MRF response to JCVI interim statement
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This document summarizes adjustments made to re-evaluate the cost-effectiveness of the Bexsero meningitis vaccine. Parameters related to disease burden that were updated included increasing the incidence rate, proportion of survivors with after effects, including litigation costs, quality of life loss for carers, adjusting for underestimation of quality of life loss in children, and including quality of life loss from acute disease. The result of updating these parameters was increased cost savings to the NHS and more quality-adjusted life years gained from vaccination. The overall conclusion was that with these adjustments, the vaccine could be cost-effective but at a low price.
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This document discusses a root cause analysis and proposed solution to improve pneumococcal vaccination rates at Wilson Health System. It found the vaccination rate is currently 58.3 patients for every 1 vaccination, while the target is 5.5 patients for every 1 vaccination. The root causes included a lack of clear processes and lack of physician standing orders. The proposed solution is to implement new screening and immunization processes in the EMR, add a blanket physician order, and monitor rates monthly. Implementing these changes could prevent 294 pneumonia admissions annually, saving over $2 million while only costing $323,000 to implement. Board approval is requested to fund the upfront and ongoing costs.
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This document summarizes evidence on pay-for-performance (P4P) schemes for chronic disease management. It finds that while P4P can have positive effects, the evidence is limited and heterogeneous. Careful design is needed to avoid unintended consequences. Effective elements include incentives at multiple levels, emphasis on protocols and record-keeping, and risk-adjusting payments. More research is still needed to understand optimal incentive sizes, measures, and interactions with existing payment systems.
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This document discusses population health management and value-based payment models. It provides an overview of Highmark's approach, which includes pay-for-performance and accountable care organization programs. Quality and cost/utilization are measured across multiple metrics and used to determine provider payments. The goal is to shift from fee-for-service to value-based models to improve outcomes and lower costs.
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This document discusses quality in nephrology leadership and management. It defines quality and outlines three categories of quality defects: underuse, overuse, and misuse of medical practices. The Donabedian model of quality is introduced, which examines structure, process, and outcomes of healthcare delivery. Quality assurance, quality control, quality assessment, and performance improvement are distinguished. The Plan-Do-Study-Act cycle for quality improvement is explained. An interdisciplinary team approach and various quality metrics and programs for end-stage renal disease are outlined. Challenges of quality incentive programs are also noted.
CPC PP Oct 2014
The Colorado Pediatric Collaborative (CPC) is a nonprofit partnership between an independent physician association of pediatric practices (CPP), a healthcare management organization (PHP), and Children's Hospital Colorado. CPC implements evidence-based clinical initiatives across 23 pediatric practices serving over 200,000 patients to improve quality of care. Key initiatives include asthma care, immunizations, and healthy living programs. Evaluation shows these initiatives have led to sustained improvements in clinical processes and health outcomes like reduced hospitalizations and missed school/work days for patients with asthma. CPC seeks to expand its initiatives and secure additional funding to continue its work improving pediatric care in Colorado.
Board presentation wilson healthsystem_ipd_prevention.ppt
This document discusses a root cause analysis and proposed solution to improve pneumococcal vaccination rates at Wilson Health System. It found the vaccination rate is currently 58.3 patients for every 1 vaccination, while the target is 5.5 patients for every 1 vaccination. The root causes included a lack of clear processes and lack of physician standing orders. The proposed solution is to implement new screening and immunization processes in the EMR, add a blanket physician order, and monitor rates monthly. Implementing these changes would cost $323,009 initially but is estimated to prevent 294 pneumonia admissions per year, saving $1.7 million annually and breaking even within 59 days. Board approval is requested to fund the upfront and ongoing costs.
