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COVID-19 vaccines have reduced the negative health and economic impact of the COVID-19 pandemic by preventing severe disease, hospitalizations and deaths. In the new socio-economic normality, the COVID-19 vaccination strategy can be universal or high-risk and seasonal or not seasonal, and different vaccines can be used. The universal vaccination strategy can achieve greater health and herd immunity effects and is associated with greater costs than the high-risk vaccination strategy. In each country, the optimal COVID-19 vaccination strategy must be decided by considering the advantages and disadvantages and assessing the costs, health effects and cost-effectiveness of the universal and high-risk vaccination strategies. The universal vaccination strategy should be implemented when the objective of the vaccination program is to achieve the greatest health benefits from COVID-19 vaccination and when its incremental cost-effectiveness ratio is lower than EUR 30,000-50,000 per QALY or LYG. The use of adapted vaccines targeting currently circulating variants of SARS-CoV-2 is necessary to avoid the immune escape of emerging variants.

The aim of this study was to evaluate and compare hepatitis A outbreak-associated healthcare and epidemiological surveillance costs in Spain in two types of autonomous regions during 2010-2018: (1) regions with a prevention strategy based on universal hepatitis A vaccination of children and vaccination of high-risk population groups (Catalonia) and (2) regions with a prevention strategy based on vaccinating high-risk population groups (Castile and Leon, Murcia, Navarra, Community of Madrid, Community of Valencia). Healthcare costs were determined based on the resources used to treat hepatitis A outbreak-associated cases and hospitalizations. Epidemiological surveillance costs were calculated from the resources used during surveillance activities. The ratios for total, healthcare and epidemiological surveillance costs (regions without universal hepatitis A vaccination of children vs. Catalonia) were used to compare the two hepatitis A prevention strategies. From 2010 to 2018, the total, healthcare and epidemiological surveillance costs per million population were 1.75 times (EUR 101,671 vs. EUR 58,032), 1.96 times (EUR 75,500 vs. EUR 38,516) and 1.34 times greater (EUR 26,171 vs. EUR 19,515) in regions without universal hepatitis A vaccination of children than in Catalonia, respectively. The ratios tended to increase over time during 2010-2018. In 2015-2018, total, healthcare and epidemiological surveillance costs per million population were 2.68 times (EUR 69,993 vs. EUR 26,158), 2.86 times (EUR 53,807 vs. EUR 18,825) and 2.21 times greater (EUR 16,186 vs. EUR 7333) in regions without universal hepatitis A vaccination of children than in Catalonia, respectively. These findings suggest that universal hepatitis A vaccination of children could reduce hepatitis A outbreak-associated costs.

The aim of this study was to identify factors associated with non-adherence to tuberculosis (TB) preventive treatment among contacts with latent TB infection for new cases of pulmonary TB cases reported in Catalonia in 2019-2021. All contacts aged 18 years or older with a latent TB infection who received a TB preventive treatment were included in the study. The Chi square test and the odds ratios (OR) were used to assess the association between non-adherence to TB preventive treatment and the study variables; a p < 0.05 was considered statistically significant. Multiple logistic regression analysis was used to detect the independent factors associated with TB preventive treatment non-adherence; a p < 0.05 was considered statistically significant. The percentage of non-adherence to TB preventive treatment found in this study was 23.7%. A multivariable logistic regression analysis determined that the following factors were significantly associated with TB preventive treatment non-adherence among adult contacts: "exposure at school or workplace" (aOR = 3.34), "exposure to an index case without laboratory confirmation of TB" (aOR = 2.07), "immigrant contact" (aOR = 1.81), "male gender" (aOR = 1.75) and "exposure duration < 6 h per week or sporadic" (aOR = 1.60. By contrast, the factor "short-term TB preventive treatment regimen" (aOR = 0.38) was significantly associated with a lower treatment non-adherence. Adherence to TB preventive treatment should be improved among adult contacts of TB pulmonary cases with latent TB infection by recommending short-term treatment regimens and by developing health education activities, with a greater focus on contacts with factors associated with treatment non-adherence.

The emergence of novel SARS-CoV-2 variants has raised concerns about the ability of COVID-19 vaccination programs to establish adequate herd immunity levels in the population. This study assessed the effectiveness of adapted vaccines in preventing SARS-CoV-2 infection and the ability of the adapted vaccines to establish herd immunity against emerging Omicron variants. A systematic literature review was conducted to estimate the absolute vaccine effectiveness (aVE) in preventing SARS-CoV-2 infection using adapted vaccines targeting Omicron variants. The ability of the adapted vaccines to establish herd immunity was assessed by taking into account the following factors: aVE, Ro values of SARS-CoV-2 and the use of non-pharmacological interventions (NPIs). This study found meta-analysis-based aVEs in preventing severe disease and SARS-CoV-2 infection of 56-60% and 36-39%, respectively. Adapted vaccines could not establish herd immunity against the Omicron BA.1 and BA.4-5 variants without using non-pharmacological interventions (NPIs). The adapted vaccines could establish herd immunity only by achieving >80% vaccination coverage, using NPIs with greater effectiveness and when 20-30% of individuals were already protected against SARS-CoV-2 in the population. New adapted COVID-19 vaccines with greater effectiveness in preventing SARS-CoV-2 infection must be developed to increase herd immunity levels against emerging SARS-CoV-2 variants in the population.

