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3. Health-care cost reduction resulting from primary-care allergy testing in children in Italy

Author

Zethraeus Niklas, Petersson Carl, Dozzi Massimiliano, Borres Magnus P, Vignati Giulio, and Fiocchi Alessandro

Subjects
Pediatrics, RJ1-570
Abstract

Abstract Background Allergy places a considerable cost burden on society. Specific immunoglobulin E (spIgE) testing may improve the management of allergy patients. There is therefore a reason to quantify the economic consequences of the use of spIgE testing in the diagnosis of allergic conditions. Methods The expected costs of spIgE testing versus no-testing were calculated using a clinical decision model based on a prospective clinical trial performed in primary care. Results The expected costs per patient over 2 years decreased from 802 euros in the "no-test strategy" to 560 euros in the spIgE "test strategy". Cost savings persisted even after assumptions about the prevalence of allergy and the prices of medications were changed. The "test strategy" increased the percentage of patients correctly diagnosed from 54 to 87%. Conclusions spIgE testing of children with respiratory and/or skin problems in primary care in Italy reduces overall costs to society. These cost savings mostly result from a reduction in the use of medications, particularly corticosteroids. The study indicates that spIgE testing of all children with respiratory and/or skin symptoms would be a cost-effective strategy.

Published
2010
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4. Serotype distribution and antimicrobial susceptibilities of nasopharyngeal isolates of Streptococcus pneumoniae from healthy children in the 13-valent pneumococcal conjugate vaccine era

Author

Metta Maria Gabriella, Giorgio Bedogni, Dario Dilillo, Gandini Vera, Ballerini Emanuela, Travaini Marta, Brioschi Manuela, Bonvissuto Milena, Di Nello Francesca, Mazzucchi Elisabetta, Sala Natascia, Moscatiello Anna, Rubini Riccardo, Porta Norberto, Erminio Torresani, Dozzi Massimiliano, Benincaso Annarita, Decarlis Silvia, Vessia Chiara, Tomasetto Mariangela, Maria Gramegna, Maria Laura Garlaschi, Nannini Pilar, Marino Faccini, Chiara Mameli, Petruzzi Mariangela, Calloni Cinzia Simona, Bricalli Dorella, Picciotti Michela, Galli Erica, Gian Vincenzo Zuccotti, Pisanelli Stefania, Torcoletti Matteo, Laviola Franca, Valentini Maurizio, De Angelis Laura, Saitta Vincenzo, Laura Daprai, Scelza Giuseppina, Camiletti Marina Irene, Ramponi Giulia, Macedoni Maddalena, Giuliani Maria Grazia, Redaelli Francesca, Loda Barbara, Tiso Rosa Maria, Colella Giacomo, and Picicco Damiano

Subjects
Serotype, Male, medicine.medical_specialty, Microbial Sensitivity Tests, medicine.disease_cause, Pneumococcal conjugate vaccine, Pneumococcal Infections, Pneumococcal Vaccines, Antibiotic resistance, Internal medicine, Nasopharynx, Epidemiology, Streptococcus pneumoniae, Drug Resistance, Bacterial, medicine, Humans, General Veterinary, General Immunology and Microbiology, Respiratory tract infections, business.industry, Public Health, Environmental and Occupational Health, Infant, Infectious Diseases, Carriage, Cross-Sectional Studies, Pneumococcal vaccine, Italy, Child, Preschool, Immunology, Carrier State, Molecular Medicine, Female, business, medicine.drug
Abstract