Board presentation wilson healthsystem_ipd_prevention.ppt
This document discusses a proposed solution to improve pneumococcal vaccination rates and prevent invasive pneumococcal disease (IPD) at Wilson Health System. It notes that currently only 58.3% of high-risk patients at Wilson are vaccinated, compared to a target rate of 5.5%. A root cause analysis identified issues like a lack of clear protocols and standing orders. The proposed solution would implement new screening and immunization processes in the EMR, include blanket vaccination orders, and allow monthly monitoring. The upfront cost is $925 with annual operating costs of $322,084, but it could prevent 294 pneumonia admissions annually, saving an estimated $1.7 million per year. Board approval is requested to fund the
Board presentation wilson healthsystem_ipd_prevention.ppt
This document discusses a proposed solution to improve pneumococcal vaccination rates and prevent invasive pneumococcal disease (IPD) at Wilson Health System. It notes that currently only 58.3% of high-risk patients at Wilson are vaccinated, compared to a target rate of 5.5%. A root cause analysis identified issues like a lack of clear protocols and standing orders. The proposed solution would implement new screening and vaccination protocols in the EMR, include blanket vaccination orders, and allow electronic pharmacy orders. This could prevent 294 pneumonia admissions annually, saving over $2 million while only costing around $323,000 to implement. Board approval is requested to fund the upfront and ongoing costs of the process changes.
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The medical director is responsible for developing, implementing, and overseeing a facility's robust quality assessment and performance improvement (QAPI) program. This includes establishing a multidisciplinary team to regularly review data, prioritize issues, and take corrective actions to improve patient outcomes and safety. The QAPI program must measure and address various clinical areas at minimum, and compliance is determined by reviewing outcomes, records, and interviewing staff.
Similar to MRF response to JCVI interim statement (20)
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Board presentation wilson healthsystem_ipd_prevention.ppt
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Board presentation wilson healthsystem_ipd_prevention.ppt
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Board presentation wilson healthsystem_ipd_prevention.ppt
Board presentation wilson healthsystem_ipd_prevention.ppt
Board presentation wilson healthsystem_ipd_prevention.ppt
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The document discusses the Global Meningitis Genome Partnership (GMGP), which aims to address inequities in genomic surveillance capacity for meningitis pathogens between high-income and low-income countries. It outlines what has been achieved so far, including establishing standardized metadata for sequencing and epidemiological data. The GMGP is working to incorporate genome surveillance into regional surveillance strategies, initially focusing on Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, and Streptococcus agalactiae in Africa. Open data sharing is encouraged according to clear governance policies. Standardizing metadata and curating sequencing data in a central library are discussed to facilitate consistent analysis and data visualization for public health benefit
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- There was a significant reduction in cases of invasive bacterial infections like pneumococcal disease, H. influenzae, and meningococcal disease in 2020 coinciding with COVID-19 containment measures across many countries. Vaccination coverage rates have decreased dramatically in Brazil representing a potential risk of rebound in infectious disease rates. Maintaining disease surveillance is important to inform authorities on current disease burden and carriage rates even though some diseases were reduced during the pandemic.
Brenda kwambana adams
This document discusses optimal schedules for controlling pneumococcal infection in countries with high and low carriage. It notes that the African Meningitis Belt has seen sub-optimal pneumococcal conjugate vaccine (PCV) coverage due to geopolitical factors and vulnerable populations. Outbreaks in Ghana pre- and post-PCV introduction show that herd protection may be inadequate. Research is needed to better understand pneumococcal biology and prevention. Improving PCV access and coverage, including schedules with boosters and catch-up campaigns targeting 5-29 year olds, may help prevent outbreaks. Strengthening surveillance systems allows rapid response.
Professor Muhamed-Kheir Taha
Professor Muhamed-Kheir TAHA MD, PhD, HDR presented on lessons and impacts for meningitis in the COVID-19 era. Data showed cumulative cases of invasive meningococcal disease (IMD) from 2014-2020 in France as well as distribution of IMD cases from 2011-2020. Vaccine use in France declined during the COVID-19 pandemic in 2020, with reduced doses of the 5-month and 12-month vaccines. Distribution of IMD cases by age group from 2011-2021 showed an immunity gap in childhood due to the pandemic. Conclusions were that reduced pathogen circulation may decrease herd immunity, social distancing was associated with lower vaccine uptake, and countries need plans to promote
Potential use of MenABCWY vaccines
Progress is being made on developing a combined MenABCWY vaccine. Studies are underway evaluating the immunogenicity and safety of combining different meningococcal vaccines that target serogroups A, C, W, Y. Combining the vaccines could simplify immunization schedules, reduce costs by needing fewer doses, and increase vaccination uptake by reducing the number of required injections. However, a combined vaccine may also increase reactogenicity and interfere with the immune response to other concomitant vaccines. Ongoing studies are evaluating different potential MenABCWY vaccine combinations to determine the optimal formulation.