Most of the complications and deaths related to seasonal flu occur in the elderly population (≥65 years) with comorbidities, and the influenza vaccine is the most effective way to prevent them. Immunization is less effective in older adults due to immunosenescence. MF59-adjuvanted vaccines, designed to improve the magnitude, persistence and amplitude of the immune response in elderly people, have been used in clinical practice since 1997 in their trivalent formulation and, since 2020, in their tetravalent formulation. Data from various studies show that these vaccines are not only safe for all age groups, with a reactogenicity profile similar to that of the conventional vaccine, but also that they are especially effective in boosting the immune response in the population aged 65 or over by increasing antibody titers after vaccination and significantly reducing the risk of hospital admission. Adjuvanted vaccines have been shown to provide cross-protection against heterologous strains and to be as effective as the high-dose vaccine in the population aged 65 or over. In this review, the scientific evidence on the efficacy and effectiveness of the MF59-adjuvanted vaccine in real clinical practice in people ≥65 years of age is analyzed through a narrative and descriptive review of the literature with data from clinical trials, observational studies and systematic reviews or meta-analysis., (©The Author 2023. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).)

Influenza surveillance and influenza vaccination are the key activities for preventing and controlling influenza epidemics. The study assessed the influenza surveillance and influenza vaccination data obtained from sentinel pharmacies of Catalonia, Spain, in the 2021-2022 influenza season. The sentinel pharmacies were selected from all community pharmacies to report all influenza-like illness (ILI) cases detected during the 2021-2022 influenza season and collect influenza surveillance and influenza vaccination data. The ILI cases were identified based on European Centre for Disease Control (ECDC) criteria. The moving epidemic method (MEM) was used to assess the ILI epidemic activity. The screening method was used to assess influenza vaccination effectiveness in patients aged 65-or-more years old. The sentinel pharmacies reported 212 ILI cases with a negative COVID-19 test and a total number of 412 ILI cases. An absence of increased ILI epidemic activity was observed in the 2021-2022 influenza season based on two criteria: (1) Number of ILI cases reported per week in the 2021-2022 influenza season significantly lower than the MEM-based epidemic threshold. (2) Mean number of ILI cases reported per week in the 2021-2022 influenza season significantly lower than during the ILI/influenza epidemic periods detected from 2017 to 2020 using the same methodology. Influenza vaccination was effective in preventing ILI among patients aged 65-or-more-years old. The absence of the influenza epidemic during the 2021-2022 influenza season could be explained by influenza vaccination and COVID-19 prevention measures (wearing face masks, social distancing). The sentinel pharmacies provided influenza surveillance data not provided by traditional influenza surveillance systems.

The pandemic associated with SARS-CoV-2 is a worldwide public health challenge. The WHO has proposed to achieve 70% COVID-19 vaccination coverage in all countries by mid-2022. Nevertheless, the prevention strategy based on COVID-19 vaccination and other applied prevention measures has not been sufficient to prevent SARS-CoV-2 epidemic waves. This study assessed the vaccination coverage that would be required to establish herd immunity against SARS-CoV-2, taking into account virus transmissibility (R o values from 1.1 to 10) and COVID-19 vaccination effectiveness. The study found that high percentages of vaccination coverage and high levels of vaccination effectiveness are necessary to block the transmission of Omicron and other SARS-CoV-2 variants with greater infectious capacity. COVID-19 vaccination programs could establish herd immunity against SARS-CoV-2, with R o values ranging from 3 to 10 and levels of COVID-19 vaccination effectiveness of 70-100%. Factors reducing COVID-19 vaccination effectiveness (emergent variants, infections among vaccinated individuals, high risk individuals) and factors increasing SARS-CoV-2 transmissibility (close settings) increased the percentages of vaccination coverage that would be required to establish herd immunity. Two measures should be implemented to establish herd immunity against SARS-CoV-2: (1) achieve ≥ 90% COVID-19 vaccination coverage in all countries worldwide, and (2) increase the effectiveness of COVID-19 vaccines in preventing Omicron infection to at least 88%.

In 2012, the World Health Organization (WHO) established the Global Vaccine Action Plan with the objective to promote essential vaccinations in all countries and achieve at least 90% vaccination coverage for all routine vaccines by 2020. The study assessed the mean percentages of vaccination coverage in 2019 for 13 routine vaccines, vaccination coverage variation from 2015 to 2019, and herd immunity levels against measles and pertussis in 2019 in countries and regions of WHO. In 2019, the mean percentages of vaccination coverage were lower than 90% for 10 (78.9%) routine vaccines. The mean percentages of vaccination coverage also decreased from 2015 to 2019 for six (46.2%) routine vaccines. The prevalence of individuals with vaccine-induced measles immunity in the target measles vaccination population was 88.1%, and the prevalence of individuals with vaccine-induced pertussis immunity in the target pertussis vaccination population was 81.1%. Herd immunity against measles viruses with Ro = 18 was established in 63 (32.5%) countries but not established in any region. Herd immunity against pertussis agents was not established in any country and in any region of WHO. National immunization programs must be improved to achieve ≥90% vaccination coverage in all countries and regions. Likewise, it is necessary to achieve ≥95% vaccination coverage with two doses of measles vaccines and three doses of pertussis vaccines in all countries and regions.

