Cost of Measles Containment in an Ambulatory Pediatric Clinic

Wendorf, Kristen; Kay, Meagan; Ortega-Sánchez, Ismael R.; Munn, Meaghan S.; Duchin, Jeffrey S.

doi:10.1097/inf.0000000000000682

Cited by 19 publications

(13 citation statements)

References 12 publications

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“…One model of a hypothetical outbreak in South Africa assumed that measles treatment impacts transmission (without providing any support for this assumption, which appears inconsistent with other models and the evidence), and suggested that saturation of treatment may support sustained transmission. Based on current rates of immunization among U.S. troops, a recent study found limited benefit associated with predeployment boosting immunization with MRCV for troops going to Afghanistan, although the model did not explicitly consider the impact of individual importations that could lead to limited local transmission and associated costs …”

Section: Resultsmentioning

confidence: 99%

Evolution and Use of Dynamic Transmission Models for Measles and Rubella Risk and Policy Analysis

Thompson¹

2016

Risk Analysis

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The devastation caused by periodic measles outbreaks motivated efforts over more than a century to mathematically model measles disease and transmission. Following the identification of rubella, which similarly presents with fever and rash and causes congenital rubella syndrome (CRS) in infants born to women first infected with rubella early in pregnancy, modelers also began to characterize rubella disease and transmission. Despite the relatively large literature, no comprehensive review to date provides an overview of dynamic transmission models for measles and rubella developed to support risk and policy analysis. This systematic review of the literature identifies quantitative measles and/or rubella dynamic transmission models and characterizes key insights relevant for prospective modeling efforts. Overall, measles and rubella represent some of the relatively simplest viruses to model due to their ability to impact only humans and the apparent life-long immunity that follows survival of infection and/or protection by vaccination, although complexities arise due to maternal antibodies and heterogeneity in mixing and some models considered potential waning immunity and reinfection. This review finds significant underreporting of measles and rubella infections and widespread recognition of the importance of achieving and maintaining high population immunity to stop and prevent measles and rubella transmission. The significantly lower transmissibility of rubella compared to measles implies that all countries could eliminate rubella and CRS by using combination of measles- and rubella-containing vaccines (MRCVs) as they strive to meet regional measles elimination goals, which leads to the recommendation of changing the formulation of national measles-containing vaccines from measles only to MRCV as the standard of care.

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Section: Resultsmentioning

confidence: 99%

Evolution and Use of Dynamic Transmission Models for Measles and Rubella Risk and Policy Analysis

Thompson¹

2016

Risk Analysis

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“…MMR vaccination for nonimmune travelers could be a cost-effective strategy to reduce measles cases in the United States given the low cost of vaccination (32), the vaccine's two-dose effectiveness of 97% (6), and the low likelihood of vaccine-related adverse events (33), especially in the context of the morbidity and costs associated with measles infection (34-36), secondary cases caused by transmission (37, 38), and the expensive outbreak investigations required with any new case of measles in the United States (37, 38). Further evaluation of the cost-effectiveness of pretravel measles vaccination is warranted given the low probability of exposure during travel but high impact of any imported measles cases.…”

Section: Discussionmentioning

confidence: 99%

Missed Opportunities for Measles, Mumps, Rubella Vaccination Among Departing U.S. Adult Travelers Receiving Pretravel Health Consultations