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Dr Maria Deloria Knoll
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Professor Nelesh govender
Cryptococcal meningitis is responsible for 15% of AIDS-related deaths globally. A strategic framework is needed to end cryptococcal meningitis deaths by 2030 by addressing gaps in screening, diagnosis, and access to critical antifungal medicines. Key targets include expanding access to CD4 and cryptococcal antigen tests, improving availability of lumbar puncture and antifungal drugs, and increasing research to develop better diagnostics and treatments.
Professor Sir Andrew Pollard
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Dr Manuel krone
This document summarizes changes in invasive meningococcal disease (IMD) cases in Germany during the COVID-19 pandemic. It finds that overall IMD cases decreased during the first pandemic period (PP) in 2020 compared to pre-pandemic levels, with the largest declines in children ages 1-4 and 5-9. However, IMD cases increased again after restrictions eased. The decrease in IMD cases during increased restrictions correlates with decreased mobility based on Google mobility indices.
Yangyupei yang
1) The PSERENADE project analyzed surveillance data from over 50 sites in 34 countries to assess the impact of PCV10 and PCV13 introduction on pneumococcal meningitis incidence globally in children under 5 years old and adults 18 years and older.
2) For both age groups, PCV10 and PCV13 significantly reduced meningitis caused by serotypes covered by the vaccines, with almost elimination in children under 5 years old within 5 years. Herd protection was observed in adults as well.
3) PCV13 significantly reduced meningitis from additional serotypes it covers compared to PCV10, though serotype 19A increased with PCV10 and serotype 3 trends were unclear
Dr Rodolfo villena
This study examined sequelae in 49 pediatric patients with invasive meningococcal disease (IMD) in Chile between 2009-2019. The researchers found that 59% of patients experienced sequelae at hospital discharge, with neurological disorders being the most common at 59.2%. Risk factors for sequelae included age under 1 year old, shock, and meningeal signs at admission. Sequelae were also associated with a clinical diagnosis of meningitis with meningococcemia. The study concludes that multidisciplinary follow-up is needed to reduce the long-term impacts of IMD in children.
Sara katz
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Dr Xin wang
National Center for Immunization & Respiratory Diseases
Rapid Diagnostic Tests for Bacterial Meningitis Pathogens: where we are now and what’s next.
Xin Wang Chief, Bacterial Meningitis Laboratory Director WHO Collaborating Center for Meningitis MVPDB/DBD/NCIRD/CDC Meningitis Research Foundation Conference Nov 1-3, 2021
The document discusses the current state of rapid diagnostic tests for bacterial meningitis pathogens and outlines a vision for their future development and deployment. It describes existing tests and their limitations. Potential new platforms are identified that could meet targets outlined in a target product profile. Advanced technologies like sequencing and CRISPR/Cas are also discussed
Professor Cal MacLennan
Gonorrhea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae that can lead to serious health complications if left untreated. There is an urgent need for a gonorrhea vaccine due to increasing antibiotic resistance and the potential for the disease to become untreatable. However, vaccine development faces several difficulties as N. gonorrhoeae is highly variable, able to avoid the immune system, and past vaccine trials have shown no efficacy. Continued research is focused on identifying conserved antigens that could induce a protective immune response through vaccination.
Dr Sami gottlieb
Dr. Sami Gottlieb of the World Health Organization discussed the potential for meningococcal B (MenB) vaccines to help prevent gonococcal infection on a global scale. MenB vaccines have shown preliminary efficacy against gonorrhea in clinical trials and epidemiological data. WHO is working to define priority populations for gonorrhea vaccines and assess how existing MenB programs could be leveraged. Effectiveness may depend on disease epidemiology, vaccine characteristics, target populations, and integration with current immunization systems. Ongoing trials of MenB vaccines against gonorrhea will provide critical data to inform introduction decisions.
Dr Lee hampton
Gavi has supported the rollout of the Meningococcal A Conjugate Vaccine (MenAfrivac) in 26 African countries since 2010 through routine immunization and preventive campaigns for those aged 1-29. No cases of meningococcal A have been identified in the African meningitis belt since 2018. In 2018, non-A outbreaks prompted Gavi to authorize support for multivalent meningococcal conjugate vaccines contingent on regulatory approval, review processes, and cost targets being met. The estimated cost per death averted for the risk-based multivalent meningococcal conjugate vaccine program would be $6,300 to $13,400.
