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OBJECTIVES: This study assesses the cost-effectiveness of universal vaccination with RV5 in a hypothetical cohort of 1,091,156 children in Japan during their first 5 years of life. METHODS: A Markov model was developed to evaluate the cost per quality-adjusted-life-year (QALY) from the healthcare and societal perspectives. The base case scenario assumes 94% of the vaccinated cohort received 3 doses of RV5 orally at 2, 4, and 6 months of age with the remaining children receiving only 1 or 2 doses. In the absence of a vaccination strategy, there is annually 1 death, 78,000 hospitalizations, and 739,874 outpatient visits. The efficacy of RV5 was based on the results of the Rotavirus Efficacy and Safety Trial (REST). The three dose efficacy in REST was similar to the one obtained from clinical trials conducted in Japan. RESULTS: Universal vaccination could reduce hospitalizations by 89% and all symptomatic episodes of rotavirus gastroenteritis by 59%. For the base case scenario, at a cost of JPY 5316 per dose and administration fee of JPY ,100 per dose, the cost per case avoided was JPY 22,704 and the cost per QALY saved was JPY 2,230,978 from the healthcare payer perspective. From the societal perspective, the cost per case avoided was JPY 8,934 and the cost per QALY saved was JPY 877,855. CONCLUSIONS: Using three times the GDP per capita as a threshold, universal vaccination with RV5 is likely to be cost-effective and to result in substantial reductions in rotavirus-related healthcare use in Japan.

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BackgroundWe investigated the association between CYP2B6 polymorphisms and efavirenz drug resistance among women living with HIV started on anti-retroviral therapy during pregnancy and with high viremia during post-partum.MethodsThis was a cross sectional study. Women between 6-12 weeks post-partum with viral load >1000 copies/ml were eligible. Sanger sequencing to detect resistant mutations and host genotyping were performed. We categorized efavirenz metabolizer genotype according to the AIDS clinical trials group algorithm as slow, intermediate and extensive; and compared efavirenz resistance among the metabolizer genotypes.Results Over a one-year period (July 2017-July 2018), three hundred and thirty two women were screened of whom 112 (34.8%) had viral load ≥1000 copies/ml of whom 62 had whole blood available for genotyping. Fifty-nine of these women had both viral resistance and human host genotypic results. We observed a higher frequency of efavirenz resistance among slow metabolizers (47% versus 34% in extensive and 28% in intermediate, metabolizers) but due to low numbers, this was not statistically significant. ConclusionsOur findings raise the possibility that CYP2B6 polymorphism may contribute to efavirenz drug resistance in women started on antiretroviral therapy during pregnancy and with high viremia in the post-partum period. If confirmed in a larger study, this would have important implications for all patients in sub-Saharan Africa receiving efavirenz and add further support to the changes in World Health Organization policy to switch away from efavirenz as first line antiretroviral therapy in countries with a high prevalence of CYP2B6 polymorphisms.

The objective of this study is to assess the value for money of introducing pneumococcal conjugate vaccines as part of the immunization program in a lower-middle income country, the Philippines, which is not eligible for GAVI support and lower vaccine prices. It also includes the newest clinical evidence evaluating the efficacy of PCV10, which is lacking in other previous studies. Methods: A cost-utility analysis was conducted. A Markov simulation model was constructed to examine the costs and consequences of PCV10 and PCV13 against the current scenario of no PCV vaccination for a lifetime horizon. A health system perspective was employed to explore different funding schemes, which include universal or partial vaccination coverage subsidized by the government. Results were presented as incremental cost-effectiveness ratios (ICERs) in Philippine peso (Php) per QALY gained (1 USD = 44.20 Php). Probabilistic sensitivity analysis was performed to deter-