Assessing the potential impact of COVID-19 booster doses and oral antivirals: A mathematical modelling study of selected middle-income countries in the Indo-Pacific
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ABSTRACT:
SUBMITTER: Bilgin G
PROVIDER: S-EPMC10506093 | biostudies-literature | 2023 Sep
REPOSITORIES: biostudies-literature
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Project description:BackgroundDecision-makers in middle-income countries need evidence on the cost-effectiveness of COVID-19 booster doses and oral antivirals to appropriately prioritise these healthcare interventions.MethodsWe used a dynamic transmission model to assess the cost-effectiveness of COVID-19 booster doses and oral antivirals in Fiji, Indonesia, Papua New Guinea, and Timor-Leste. We conducted cost-effectiveness analysis from both healthcare and societal perspectives using data collated from publicly available sources. We developed an interactive R Shiny which allows the user to vary key model assumptions, such as the choice of discounting rate, and view how these assumptions affect model results.FindingsBooster doses were cost saving and therefore cost-effective in all four middle-income settings from both healthcare and societal perspectives using 3% discounting. Providing oral antivirals was cost-effective from a healthcare perspective if procured at a low generic price (US$25) or middle-income reference price (US$250); however, their cost-effectiveness was strongly influenced by rates of wastage or misuse, and the ongoing costs of care for patients hospitalised with COVID-19. The cost or wastage of rapid antigen tests did not appear strongly influential over the cost-effectiveness of oral antivirals in any of the four study settings.ConclusionsOur results support that COVID-19 booster programs are cost-effective in middle-income settings. Oral antivirals demonstrate the potential to be cost-effective if procured at or below a middle-income reference price of US$250 per schedule. Further research should quantify the rates of wastage or misuse of oral COVID-19 antivirals in middle-income settings.
| S-EPMC11441647 | biostudies-literature
Project description: Not available
| S-EPMC10557953 | biostudies-literature
Project description:This paper examines the revenue implications of trade deregulation in a panel of Pacific Island countries from 2010 to 2021. First, we undertake a cross-country analysis of tax revenue, trade, and tax structure. Secondly, we empirically analyze the effect of trade deregulation on trade tax and overall government tax revenue. We find that as the countries have become more deregulated over the decade, the trade tax revenues and direct income tax revenues have declined whereas domestic indirect tax revenues have increased. The empirical estimation reveals the potential Laffer effect for trade tax revenues with respect to trade openness. The effect of regional trade agreements also shows some support for trade tax revenues. Further, the external public debt has a significant positive effect on aggregate tax revenues, while foreign aid has been significant in explaining the decline in both aggregate tax revenues as well as trade tax revenues in the selected Pacific Island countries.
| S-EPMC11694958 | biostudies-literature
Project description:BackgroundIntroduction of human papillomavirus (HPV) vaccination has been slow in low-income and middle-income countries (LMICs) because of resource constraints and worldwide shortage of vaccine supplies. To help inform WHO recommendations, we modelled various HPV vaccination strategies to examine the optimal use of limited vaccine supplies and best allocation of scarce resources in LMICs in the context of the WHO global call to eliminate cervical cancer as a public health problem.MethodsIn this mathematical modelling analysis, we developed HPV-ADVISE LMIC, a transmission-dynamic model of HPV infection and diseases calibrated to four LMICs: India, Vietnam, Uganda, and Nigeria. For different vaccination strategies that encompassed use of a nine-valent vaccine (or a two-valent or four-valent vaccine assuming high cross-protection), we estimated three outcomes: reduction in the age-standardised rate of cervical cancer, number of doses needed to prevent one case of cervical cancer (NNV; as a measure of efficiency), and the incremental cost-effectiveness ratio (ICER; in 2017 international $ per disability-adjusted life-year [DALY] averted). We examined different vaccination strategies by varying the ages of routine HPV vaccination and number of age cohorts vaccinated, the population targeted, and the number of doses used. In our base case, we assumed 100% lifetime protection against HPV-16, HPV-18, HPV-31, HPV-33, HPV-45, HPV-52, and HPV-58; vaccination coverage of 80%; and a time horizon of 100 years. For the cost-effectiveness analysis, we used a 3% discount rate. Elimination of cervical cancer was defined as an age-standardised incidence of less than four cases per 100 000 woman-years.FindingsWe predicted that HPV vaccination could lead to cervical cancer elimination in Vietnam, India, and Nigeria, but not in Uganda. Compared with no vaccination, strategies that involved vaccinating girls aged 9-14 years with two doses were predicted to be the most efficient and cost-effective in all four LMICs. NNV ranged from 78 to 381 and ICER ranged from $28 per DALY averted to $1406 per DALY averted depending on the country. The most efficient and cost-effective strategies were routine vaccination of girls aged 14 years, with or without a later switch to routine vaccination of girls aged 9 years, and routine vaccination of girls aged 9 years with a 5-year extended interval between doses and a catch-up programme at age 14 years. Vaccinating boys (aged 9-14 years) or women aged 18 years or older resulted in substantially higher NNVs and ICERs.InterpretationWe identified two strategies that could maximise efforts to prevent cervical cancer in LMICs given constraints on vaccine supplies and costs and that would allow a maximum of LMICs to introduce HPV vaccination.FundingWorld Health Organization, Canadian Institute of Health Research, Fonds de recherche du Québec-Santé, Compute Canada, PATH, and The Bill & Melinda Gates Foundation.TranslationsFor the French and Spanish translations of the abstract see Supplementary Materials section.