Background: The World Health Organization (WHO) proposed two-dose measles vaccination coverage of at least 95% of the population and percentages of measles immunity in the population of 85%-95% in order to achieve measles elimination in Europe. The objectives of this study were: (1) to determine the measles vaccination coverage required to establish herd immunity against measles viruses with basic reproduction numbers (Ro) ranging from 6 to 60, and (2) to assess whether the objectives proposed by the WHO are sufficient to establish herd immunity against measles viruses. Methods: The herd immunity effects of the recommended objectives were assessed by considering the prevalence of protected individuals required to establish herd immunity against measles viruses with Ro values ranging from 6 to 60. Results: The study found that percentages of two-dose measles vaccination coverage from 88% to 100% could establish herd immunity against measles viruses with Ro from 6 to 19, assuming 95% measles vaccination effectiveness. The study found that the objective of 95% for two-dose measles vaccination coverage proposed by the WHO would not be sufficient to establish herd immunity against measles viruses with Ro ≥ 10, assuming 95% measles vaccination effectiveness. By contrast, a 97% measles vaccination coverage objective was sufficient to establish herd immunity against measles viruses, with Ro values from 6 to 13. Measles immunity levels recommended in individuals aged 1-4 years (≥85%) and 5-9 years (≥90%) might not be sufficient to establish herd immunity against most measles viruses, while those recommended in individuals aged 10 or more years (≥95%) could be sufficient to establish herd immunity against measles viruses with Ro values from 6 to 20. Conclusion: To meet the goal of measles elimination in Europe, it is necessary to achieve percentages of two-dose measles vaccination coverage of at least 97%, and measles immunity levels in children aged 1-9 years of at least 95%.

Several factors may explain why measles persisted in the European Union in 2017-2018. The study assessed mean measles vaccination coverage and anti-measles herd immunity levels in the target measles vaccination population in countries of the European Union during the 2015-2017 period. The study found that the measles vaccination coverage with two doses of vaccine was < 95% in 28 (96.5%) countries, and that the prevalence of individuals with vaccine-induced measles protection in the target vaccination population was lower than the herd immunity threshold of 94.4% in 22 (75.9%) countries during 2015-2017. The study found a significant negative correlation between the incidence of measles in 2017-2018 in different countries of the European Union and measles vaccination coverage with two doses of measles vaccine, prevalence of individuals with vaccine-induced measles protection and herd immunity levels in the target measles vaccination population during 2015-2017. Measles vaccination coverage and herd immunity levels did not improve from 2010-2015 to 2015-2017 in the European Union. Low percentages of measles vaccination coverage with two doses of vaccine and low herd immunity levels could explain measles incidence in countries of the European Union in 2017-2018. New measles prevention strategies should be developed to increase measles vaccination coverage and herd immunity levels in the European Union.

Objectives: The aim of this study was to assess direct health costs in children with pertussis aged 0-9 years who were vaccinated, partially vaccinated, and unvaccinated during childhood, and to assess the association between pertussis costs and pertussis vaccination in Catalonia (Spain) in 2012-2013., Methods: Direct healthcare costs included pertussis treatment, pertussis detection, and preventive chemotherapy of contacts. Pertussis patients were considered vaccinated when they had received 4-5 doses, and unvaccinated or partially vaccinated when they had received 0-3 doses of vaccine. The Chi square test and the odds ratios were used to compare percentages and the t test was used to compare mean pertussis costs in different groups, considering a p < 0.05 as statistically significant. The correlation between pertussis costs and study variables was assessed using the Spearman's ρ, with a p < 0.05 as statistically significant. Multiple linear regression analysis (IBM-SPSS program) was used to quantify the association of pertussis vaccination and other study variables with pertussis costs., Results: Vaccinated children with pertussis aged 0-9 years had significantly lower odds ratios of hospitalizations (OR 0.02, p < 0.001), laboratory confirmation (OR 0.21, p < 0.001), and severe disease (OR 0.02, p < 0.001) than unvaccinated or partially vaccinated children with pertussis of the same age. Mean direct healthcare costs were significantly lower (p < 0.001) in vaccinated patients (€190.6) than in unvaccinated patients (€3550.8), partially vaccinated patients (€1116.9), and unvaccinated/partially vaccinated patients (€2330). Multivariable linear regression analysis showed that pertussis vaccination with 4-5 doses was associated with a non-significant reduction of pertussis costs of €107.9 per case after taking into account the effect of other study variables, and €200 per case after taking into account pertussis severity., Conclusions: Direct healthcare costs were lower in children with pertussis aged 0-9 years vaccinated with 4-5 doses of acellular vaccines than in unvaccinated or partially vaccinated children with pertussis of the same age.