Few epidemiological data are available since the introduction of 13-valent pneumococcal vaccine (PCV13) in 2010. We conducted a cross-sectional study to estimate the prevalence of Streptococcus pneumoniae (SP) nasopharyngeal carriage in healthy Italian infants and young children and to evaluate the impact of PCV13 on pneumococcal colonization. In the trimester September-December 2011 nasopharyngeal swabs were collected from healthy children aged 3-59 months presenting for routine well careat 16 primary care pediatricians in Milan. SP carriage isolates were serotyped and tested for antimicrobial resistance using EUCAST breakpoints. Among 1250 enrolled children, 618 had received at least 1 dose of PCV13, 292 at least 1 dose of PCV7, 94 a combination of the two vaccines and 246 were not vaccinated. The prevalence of SP carriage was 27% (95% confidence interval [CI] 25-30). At multivariable analysis, age≥25 months (prevalence ratio [PR]=0.74) and use of antibiotics in the previous 3 months (PR=0.67) were associated with lower SP carriage prevalence. Having siblings (PR=1.79 for 1 sibling and PR=2.23 for ≥2 siblings), day-care attendance (PR=2.27) and respiratory tract infections in the previous 3 months (PR=1.39) were associated with higher SP carriage prevalence. The immunization status for SP was not associated with SP carriage at univariable or at multivariable analysis. The most common carriage isolates were 6C, 19A and 23A. The prevalence of the six additional PCV13 serotypes carriage in children appropriately vaccinated with PCV13 was lower than in children appropriately vaccinated with PCV7 (0 vs. 0.060); the greater reduction in prevalence of carriage was observed for serotype 19A (0 vs. 0.041). Serotype 6C was the most common drug-resistant serotype (17.2%). Further epidemiological studies are needed to assess changes in circulating SP serotypes following the large-scale introduction of PCV13.

Published
2013

5. Serotype distribution and antimicrobial susceptibilities of nasopharyngeal isolates of Streptococcus pneumoniae from healthy children in the 13-valent pneumococcal conjugate vaccine era.

Author

Zuccotti G, Mameli C, Daprai L, Garlaschi ML, Dilillo D, Bedogni G, Faccini M, Gramegna M, Torresani E, Ballerini E, Benincaso A, Bonvissuto M, Bricalli D, Brioschi M, Calloni CS, Camiletti MI, Colella G, De Angelis L, Decarlis S, Di Nello F, Dozzi M, Galli E, Gandini V, Giuliani MG, Laviola F, Loda B, Macedoni M, Mazzucchi E, Metta MG, Moscatiello A, Nannini P, Petruzzi M, Picicco D, Picciotti M, Pisanelli S, Porta N, Ramponi G, Redaelli F, Rubini R, Sala N, Saitta V, Scelza G, Tiso RM, Tomasetto M, Torcoletti M, Travaini M, Valentini M, and Vessia C

Subjects
Child, Preschool, Cross-Sectional Studies, Drug Resistance, Bacterial, Female, Humans, Infant, Italy, Male, Microbial Sensitivity Tests, Pneumococcal Vaccines administration & dosage, Streptococcus pneumoniae drug effects, Streptococcus pneumoniae isolation & purification, Carrier State microbiology, Nasopharynx microbiology, Pneumococcal Infections epidemiology, Streptococcus pneumoniae classification
Abstract

Few epidemiological data are available since the introduction of 13-valent pneumococcal vaccine (PCV13) in 2010. We conducted a cross-sectional study to estimate the prevalence of Streptococcus pneumoniae (SP) nasopharyngeal carriage in healthy Italian infants and young children and to evaluate the impact of PCV13 on pneumococcal colonization. In the trimester September-December 2011 nasopharyngeal swabs were collected from healthy children aged 3-59 months presenting for routine well careat 16 primary care pediatricians in Milan. SP carriage isolates were serotyped and tested for antimicrobial resistance using EUCAST breakpoints. Among 1250 enrolled children, 618 had received at least 1 dose of PCV13, 292 at least 1 dose of PCV7, 94 a combination of the two vaccines and 246 were not vaccinated. The prevalence of SP carriage was 27% (95% confidence interval [CI] 25-30). At multivariable analysis, age≥25 months (prevalence ratio [PR]=0.74) and use of antibiotics in the previous 3 months (PR=0.67) were associated with lower SP carriage prevalence. Having siblings (PR=1.79 for 1 sibling and PR=2.23 for ≥2 siblings), day-care attendance (PR=2.27) and respiratory tract infections in the previous 3 months (PR=1.39) were associated with higher SP carriage prevalence. The immunization status for SP was not associated with SP carriage at univariable or at multivariable analysis. The most common carriage isolates were 6C, 19A and 23A. The prevalence of the six additional PCV13 serotypes carriage in children appropriately vaccinated with PCV13 was lower than in children appropriately vaccinated with PCV7 (0 vs. 0.060); the greater reduction in prevalence of carriage was observed for serotype 19A (0 vs. 0.041). Serotype 6C was the most common drug-resistant serotype (17.2%). Further epidemiological studies are needed to assess changes in circulating SP serotypes following the large-scale introduction of PCV13., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Published
2014
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