Economics of Cardiac Adverse Events after Smallpox Vaccination: Lessons from the 2003 US Vaccination Program

Ortega-Sánchez, Ismael R.; Sniadack, Mercedes M.; Mootrey, Gina T.

doi:10.1086/524380

Cited by 9 publications

(8 citation statements)

References 17 publications

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“…For every million smallpox vaccinees, there would be >3000 cardiac adverse events that would require a sizeable amount of medical resource utilization including nearly 8000 healthcare visits, over 15,000 medical tests, and hundreds of hospitalization days. Worker productivity would also be reduced by nearly 16,000 work days [24]. Thus, economic barriers at the manufacturing, distribution, individual, and societal levels continue to conspire against the rapid development and use of new biodefense vaccines.…”

Section: Economic Concerns and Challengesmentioning

confidence: 99%

The social, political, ethical, and economic aspects of biodefense vaccines

Jacobson¹,

Tilburt²,

Nichol³

2009

Vaccine

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Besides natural disasters and naturally occurring novel infectious diseases, nothing potentially threatens the health and stability of nations and health systems as much as the devastating threat and unfathomability of bioterrorism. Other than attempts at political solutions and interdictive attempts, only antimicrobials and vaccines offer possible means for protection. Of these, vaccines offer the most immediate and definitive of preventive solutions. Limiting the development and use of vaccines however are social, political, ethical, and economic considerations, and this article will provide a brief exploration of each of these issues and the intersection with the need for such vaccines. In this article we define bioterrorism as the deliberate use of naturally occurring or bioengineered microorganisms in order to cause harm to people, animals, or plants.

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Section: Economic Concerns and Challengesmentioning

confidence: 99%

The social, political, ethical, and economic aspects of biodefense vaccines

Jacobson¹,

Tilburt²,

Nichol³

2009

Vaccine

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“…Finally, if the post-event vaccination strategy is used in errant response to a successful hoax, the degree of panic and alarm as well as the morbidity and mortality of post-event vaccinia distribution would be a success for the terrorists. [10][11][12] The choices are difficult for the targets given the best response of the terrorists, and this is where a game theory application can be illustrative.…”

Section: Precommitment and Informationmentioning

confidence: 99%

“…Harsanyi developed a Bayesian approach to game theory that stated that over time players will, maximize the expected value of their payoffs based on the probabilities of other players' strategies, and revise their strategies to achieve some satisfying strategy, after which they do not change. 11 Further along these lines, W. Brian Arthur suggested that in games involving multiple participants played out over time and each participant uses inductive reasoning to generate his/her own strategies (however unique or commonplace), and then, observes their effectiveness over time and makes there is an attack and the healthcare worker is unvaccinated, the payoff is also nonlinear ( Figure 5). This is the plot of a quadratic equation -4+x+2x2, and yields -4 if none are vaccinated, -3 if half are vaccinated, and -1 if all are vaccinated.…”

Section: An N-person Game Examplementioning

confidence: 99%

Smallpox, Risks of Terrorist Attacks, and the Nash Equilibrium: An Introduction to Game Theory and an Examination of the Smallpox Vaccination Program

Hamilton

McCain

2009

Prehosp. Disaster med.

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Introduction:The smallpox vaccination emergency preparedness program has been unsuccessful in enrolling sufficient numbers of healthcare workers.Objective:The objective of this study was to use game theory to analyze a pre-event vaccination versus post-event vaccination program using the example of a terrorist considering an attack with smallpox or a hoax.Methods:A three-person game (normal and extensive form), and an in-person game are played for pre-event and post-event vaccinations of healthcare workers facing the possibility of a smallpox attack or hoax.Results:Full pre-event vaccinations of all targeted healthcare workers are not necessary to deter a terrorist attack. In addition, coordinating vaccinations among healthcare workers, individual healthcare worker risk aversion, and the degree to which terrorists make the last move based on specific information on the status of pre-event vaccination all greatly impact strategy selection for both sides. A Nash Equilibrium of pre- and post-event vaccination strategies among a large number of healthcare professionals will tend to eliminate the advantage (of the terrorists) of a smallpox attack over a hoax, but may not eliminate some probability of a smallpox attack.Conclusions:Emergency preparedness would benefit from game theory analysis of the costs and payoffs of specific terrorism/counter-terrorism strategies.

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“…Moreover, a literature review of the implementation costs and resource use associated with the 2003 US Civilian Smallpox Vaccination Program was conducted. This yielded an economic analysis on frequency and cost of cardiovascular events (Ortega-Sanchez, Sniadack, & Mootrey, 2008). Moreover, to illustrate the potential costs of treating SAEs, an in-depth analysis was performed of the costs associated with treating eczema vaccinatum (Vora et al, 2008) and progressive vaccinia (Lederman et al, 2012), two rare SAEs associated with the use of replicating smallpox vaccines.…”

Section: Introductionmentioning

confidence: 99%

Total costs associated with replicating and non-replicating smallpox vaccines

Rouvroit¹,

Heegaard²

2016

Global Security: Health, Science and Policy

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Routine vaccination against smallpox among the general public was discontinued more than three decades ago, resulting in a population that is increasingly susceptible to infection. Moreover, the likelihood of re-introduction of eradicated diseases, such as smallpox, increases with time primarily due to the rapid advancement of biotechnology. Our analysis outlines the relative contribution of each component to the total cost of immunisation as it compares replicating and non-replicating smallpox vaccines for the first time. We calculated the total cost of immunising one person using a replicating vaccine such as ACAM2000 was $139, while using a non-replicating vaccine (IMVAMUNE ®) cost $115. Overall, the analysis indicates that the main cost component differences of replicating and non-replicating vaccines are made up of the need for screening, follow-up visit, adverse events, reimbursement and compensation when using replicating vaccines. These costs are almost perfectly balanced against the higher cost of goods, reduced productivity loss and the need for an extra vaccination visit when using a non-replicating vaccine. With the availability of a new vaccine option, preparedness planners will benefit from this analysis to support evidence-based decision-making when preparing a safe, efficacious and cost-effective stockpile and immunisation programme against smallpox.

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Economics of Cardiac Adverse Events after Smallpox Vaccination: Lessons from the 2003 US Vaccination Program

Cited by 9 publications

References 17 publications

The social, political, ethical, and economic aspects of biodefense vaccines

The social, political, ethical, and economic aspects of biodefense vaccines

Smallpox, Risks of Terrorist Attacks, and the Nash Equilibrium: An Introduction to Game Theory and an Examination of the Smallpox Vaccination Program

Total costs associated with replicating and non-replicating smallpox vaccines

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