Several reasons may explain why measles was not eliminated by 2015 and continues to persist in Europe, including low measles vaccination coverage, low anti-measles herd immunity levels, and the mobility of individuals with measles across Europe. The study assessed the mean measles vaccination coverage in the European Union and the WHO European region with one and two doses of measles vaccine from 1980 to 2015, and the prevalence of vaccine-induced protected individuals and anti-measles herd immunity levels in the WHO European region during 2000-2015. The study found that measles vaccination coverage with two doses of vaccine was <90% in the European Union and the WHO European region from 1995 to 2015. In the WHO European region, the two-dose measles vaccination coverage during the 2000-2015 period was <95% in 41 countries (79%), and the prevalence of vaccine-induced protected individuals in the target vaccination population was lower than the herd immunity threshold of 94.4% in 33 countries (63%). The additional vaccination coverage required to establish herd immunity in these countries ranged from 0.2% to 18%. Two of the factors explaining measles persistence in Europe in 2015 were the two-dose measles vaccination coverage <95% and the prevalence of individuals with vaccine-induced protection of <94.4% in most countries of the WHO European region during the 2000-2015 period. Screening and vaccination programs should be developed to detect and immunize susceptible individuals in areas and population groups without anti-measles herd immunity in all European countries.

Objective: 1) To determine the influenza vaccination coverage required to establish herd immunity, and 2) to assess whether the percentages of vaccination coverage proposed and those registered in the United States and Europe are sufficient to establish herd immunity., Methods: The vaccination coverage required to establish herd immunity was determined by taking into account the number of secondary cases per infected case (R(o)) and the vaccine effectiveness., Results: The required percentage that would have been required to establish herd immunity against previous influenza viruses ranged from 13% to 100% for the 1918-19, 1957-58, 1968-69 and 2009-10 pandemic viruses, and from 30% to 40% for the 2008-09 epidemic virus. The objectives of vaccination coverage proposed in the United States - 80% in healthy persons and 90% in high-risk persons - are sufficient to establish herd immunity, while those proposed in Europe - only 75% in elderly and high-risk persons - are not sufficient. The percentages of vaccination coverage registered in the United States and Europe are not sufficient to establish herd immunity., Conclusion: The influenza vaccination coverage must be increased in the United States and Europe in order to establish herd immunity. It is necessary to develop new influenza prevention messages based on herd immunity., (Copyright © 2012 Elsevier Inc. All rights reserved.)

The necessary herd immunity blocking the transmission of an infectious agent in the population is established when the prevalence of protected individuals is higher than a critical value, called the herd immunity threshold. The establishment of herd immunity in the population can be determined using the vaccination coverage and seroepidemiological surveys. The vaccination coverage associated with herd immunity (V(c)) can be determined from the herd immunity threshold and vaccine effectiveness. This method requires a vaccine-specific effectiveness evaluation, and it can be used only for the herd immunity assessment of vaccinated communities in which the infectious agent is not circulating. The prevalence of positive serological results associated with herd immunity can be determined from the herd immunity threshold, in terms of prevalence of antibodies (p(c)) and serological test performance. The herd immunity is established when the prevalence of antibodies is higher than pc. This method can be used to assess the establishment of herd immunity in different population groups, both when the infectious agent is circulating and when it is not possible to assess vaccine effectiveness. The herd immunity assessment in Catalonia, Spain, showed that the additional vaccination coverage required to establish herd immunity was 3-6% for measles, mump and varicella and 11% poliovirus type III in school children, 17-59% for diphtheria in youth and adults and 25-46% for persussis in school children, youth and adults.

Background: HMG-CoA reductase inhibitors (statins) are the first-line drugs for use in the reduction of low-density lipoprotein cholesterol (LDL-C) levels and prevention of coronary heart disease (CHD) in patients with hypercholesterolemia. Generic statins could change the cost effectiveness of statin therapies in Spain, and more population groups could be included in the recommendations for reduction of cholesterol levels based on cost effectiveness., Objectives: The objectives of this study were: (i) to assess the cost effectiveness of available statins for the reduction of LDL-C levels in Spain in 2010, after the introduction of generics and reference prices; (ii) to assess the cost effectiveness of combination therapy using a statin plus cholestyramine or ezetimibe; and (iii) to estimate the mean cost per patient to achieve National Cholesterol Education Program (Adult Treatment Panel-III) therapeutic objectives., Methods: The following treatments were evaluated: rosuvastatin 5-20 mg/day; atorvastatin, simvastatin, and pravastatin 10-40 mg/day; lovastatin and fluvastatin 20-80 mg/day; and combination therapy with a statin plus either cholestyramine 12-24 g/day or ezetimibe 10 mg/day. The cost effectiveness was evaluated in terms of cost per percentage point reduction in LDL-C, comparing the annual treatment costs with the effectiveness in reducing LDL-C. Treatment costs included those for medications (2010 wholesale prices), control measures, and treatment of adverse drug effects. The effectiveness of statins was estimated by developing a meta-analysis of clinical trials published between 1993 and 2005 that met several inclusion criteria. Average and incremental cost-effectiveness ratios were calculated to assess the efficiency of individual statin and combination therapies in reducing LDL-C levels., Results: The effectiveness in terms of percentage reduction in LDL-C ranged from 19% for pravastatin 10 mg/day to 55% for atorvastatin 80 mg/day. Annual treatment costs ranged from Euro 189.7 for simvastatin 10 mg/day to Euro 759.3 for atorvastatin 80 mg/day. The cost-effectiveness ratios, in terms of cost per percentage point reduction in LDL-C, were: Euro 6 for simvastatin, Euro 10-12 for rosuvastatin, Euro 10 for lovastatin, Euro 13-16 for atorvastatin, Euro 13-14 for fluvastatin, and Euro 14-20 for pravastatin. Rosuvastatin + ezetimibe, simvastatin + ezetimibe, and atorvastatin + ezetimibe were the most cost-effective combination therapies for reducing LDL-C levels. Rosuvastatin was the most cost-effective statin for achieving the LDL-C therapeutic goal in patients at high risk for CHD, with a mean cost per patient of Euro 516. Simvastatin was the most cost-effective statin to achieve the LDL-C goal in patients with moderate or low CHD risk, with a cost per patient of Euro 217 and Euro 190, respectively., Conclusion: Rosuvastatin should be the first-choice agent in patients with high CHD risk, while simvastatin should be the first choice in patients with moderate or low risk. The addition of ezetimibe to rosuvastatin, simvastatin, or atorvastatin should be the preferred combination therapies when greater LDL-C reductions are required. The cost effectiveness of all statin therapies has increased in Spain after the introduction of generic statins and reference prices.