et al. 2017

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Background Measles outbreaks continue to occur in the United States and are mostly due to infections in returning travelers. Objective We described how providers assessed the measles immunity status of departing U.S. adult travelers seeking pretravel consultation and assessed reasons given for nonvaccination among those considered eligible to receive the measles-mumps-rubella (MMR) vaccine. Design Observational study in U.S. pretravel clinics. Setting 24 sites associated with Global TravEpiNet (GTEN), a Centers for Disease Control and Prevention-funded consortium. Patients Adults (born in or after 1957) attending pre-travel consultations at GTEN sites (2009-2014). Measurements Structured questionnaire completed by traveler and provider during pretravel consultation. Results We included 40,810 adult travelers; providers considered 6,612 (16%) to be eligible for MMR vaccine at the time of pretravel consultation. Of the MMR-eligible, 3,477 (53%) were not vaccinated at the visit; of these, 1,689 (48%) were not vaccinated due to traveler refusal, 966 (28%) due to provider decision, and 822 (24%) due to health systems barriers. Most MMR-eligible travelers who were not vaccinated were evaluated in the South (2,262 travelers, 65%) or at nonacademic centers (1,777 travelers, 51%). Nonvaccination due to traveler refusal was most frequent in the South (1,432 travelers, 63%) or at nonacademic centers (1,178 travelers, 66%). Limitations Our estimates could underrepresent the opportunities for MMR vaccination, as providers accepted verbal histories of disease and vaccination as evidence of immunity. Conclusions Sixteen percent of U.S. adult travelers who presented for pretravel consultation at GTEN sites met criteria for MMR vaccination according to the provider's assessment, but fewer than half of these travelers were vaccinated. An increase in MMR vaccination of eligible U.S. adult travelers could reduce the likelihood of measles importations and transmissions.

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“…For low‐income countries, we assume outbreak response costs of approximately $45 per case and for high‐income countries we assume costs of $216 per case . The outbreak response cost estimate for high‐income countries may significantly underestimate the costs, with U.S. aggressive outbreak response to maintain national measles elimination implying costs of approximately $5,000 to $50,000 per case . For LMI and UMI we estimate the costs using the same approach we used to apportion treatment costs.…”

Section: Methodsmentioning

confidence: 99%

“…We separately reviewed and extracted cost and valuation data from the existing benefit‐cost and cost‐effectiveness analyses, which included the identification of some cost‐only studies for measles and rubella immunization interventions . These and other cost studies provide useful data to support characterization of cost and valuation inputs. In our reviews, we found one cost‐only study for a developed country that characterized adverse health outcomes and costs associated with measles infections by age, and noted that most economic analyses for measles that reported DALYs only considered mortality .…”

Section: Introductionmentioning

confidence: 99%

The Costs and Valuation of Health Impacts of Measles and Rubella Risk Management Policies

Thompson

Odahowski²

2015

Risk Analysis

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National and global health policymakers require good information about the costs and benefits of their investments in measles and rubella immunization programs. Building on our review of the existing measles and rubella health economics literature, we develop inputs for use in regional and global models of the expected future benefits and costs of vaccination, treatment, surveillance, and other global coordination activities. Given diversity in the world and limited data, we characterize the costs for countries according to the 2013 World Bank income levels using 2013 U.S. dollars (2013$US). We estimate that routine immunization and supplemental immunization activities will cost governments and donors over 2013$US 2.3 billion per year for the foreseeable future, with high-income countries accounting for 55% of the costs, to vaccinate global birth cohorts of approximately 134 million surviving infants and to protect the global population of over 7 billion people. We find significantly higher costs and health consequences of measles or rubella disease than with vaccine use, with the expected disability-adjusted life year (DALY) loss for case of disease generally at least 100 times the loss per vaccine dose. To support estimates of the economic benefits of investments in measles and/or rubella elimination or control, we characterize the probabilities of various sequelae of measles and rubella infections and vaccine adverse events, the DALY inputs for health outcomes, and the associated treatment costs. Managing measles and rubella to achieve the existing and future regional measles and rubella goals and the objectives of the Global Vaccine Action Plan will require an ongoing commitment of financial resources that will prevent adverse health outcomes and save the associated treatment costs.

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Cost of Measles Containment in an Ambulatory Pediatric Clinic

Cited by 19 publications

References 12 publications

Evolution and Use of Dynamic Transmission Models for Measles and Rubella Risk and Policy Analysis

Evolution and Use of Dynamic Transmission Models for Measles and Rubella Risk and Policy Analysis

Missed Opportunities for Measles, Mumps, Rubella Vaccination Among Departing U.S. Adult Travelers Receiving Pretravel Health Consultations

The Costs and Valuation of Health Impacts of Measles and Rubella Risk Management Policies

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