| S-EPMC8554391 | biostudies-literature
Project description:Indo-Pacific humpback dolphins (Sousa chinensis) inhabiting Hong Kong waters are thought to be among the world's most anthropogenically impacted coastal delphinids. We have conducted a 5-year (2010-2014) photo-ID study and performed the first in this region comprehensive mark-recapture analysis applying a suite of open population models and robust design models. Cormack-Jolly-Seber (CJS) models suggested a significant transient effect and seasonal variation in apparent survival probabilities as result of a fluid movement beyond the study area. Given the spatial restrictions of our study, limited by an administrative border, if emigration was to be considered negligible the estimated survival rate of adults was 0.980. Super-population estimates indicated that at least 368 dolphins used Hong Kong waters as part of their range. Closed robust design models suggested an influx of dolphins from winter to summer and increased site fidelity in summer; and outflux, although less prominent, during summer-winter intervals. Abundance estimates in summer (N = 144-231) were higher than that in winter (N = 87-111), corresponding to the availability of prey resources which in Hong Kong waters peaks during summer months. We point out that the current population monitoring strategy used by the Hong Kong authorities is ill-suited for a timely detection of a population change and should be revised.
| S-EPMC5371324 | biostudies-literature
Project description:The discovery of multi-species synchronous spawning of scleractinian corals on the Great Barrier Reef in the 1980s stimulated an extraordinary effort to document spawning times in other parts of the globe. Unfortunately, most of these data remain unpublished which limits our understanding of regional and global reproductive patterns. The Coral Spawning Database (CSD) collates much of these disparate data into a single place. The CSD includes 6178 observations (3085 of which were unpublished) of the time or day of spawning for over 300 scleractinian species in 61 genera from 101 sites in the Indo-Pacific. The goal of the CSD is to provide open access to coral spawning data to accelerate our understanding of coral reproductive biology and to provide a baseline against which to evaluate any future changes in reproductive phenology.
| S-EPMC7846567 | biostudies-literature
Project description:The Indo-Pacific warm pool (IPWP) has warmed and grown substantially during the past century. The IPWP is Earth's largest region of warm sea surface temperatures (SSTs), has the highest rainfall, and is fundamental to global atmospheric circulation and hydrological cycle. The region has also experienced the world's highest rates of sea-level rise in recent decades, indicating large increases in ocean heat content and leading to substantial impacts on small island states in the region. Previous studies have considered mechanisms for the basin-scale ocean warming, but not the causes of the observed IPWP expansion, where expansion in the Indian Ocean has far exceeded that in the Pacific Ocean. We identify human and natural contributions to the observed IPWP changes since the 1950s by comparing observations with climate model simulations using an optimal fingerprinting technique. Greenhouse gas forcing is found to be the dominant cause of the observed increases in IPWP intensity and size, whereas natural fluctuations associated with the Pacific Decadal Oscillation have played a smaller yet significant role. Further, we show that the shape and impact of human-induced IPWP growth could be asymmetric between the Indian and Pacific basins, the causes of which remain uncertain. Human-induced changes in the IPWP have important implications for understanding and projecting related changes in monsoonal rainfall, and frequency or intensity of tropical storms, which have profound socioeconomic consequences.