Seroepidemiological surveys can be defined as seroepidemiological studies carried out in population samples to investigate immunity levels against vaccinable and not vaccinable diseases. The objective of this paper is to present the methodology and applicability of serological surveys. Problems related to seroepidemiological surveys in immigrant population are also discussed. Seroepideniological surveys should be developed in representative samples of the population, determining the sample size taking into account the sample error and precision that should be obtained for population parameters. It is necessary to develop an adequate questionnaire to collect sociodemographical and medical information from all participants. Serological tests should sensitive and specific. Seroepidemiological surveys can be used assess immunity levels in different population groups, and to detect sociodemographical and medical variables associated with the immunity, vaccination and infectious diseases.

Despite recommendations for annual vaccination against influenza, more than half of patients with chronic obstructive pulmonary disease (COPD) in developed countries do not receive this vaccine. Influenza is characterized by its potentially of causing epidemics and by excess morbidity and mortality in patients with COPD and other chronic medical conditions. Good evidence of the efficacy, effectiveness, and cost-effectiveness of influenza vaccination underlines the recommendation of use in patients with COPD. Influenza vaccination could reduce influenza-related complications and exacerbations in patients with COPD, therefore reducing hospitalizations and deaths. Each year, all persons with COPD should be vaccinated with the inactivated trivalent influenza vaccine containing the most frequent two influenza A viral strains and one influenza B viral strain detected in the influenza season of the previous year. To achieve a 100% vaccination rate in patients with COPD, all patients with COPD registered in health insurance companies and attended in health centers and specialized clinics should be vaccinated during the immunization period (October-December). Antiviral therapies could be used as an adjunct to vaccination and to reduce influenza transmission in outbreaks. Antiviral therapies could reduce the duration and complications of influenza when administered within two days of the onset of illness. Research is necessary for new antiviral therapies that could prevent influenza with cost-effectiveness similar to the influenza vaccine.

Background and Objective: To evaluate the immunity level achieved with oral polio vaccine in schoolchildren aged 6-12 years of Catalonia (Spain)., Subjects and Method: The prevalence of antibodies against poliovirus 1, 2 and 3 was investigated using the neutralizing technique in a representative (n = 197) sample of schoolchildren aged 6-12 years of Catalonia (Spain) obtained in 2001., Results: The prevalence of antibodies was 94.4% for poliovirus 1; 98.5% for poliovirus 2, y 73.1% for poliovirus 3. 93.4% of serum samples had antibodies against poliovirus 1 and 2; 70.6% against poliovirus 1 and 3, and 69.5% against poliovirus 1, 2 and 3. The prevalence of antibodies was similar in different socio-demographic groups. Schoolchildren who had been vaccinated (5 doses) had a higher level of antibodies against poliovirus 3 than those who had not completed vaccination (4 or less doses): 75.4% vs 50.0% (p < 0.05). The prevalence of antibodies against poliovirus 1 and 2 was similar in schoolchildren completing and not completing vaccination., Conclusions: Results obtained in this study show that 26.9% of schoolchildren aged 6-12 years do not have an adequate immunity level against poliovirus 3 with the oral polio vaccine, being it necessary to develop an immunization program using the inactivated polio vaccine.