Professor Stefan flasche
While pneumococcal disease primarily burdens infants in their first year of life, relying on herd effects from PCV schedules could help protect others indirectly and reduce costs. However, caution is needed, as indirect protection depends on direct protection of main transmitters, and key questions remain around who transmits, the duration of protection from boosters, and lessons from cRCTs comparing 2-dose and 3-dose schedules in Malawi and Gambia. Programmatic concerns like booster dose coverage, incomplete dosing, travel/border effects, and lack of surveillance also warrant consideration.
Professor Shrijana shrestha
The document discusses Nepal's introduction of the PCV 10 vaccine using a 2+1 schedule of administration at 6 weeks, 10 weeks, and 9 months. A trial found this schedule to be equally effective as a 3+0 schedule. Surveillance data showed declines in invasive pneumococcal disease cases and pneumonia with consolidation following vaccine introduction. Pneumococcal carriage among children with clinical pneumonia under 2 years old declined significantly, but no decrease was seen in older children. Short term impact was observed using the 2+1 schedule, but continued surveillance is needed to assess long term vaccine impact.
Professor David goldblatt
The document discusses optimal vaccination schedules for pneumococcal disease in countries with high and low disease carriage. It summarizes studies comparing 1+1 and 2+1 vaccination schedules for PCV10 and PCV13 vaccines. The studies found immunogenicity was equivalent or higher for many serotypes with 1+1 schedules. The UK switched to a 1+1 schedule in 2020 and ongoing surveillance will monitor its impact on invasive pneumococcal disease cases. Future studies will evaluate the impact of the schedule change and potential for disease rebound over time.
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MRF response to JCVI interim statement
- 1. Our response to the JCVI interim cost effectiveness analysis • The burden of this disease had not been adequately captured • Incidence of disease estimate was too low • Proportion of survivors with after effects was underestimated Costs • NHS litigation costs had not been included • Public health costs had not been fully considered • Costs of treating severe cases of diseases were not fully reflected Benefits • QALY loss to carers was not included • The tool used to measure QALY loss underestimates health loss in children • Short term complications and late developing after effects had not been included
- 2. Re-evaluation of the cost effectiveness of Bexsero Parameters associated with disease burden that were adjusted • Incidence of disease was increased to reflect fluctuating disease levels • The result is increased NHS cost savings and more QALYs gained from vaccination because more are prevented from becoming ill QALY’s
- 3. Re-evaluation of the cost effectiveness of Bexsero Parameters associated with disease burden that were adjusted • The proportion of survivors with after effects was increased to take into account the most recent evidence • The result is increased NHS cost savings and more QALYs gained from vaccination QALY’s
- 4. Re-evaluation of the cost effectiveness of Bexsero Parameters associated with disease burden that were adjusted • Litigation cost savings were included • The result is increased NHS cost savings because the vaccine prevents clinical negligence claims • Because meningitis is notoriously difficult to detect, litigation claims are disproportionately associated with this disease and should be included in the analysis
- 5. Re-evaluation of the cost effectiveness of Bexsero Parameters associated with disease burden that were adjusted • QALY loss to carers was considered • The result is more QALYs gained because vaccination reduces the burden on carers • The knock-on health effect to carers was found to be considerable and including this substantially increased the value of the vaccine • Carer quality of life data was obtained from research involving MRF members QALY’s
- 6. Re-evaluation of the cost effectiveness of Bexsero Parameters associated with disease burden that were adjusted • A quality adjustment factor (QAF) was applied to account for underestimation of QALY losses in children • The result is more QALYs gained from vaccination QALY’s
- 7. Re-evaluation of the cost effectiveness of Bexsero Parameters associated with disease burden that were adjusted • Quality of life loss associated with acute disease added • The result is more QALYs gained from vaccination because the health loss associated with the acute disease is considered for the first time QALY’s
- 8. Re-evaluation of the cost effectiveness of Bexsero Parameters associated with disease burden that were adjusted • Incidence of disease increased to reflect fluctuating disease levels • Proportion of survivors with after effects increased to take into account most recent evidence • Litigation cost savings included • QALY loss to carers considered • A quality adjustment factor (QAF) applied to account for underestimation of QALY losses in children • Quality of life loss associated with acute disease added RESULT Vaccine could be cost effective but at a low price. The JCVI recommend vaccination of infants at 2, 4 and 12 months