OBJECTIVES: Influenza vaccination programs targeted at children have gained increasing attention in recent years. In the US, recommendations for influenza vaccination have expanded over the last decade to include all children aged 6 months to 18 years. However, in most other developed countries childhood influenza vaccination has been restricted to targeted programs for children at risk of influenza complications. METHODS: A literature search was conducted for English-language economic evaluations of influenza vaccination in those aged less than 18 years. Studies evaluating vaccination options exclusively targeted at specific risk groups were excluded. The literature search identified 20 relevant studies which were reviewed. RESULTS: The studies differed widely in terms of the costs and benefits that were included. All but one of the studies were conducted from a societal perspective. The majority of the studies included the value of lost productivity due to caregivers missing work to care for sick children. However, other forms of lost productivity were considered by some studies, including those resulting from being vaccinated, school absenteeism, premature death, and illness in caregivers. Only a small minority of studies also measured benefits in terms of non-monetised utilities such as quality-adjusted life years. Several evaluations, particularly those directly targeted at healthy children, did not include serious influenza complications. Only one of the reviewed studies used a dynamic transmission model able to fully incorporate the indirect herd protection to the wider population. CONCLUSIONS: The conclusions of the studies were generally favourable towards vaccination. Methodological decisions in terms of what costs and benefits to include appeared influential. Many studies applied a wider perspective (i.e. including productivity losses) than the reference case for economic evaluations used in many countries.

OBJECTIVES: Define the treatment patterns and associated costs to treat metastatic prostate cancer in Brazilian private health care system. METHODS: In a nationwide oncology claims database of 3.5 million lives, from August 2010 to July 2011, 67 patients were identified with metastatic prostate cancer using chemotherapy. Patients using hormone therapy were excluded. The database gathered information regarding the treatment patients were submitted, to average duration and medication dosage. RESULTS: Patients were on average 71 years old, weighted 78 kilograms and measured 1.70 meters. Among the 67 patients, only 5 (7%) were submitted to first line treatment with mitoxantrone and 62 (93%) with docetaxel; 58% of all patients took a second line treatment. From the 62 patients that started with docetaxel (121.5 mg average dose for each of the 6.5 cycles (21days)), 28 had a second line treatment with mitoxantrone (20mg average dose for each of the 3.9 cycles (21days)) with total average cost/patient of R$ 39,698 (USD 22,056); 7 were retreated with docetaxel (60mg average dose for each of the 6 cycles (7days)). From the 5 patients that started with mitoxantrone (20.6mg average dose for each of the 3.2 cycles (21 days)), 4 continued the treatment with docetaxel (60mg average dose for each of the 3 applications (21 days)) with a total average cost/patient of R$ 12,795 (USD 7,107). CONCLUSIONS: The database suggests that docetaxel is the most commonly used first line treatment to metastatic prostate cancer in the Brazilian private health care system. Forty-two percent of the patients were not submitted to a second pattern in the period studied, being that 18% of the ones that had a second line treatment were retreated with the same medication (docetaxel).

The nine-regional GPI PCI utilization rates ranged from a low of 12.9% (Mountain Region) to a high of 28.4% (West North Central). ConClusions: GPI utilization in PCI patients varies greatly among the nine US regions defined by the Premier hospital database. There is a consistent pattern of decreasing utilization with varying rates of decline from 2008 to 2014. Using a 19.8% average national rate for PCI GPI use in 2014 will miss the important regional variation occurring in the US.

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