Objective: To assess the cost efficacy of atorvastatin, simvastatin, lovastatin, fluvastatin, pravastatin, and colestyramine in the reduction of low-density lipoprotein-cholesterol (LDL-C) levels and the cost per patient to achieve the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) therapeutic objectives in Spain., Method: The following treatments were evaluated: atorvastatin, simvastatin, and pravastatin 10-40 mg/day; lovastatin and fluvastatin 20-80 mg/day; and colestyramine 12-24 g/day. The cost effectiveness of these treatments was evaluated, in terms of cost per percentage of LDL-C reduction, by comparing annual treatment costs versus the efficacy of LDL-C reduction. Treatment costs included medication costs (2003 wholesale prices), control measures, and the treatment of adverse affects. The efficacy of HMG-CoA reductase inhibitors (statins) was obtained from a meta-analysis of results obtained from clinical trials published between 1993 and 2003 that met the following criteria: monotherapy; >16 weeks of treatment; randomized allocation of individuals to the intervention and comparator groups; dietary treatment for > or =3 months before administration of medication; and double-blind measurement of outcomes. Average and incremental cost-effectiveness ratios were calculated to assess the efficiency of cholesterol-lowering treatments., Results: Efficacy, in terms of percentage of LDL-C reduction, ranged from 10% for colestyramine 12 g/day to 49% for atorvastatin 40 mg/day. Total annual treatment costs ranged from euro 321 for fluvastatin 20 mg/day to euro 1151 for atorvastatin 40 mg/day. Cost-effectiveness ratios, in terms of cost per percentage of LDL-C reduced, were: euro 11-23 for atorvastatin; euro 12-21 for simvastatin; euro 14-22 for lovastatin; euro 15-24 for fluvastatin; euro 21-42 for pravastatin; and euro 35-46 for colestyramine. Atorvastatin 10 mg/day was the most cost-effective treatment, followed by simvastatin 10 mg/day, lovastatin 20 mg/day, and fluvastatin 20 mg/day. Atorvastatin was the most cost-effective treatment in the achievement of the NCEP ATP III LDL-C reduction objectives in patients with high (<100 mg/dL) and moderate (<130 mg/dL) risk of coronary heart disease (CHD), with a cost per patient of euro 747 and euro 405 per year, respectively. Fluvastatin was the most cost-effective treatment in the achievement of the NCEP ATPIII therapeutic objective in patients with low-risk of CHD (LDL-C <160 mg/dL), with a cost per patient of euro 321., Conclusion: Atorvastatin 10 mg/day was the most cost-effective cholesterol-lowering drug, followed by simvastatin 10 mg/day, lovastatin 20 mg/day, and fluvastatin 20 mg/day. The preferred statin should be atorvastatin in patients with moderate-to-high CHD risk and fluvastatin in patients with low risk for CHD.

Pneumococcal vaccination is an effective intervention to prevent pneumococcal infections. Earlier randomized clinical trials and most case-control studies have shown a significant protection against invasive pneumococcal diseases and pneumococcal pneumonia in the elderly and chronic patients with a higher risk of pneumococcal infections. However, more recent randomized clinical trials have only detected a significant protection in immunocompetent individuals. A review of the studies assessing the cost-effectiveness of the 23-valent polysaccharide vaccine has shown that pneumococcal vaccination should be recommended in all individuals aged over 64 years, and in chronic patients with a higher risk of pneumocccal infections. In these population groups, vaccination costs are lower than healthcare costs reduced with the intervention. In individuals aged over 64 years, cost savings could be obtained when the vaccine effectiveness is higher than 30%. Recent cost-effectiveness studies have shown that pneumococcal vaccination could also be recommended in individuals aged between 45 and 64 years without risk factors, since the cost-effectiveness ratio is lower than euro 30,000 per life-year gained. In individuals aged between 45 and 64 years, cost savings could be obtained when the vaccine effectiveness is higher than 90%, and when the percentage of pneumonias caused by Streptococcus pneumoniae are 40%.

The prevalence of seropositive individuals that makes costs of vaccinating all individuals equal to that for screening and vaccination of susceptible individuals is defined as the critical prevalence of antibodies (p*). Screening and vaccination is more efficient when the prevalence of seropositive individuals (p) in the population is higher than p*. In this study, the formula to obtain p* was derived from the cost-effectiveness equations, showing that it depends on screening and vaccination costs, programme compliance, screening test performance, vaccine efficacy and disease costs. The formula was used to determine the least costly vaccination strategy for hepatitis A and B, varicella, measles and tetanus in adults and adolescents in Catalonia. The least costly vaccination strategy was vaccination without screening (since p was lower than p*) for hepatitis B, measles and tetanus in adults and adolescents (5-14 years) and for hepatitis A in individuals aged 5-24 years, and screening and vaccination (since p was higher than p*) for varicella in adults and adolescents and for hepatitis A in adults aged >24 years. Vaccination strategies based on the critical prevalence of antibodies could maximize the immunity level in the community from available resources.

Objective: To use the social welfare function to decide on allocation of resources between smoking cessation methods and lovastatin treatment of hypercholesterolaemia for the primary prevention of coronary heart disease., Method: Three smoking cessation therapies (medical advice, nicotine gum and nicotine patch) were considered in smokers, and lovastatin 20, 40 and 80 mg/day was considered in individuals with hypercholesterolaemia (total cholesterol > 7.24 mmol/L [> 270 mg/dL]). Multiple logistic regression analysis was used to obtain parameter epsilon determining the exact form of the social welfare function in Catalonia, Spain. The preferable strategy was to give higher priority to the intervention that used one smoking cessation method and lovastatin treatment for hypercholesterolaemia and that was associated with a value of epsilon consistent with the social welfare function., Results: A value of 1.58 (95% CI: 0.75-2.84) was obtained for parameter epsilon of the social welfare function, showing a nonutilitarian form. A higher priority should be given, based on the social welfare function, to the intervention using medical advice for smoking cessation and lovastatin 20-80 mg/day for hypercholesterolaemia, since this approach was associated with epsilon values of 2.8-2.9 in men and 1.8-2.4 in women, while interventions using nicotine substitution therapies were associated with epsilon values of < 0.9 in men and < 0.4 in women. The cost of treating all smokers and individuals with hypercholesterolaemia was 35% lower using medical advice for smoking cessation and lovastatin 20 mg/day, which was associated with epsilon values of 2.9 in men and 2.4 in women, than using a utilitarian solution consisting of nicotine patches for smoking cessation and lovastatin 20 mg/day., Conclusion: These results show that higher priority should be given to lovastatin treatment of hypercholesterolaemia than to nicotine substitution treatments for smoking cessation, based on cost effectiveness and the social welfare function. The study also showed the applicability of this method to decisions about resource allocation between competing treatments when society has a nonutilitarian social welfare function.

