism (%). The same indicator has been weighted to consider the different levels of risk (high and low risk) for the population.

  10. A) Probability of absenteeism (reduction %) Oseltamvir HR 13% LR 13% Zanamvir HR 13% LR 13% Vaccino HR 29% LR 29% B) Probability of Hospitalization (reduction %) Oseltamvir HR 25% LR 84% Zanamvir HR 33% LR 64% Vaccino HR 50% LR 50% C) Probability of Death (reduction %) Oseltamvir HR 29% LR 74% Zanamvir HR 29% LR 64% Vaccino HR 68% LR 68% D) MMG examination (reduction %) Oseltamvir HR 24% LR 24% Zanamvir HR 24% LR 24% Vaccino HR 29% LR 29% Indicatore di efficacia per Oseltamvir (dato dalla somma della riduzione percentuale di A), B), C), D) 2,49 Indicatore di efficacia per Zanamvir 3,075 Indicatore di efficacia per vaccino 4,68 Table 1: effectiveness of alternatives

  11. Although costs and effectiveness estimation of vaccine vs. antiviral and antipyretic administration leads to prefer the first option, it is appropriate to deepen the analysis considering another variable that could address choices of policy makers: the available budget introduced by NHS to administrate FLU vaccination. • In the present study we take into account the financial resources allocated in 2006 for flu vaccination: € 57 mln(source: AIFA). We repeated the exercise for different levels of budget (+/- 10%) to analyze alternative allocations.

  12. Study Perspective The perspective of the study is that of NHS. We do not consider indirect costs already estimated using Influsim Model, but only direct costs for each alternative.

  13. The optimization problem The equation that should be maximized is J =S dixi1 With the constraintSdi xi2 ≤ R xi1is the net benefit for each alternative i. di is the proportion that should be chosen for each alternative. The costs xi2associated to the alternatives should not be higher than the available budget R.

  14. The optimization problem In our context the problem becomes: L = S Ei xi + l (Bi - S Ci xi) + m (1 - S xi) where xi = x1, x2, x3, represent the alternatives: x1 (Oseltamvir), x2 (Zanamvir), x3 (vaccine) E is an indicator of effectiveness, C are the costs and B is the budget. Constraints are: dL/dxi = E xi - lCi xi - m≤ 0 dL/dl = Bi - S Ci xi ≤ 0 (the whole budget should be used) dL/dm =1 - S xi = 0

  15. The optimization problem • The equation should point out in which proportion antiviral treatments and the vaccine (x of the problem) should be administered to the population sample (population between 50 and 64 years, 10,748,040 people overall). • We repeated the exercise both for different levels of coverage (30%), (50%), (up to 80%), and for different levels of available budget (+/- 10%).

  16. Results 3 scenarios have been considered: 1) use of the vaccine for 30% of the population (hence assuming that only 3,224,412 people are vaccinated). The simulation is repeated for different values of Basic Reproduction Number (BRN) from Influsim model (1.68, 2, 3). 2) vaccine administrated to 50% of population (5,374,020 people). Once again, the simulation is repeated for different values of BRN from Influsim model. 3) vaccine administrated up to 80% of population (8,598,432 people).

  17. Trattamenti anti - influenzali SCENARIO 1: il vaccino è somministrato al 30% della popolazione (ripartizione eguale degli altri trattamenti antivirali) – budget pari a € 57.000.000,00 SCENARIO 2: il vaccino è somministrato al 50% della popolazione (ripartizione eguale degli altri trattamenti antivirali) – budget pari a € 57.000.000,00 SCENARIO 3: il vaccino è somministrato fino all’80% della popolazione (ripartizione eguale degli altri trattamenti antivirali) BRN 1,68 BRN 2 BRN 3 BRN 1,68 BRN 2 BRN 3 BRN 1,68 BRN 2 BRN 3 BRN 1,68 BRN 2 BRN 3 BRN 1,68 BRN 2 BRN 3 Budget pari a € 57.000.000,00 Budget pari a € 57.000.000,00 Budget pari a € 57.000.000,00 Budget – 10% (€ 51.300.000,00 Budget – 10% (€ 51.300.000,00 Budget – 10% (€ 51.300.000,00 Budget +10% (€ 62.700.000,00 Budget + 10% (€ 62.700.000,00 Budget –+10% (€ 62.700.000,00 Alternativa A 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% Alternativa B 0% 0% 0% 0% 0% 0% 5,76% 5,67% 5,33% 16,05% 15,81% 14,84% 0% 0% 0% Vaccino 100% 100% 100% 100% 100% 100% 94,24% 94,33% 94,67% 83,95% 84,19% 85,16% 100% 100% 100%

  18. Results The percentage of the population to vaccinate could increase up to 80%. In this scenario it is possible to see how the vaccine always results as the most preferable alternative, althoughresources for vaccination should not be the 100% of the available budget. An example: presuming an available budget of € 57.000.000,00 (effective budget) and BRN as 1.68, the efficient allocation of the budget in favour of vaccine should be 94.24%, assigning the residual share (5.76%) to the other alternatives.

  19. Results To sum up, vaccine seems to be the best alternative to prefer for the population considered in this study (people aged 50-64 years). opportunities to boost vaccination for largest part of population belonging to 50-64 years, should be created. more generally, resources to spend on vaccination policy should be fixed looking at the results of such maximization problems.

  20. www.ceistorvergata.it/sanitaLara GittoGitto@CEIS.uniroma2.it

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