| S-EPMC4942332 | biostudies-literature
Project description:The Kusunda people of central Nepal have long been regarded as a relic tribe of South Asia. They are, or were until recently, seminomadic hunter-gatherers, living in jungles and forests, with a language that shows no similarities to surrounding languages. They are often described as shorter and darker than neighboring tribes. Our research indicates that the Kusunda language is a member of the Indo-Pacific family. This is a surprising finding inasmuch as the Indo-Pacific family is located on New Guinea and surrounding islands. The possibility that Kusunda is a remnant of the migration that led to the initial peopling of New Guinea and Australia warrants additional investigation from both a linguistic and genetic perspective.
| S-EPMC397480 | biostudies-literature
Project description:IntroductionEconomic transition has historically been shown to be associated with longer life expectancy in current high-income countries. We examined the role of alcohol consumption in this transition process for lower- and middle-income countries.MethodsWe tested three hypotheses on the interrelationship between economic growth, level of alcohol consumption and life expectancy in all six countries in the WHO Western Pacific Region, which transitioned from low- to lower-middle-income countries over the past 20 years. Structural equation modelling, corrected for autoregressive effects, was used to test the association between economic development and life expectancy, adult per capita consumption of alcohol, the prevalence of past-year drinkers and alcohol-attributable mortality. The direct impact of alcohol per capita consumption (APC) on life expectancy was also estimated.ResultsOverall, economic development was strongly positively associated with both life expectancy and alcohol consumption, and a higher level of alcohol consumption resulted in a lowered life expectancy, when directly measured. Thus, changes in gross domestic product per capita at purchasing power parity of $ 1000 Int. were linked to changes in the same direction in life expectancy of 0.94% (95% CI 0.66%, 1.21%) and with an increase in APC of 76.8% (55.38%, 98.3%). Average loss in life expectancy due to alcohol consumption was 1.76 (0.81, 2.72) years for males and 0.59 (0.12, 1.07) for females. There was heterogeneity found between countries.ConclusionAlcohol consumption is expected to increase in an economic transition from a low- to lower-middle-income country and to have a negative impact on life expectancy. Alcohol control policies should be enacted to reap the full health benefits of economic growth.
| S-EPMC11816530 | biostudies-literature
Project description:ObjectiveTo investigate whether a single optimal vaccination strategy exists across countries to deal with a future influenza pandemic by comparing the cost effectiveness of different strategies in various pandemic scenarios for three European countries.DesignEconomic and epidemic modelling study.SettingsGeneral populations in Germany, the Netherlands, and the United Kingdom.Data sourcesCountry specific patterns of social contact and demographic data.ModelAn age structured susceptible-exposed-infected-recovered transmission model that describes how an influenza A virus will spread in the populations of Germany, the Netherlands, and the United Kingdom.InterventionsComparison of four vaccination strategies: no vaccination, blanket vaccination, vaccination of elderly people (≥ 65 years), and vaccination of high transmitters (5-19 years). The four strategies were evaluated for scenarios in which a vaccine became available early or at the peak of the pandemic, and in which either everyone was initially susceptible or older age groups had pre-existing immunity.Main outcome measureCost per quality adjusted life years (QALYs) gained.ResultsAll vaccination strategies were cost effective (incremental cost per QALY gained, comparing intervention with non-intervention). In scenarios where the vaccine became available at the peak of the pandemic and there was pre-existing immunity among elderly people the incremental cost effectiveness ratios for vaccinating high transmitters were €7325 (£5815; $10,470) per QALY gained for Germany, €10,216 per QALY gained for the Netherlands, and €7280 per QALY gained for the United Kingdom. The most cost effective strategy not only differed across the pandemic scenarios but also between countries. Specifically, when the vaccine was available early in the pandemic and there was no pre-existing immunity, in Germany it would be most cost effective to vaccinate elderly people ( €940 per QALY gained), whereas it would be most cost effective to vaccinate high transmitters in both the Netherlands (€525 per QALY gained) and the United Kingdom (€163 per QALY gained). This difference in optimal strategies was due to differences in the demographic characteristics of the countries: Germany has a significantly higher proportion of elderly people compared with the Netherlands and the United Kingdom.ConclusionsNo single vaccination strategy was most cost effective across countries. With aging populations, pre-existing immunity in particular could be of crucial importance for the cost effectiveness of options to mitigate a future influenza pandemic.
| S-EPMC3395306 | biostudies-literature