Background: To evaluate the impact in Catalonia and the agreement between the qualitative (NCEP-II) and quantitative criteria proposed by the Health Ministry for the lipid-lowering drug therapy among individuais without coronary artery disease., Methods: Both qualitative (NCEP-II) and quantitative methods were used in individuals without coronary artery disease studied in a random sample of adult populations in Catalonia (n = 304) aged >/= 16 years. Patients with a LDL-cholesterol levels >/= l90 mg/dl or 160-189 mg/dl plus at least two risk factors fulfilled the qualitative criteria for the lipid-lowering drug therapy; patients with a risk >/= 20% in 10 years fulfilled the quantitative criteria. The agreement between both qualitative and quantitative criteria was evaluated by means of the Kappa index., Results: 20% of males and 20.1% of females, and 24% of males and 33.1% of females fulfilled the qualitative and quantitative criteria for lipid-lowering drug therapy, respectively. A low (Kappa = 0.30) and a moderate (Kappa = 0.44) agreement was observed among males and females, respectively, regarding qualitative and quantitative criteria. Increased serum cholesterol was the determinant risk factor for fulfilling qualitative criteria (ORadj) y whereas age, increased blood pressure and increased serum cholesterol were determinants for fulfilling the quantitative criteria., Conclusion: The results obtained in this study showed a low agreement between qualitative and quantitative criteria proposed by the report of the Ministry of Health Report to lower cholesterol levels by means of drug therapy among healthy people. Clear and unequivocal criteria to decide what persons are candidates for cholesterol-lowering drug therapy should be developed.

Background: We assessed the cost-effectiveness of pharmacological treatments for hypertension to prevent coronary heart disease and stroke in Catalonia (Spain)., Methods: Cost-effectiveness was measured as the cost in Spanish Ptas per life year gained (LYG) in 1998 in individuals aged 40 to 69 years with moderate/severe hypertension (>= 105 mmHg) and mild hypertension (95-104 mmHg). We evaluated hydrochlorothiazide (diuretic), propranolol (-blocker), nifedipine (calcium antagonist), captopril (angiotensin-converting-enzyme inhibitor) and prazosin (*-adrenergic blocker)., Results: Cost-effectiveness ranged from 706,100 to 446,780 ptas. per LYG in men and from 635,100 to 810,270 ptas. per LYG in women with moderate/severe hypertension and from 108,770 to 682,460 ptas. per LYG in men and from 101,000 to 12,699,000 ptas. per LYG in women with mild hypertension. Incremental cost-effectiveness analysis showed that hydrochlorothiazide and propranolol were the most cost-effective treatments in individuals with moderate/severe hypertension while hydrochlorothiazide and nifedipine were most cost-effective in those with mild hypertension., Conclusion: In this study, greatest-to-lowest cost-effectiveness of assessed treatments was as follows: hydrochlorohiazide, propranolol, nifedipine, prazosin and captopril in moderate/severe hypertension and hydrochlorothiazide, nifedipine, propranolol, prazosin and captopril in mild hypertension.

This study assessed the cost effectiveness of treatments for the primary prevention of coronary heart disease in Spain, which included smoking cessation and reductions in blood cholesterol levels and BP. Cost-effectiveness ratios (measured in terms of US dollars per life-year gained) ranged from 2,608 US dollars to 8,058 US dollars per life-year gained for therapies aimed at smoking cessation, from 7,061 US dollars to 126,990 US dollars per life-year gained for antihypertensive drug treatment, from 15,487 US dollars to 1,689,022 US dollars per life-year gained for the drug treatment of hypercholesterolaemia and from 12,792 US dollars to 149,246 US dollars per life-year gained for cholesterol-lowering diets. In individuals with blood cholesterol levels of 7.7 mmol/L, cost-effectiveness ratios of drug treatment ranged from 33,850 US dollars to 302,088 US dollars. Cost-effectiveness ratios were lower in men than in women for all programmes evaluated. Cost-effectiveness analysis of cholesterol-lowering drugs indicated that lovastatin (HMG-CoA reductase inhibitor) was more cost effective than cholestyramine (bile acid sequestrant) and gemfibrozil (fibrate). Hydrochlorothiazide, propranolol and nifedipine were more cost effective antihypertensive treatments than prazosin and captopril. Cost-effectiveness ratios obtained in this study could be used to develop disease management strategies to facilitate the efficient use of healthcare resources and to reduce costs. When resources for coronary heart disease are limited, available treatments should be selected on the basis of their average and incremental cost-effectiveness ratios.

Individual programs for prevention of cardiovascular disease include dietary and drug treatment of hypercholesterolemia, hypertension treatment, and smoking cessation therapies. In this study, the cost-effectiveness of available cardiovascular prevention programs was assessed in Spain in terms of net cost per life-year gained (LYG). Cost-effectiveness ratios ranged from US $2,600 to $80,000 per LYG in men and from $4,500 to $230,000 per LYG in women. In men aged 40-59 years, the ranking of increasing cost-effectiveness was: smoking cessation ($2,608-3,738 per LYG); treatment of moderate and severe hypertension ($8,564-38,678 per LYG); treatment of mild hypertension ($11,906-59,840 per LYG); dietary treatment ($16,143-20,158 per LYG); and drug treatment of hypercholesterolemia ($33,850-81,010 per LYG). In women, the ranking list was:smoking cessation ($4,482-5,756 per LYG), treatment of moderate and severe hypertension ($9,585-57,983 per LYG), treatment of mild hypertension ($15,248-86,075 per LYG), dietary treatment ($57,175-62,154 per LYG); and drug treatment of hypercholesterolemia ($104,100-259,150 per LYG).

Programmes using screening and vaccination are efficient in populations with higher levels of antibodies, while in those with lower levels is more efficient to vaccine the whole target population. The prevalence that makes the cost-effectiveness of vaccination programmes equal to that obtained for programmes using screening and vaccination is defined as the critical value of prevalence p*. In this study, a mathematical procedure to obtain the critical value of prevalence is developed. The formula obtained is used to decide the best vaccination strategy against hepatitis A in Spain. If V is the vaccination cost, S the screening cost, PV the predictive value of a positive test result, D the mean disease cost, A the attack rate in susceptible individuals, E the vaccine efficacy and C the vaccination compliance, the critical value of prevalence is equal to: [formula: see text] The critical value of prevalence obtained for vaccination against hepatitis A in Spain with three doses of vaccine Havrix 720 is 22%. This result show that the optimal decision is to implement vaccination programmes without screening for immunity in individuals aged < 15 years and with screening in those aged > 15 years.

Background: The cost-effectiveness of hypolipemiant treatment with lovastatine (0.02, 0.04 and 0.08 g/day), cholestyramine (12 and 24 g/day), cholestipol (10 and 20 g/day) and gemfibrocyl (1.2 g/day) was estimated in individuals presenting hypercholesterolemia (> 200 mg/dl or 5.17 mmol/l) following dietetic treatment., Methods: The cost-effectiveness relationship was measured in terms of cost per year of life gained comparing the net cost of the program with its effectiveness for each treatment studied. The net cost of the program was calculated taking the costs associated with hypolipemiant treatment into account and subtracting the estimated reduction of the costs of coronary heart disease attributed to the prevention program. The Framingham equation and the information concerning to the prevalence of cardiovascular risk factors and life expectancy according to age and sex in the Catalonian (Spain) population were used to estimate the effectiveness., Results: The lesser to greater cost per year of life gained is lovastatine-0.02, cholestyramine-12, cholestipol-12, lovastatine-0.04, gemfibrocyl, cholestyramine-24, cholestipol-10, lovastatine-0.08 and cholestipol-20. In males from 45-49 years of age with cholesterol concentration of 300 mg/dl (7.76 mmol/l) the costs per year of life gained were 3.4 millions for lovastatine-0.02, 4.6 for cholestyramine-12, 4.8 for lovastatine-0.04, 5.4 for gemfibrocyl, 6.5 for cholestyramine-24, 7.8 for cholestipol-10, 8.1 for lovastatine 0.08 and 11.6 for cholestipol-20. In women the cost-effectiveness were 11.6, 15.4, 17.7, 21.3, 25.4, 25.9 and 37.1, respectively. The cost-effectiveness for the most effective treatments was less than 5 million of pesetas per year of life gained in males presenting a cholesterol concentration higher than 300 mg/dl (7.76 mmol/l) and those under the age of 65 years. In women the cost-effectiveness was lower than 10 million of pesetas per year of life gained in those presenting more than 340 mg/dl (8.79 mmol/l) under the age of 65 years., Conclusions: The results of this study demonstrate that the administration of lovastatine at 0.02 g/day is the most effective hypolipemiant treatment in preventing coronary heart disease.

Background: Pneumococcal vaccine is an effective preventive measure against pneumococcal infections. Cost-effectiveness of pneumococcal vaccination of 5 or more years aged population of Catalonia has been evaluated in this study., Methods: Cost-effectiveness has been estimated in terms of net cost per life-year gained (LYG) and net cost per quality adjusted life year gained (QALY). To calculate the net program cost, a cost of 1200 pesetas ($ 10) per individual has been assumed and averted disease cost in hospital and primary health care have been calculated., Results: Pneumococcal vaccination could obtain 3,360 LYGs and 6,463 QALYs in the population of Catalonia. The program cost has been estimated at 2,800 million pesetas. Cost-effectiveness in million pesetas is 10.1 per LYG and 4.3 QALY in the age group from 5 to 24; 4.2 per LYG and 1.9 per QALY in the age group from 25 to 44; 1.0 per LYG and 0.5 per QALY in the age group from 45 to 44, and it is negative (benefits > costs) in the age group of 65 years old and over., Conclusions: Pneumococcal vaccination is cost-effective in individuals aged 65 or more, and has a favourable ratio in those aged from 45 to 64.