#16
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#17
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#18
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Âî-âòîðûõ, ÿ ïðåäëàãàþ Âàì ïîäóìàòü äàæå íå î åãî æåíå, à î Âàøåì âíóêå.  ëþáîì ñëó÷àå, òàêàÿ ñèòóàöèÿ âîçìîæíà, è âèíà áóäåò íà Âàñ òîæå. Öèòàòà:
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#19
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Íî è ñî âçðîñëûìè âñ¸ íå òàê îäíîçíà÷íî. Vaccine. 2003 Sep 8;21(25-26):3614-22. Varicella in French adolescents and adults: individual risk assessment and cost-effectiveness of routine vaccination. Hanslik T, Boelle PY, Schwarzinger M, Carrat F, Freedberg KA, Valleron AJ, Flahault A. Department of Public Health, Hopital Saint Antoine, INSERM U444, Universite Paris 6, Assistance Publique-Hopitaux de Paris, Paris, France. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Age-specific force of varicella infection, hospitalisation and death rates in non-immune persons were calculated using an age-based mathematical model and national data for France. A cost-effectiveness model was then applied to hypothetical cohorts of persons aged 15-45 years with a negative or uncertain history of varicella. Vaccination strategies with and without prior serotesting, and healthcare payer perspective and societal perspective were considered. A sensitivity analysis was performed. Vaccination prevented more than one third of all varicella-related deaths. With serotesting, compared with no intervention, the cost per case avoided and per year of life saved for subjects aged 15 years were 335 and 55,100 Euro, respectively. When work-loss costs were also included, savings were associated with screening and vaccination of subjects less than 30 years old. Without serotesting, the costs raised markedly, with an almost identical effectiveness, resulting in an unfavourable incremental cost-effectiveness. Based on medical costs, routine serotesting and varicella vaccination for French adolescents and young adults with a negative or uncertain history of varicella affords health benefits at a cost comparable to those of other very expensive therapies considered worthwhile. From the societal perspective, such screening and vaccination might save costs. ------------------ Am J Med. 2000 Jun 15;108(9):723-9. Cost effectiveness of vaccination strategies in adults without a history of chickenpox. Smith KJ, Roberts MS. Mercy Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pennsylvania, USA. PURPOSE: Some authorities recommend varicella antibody testing or vaccination for adults without a history of chickenpox, but the cost effectiveness of these interventions is uncertain. SUBJECTS AND METHODS: Using a Markov decision model, we estimated the cost effectiveness of three strategies for adults with no history of chickenpox: no vaccination, varicella antibody testing followed by vaccination for those without antibody, and vaccinating all. Societal and third-party payer perspectives were taken, with costs and benefits discounted at 3% per year. Assumptions for the baseline analysis were chosen to bias against no vaccination. RESULTS: In the baseline analysis for 20- to 29-year-old patients, testing followed by vaccination compared with no vaccination is cost saving from a societal perspective and costs $6,670 per quality-adjusted life-year (QALY) gained from a third-party payer perspective. When less favorable assumptions are used, results are sensitive to the rates of compliance with vaccination follow-up; testing followed by vaccination costs more than $50,000 per QALY if <75% comply. For patients 30 years of age and older, the incremental cost of testing followed by vaccination is at least $97,100 per QALY compared with no vaccination, with costs greater than $50,000 per QALY unless testing costs less than $7.73, the chickenpox case-fatality rate is >0.067% (baseline 0.025%), or immunity with no chickenpox history is <25% (baseline 71%). In either age group, vaccinating all has an incremental cost of $2 to $16 million per QALY gained compared with testing followed by vaccination. CONCLUSION: Testing followed by vaccination for varicella in US adults aged 20 to 29 years may be cost effective by conventional criteria but is sensitive to rates of compliance with vaccination protocols. Testing or vaccination of older adults is expensive but may be cost effective in patients with lower probabilities of immunity or in those who have a greater risk of complications from chickenpox. -------------------- Arch Dis Child. 2003 Oct;88(10):862-9. Varicella vaccination in England and Wales: cost-utility analysis. Brisson M, Edmunds WJ. Immunisation Division, PHLS Communicable Disease Surveillance Centre, London NW9 5EQ, UK. AIMS: To assess the cost-effectiveness of varicella vaccination, taking into account its impact on zoster. METHODS: An age structured transmission dynamic model was used to predict the future incidence of varicella and zoster. Data from national and sentinel surveillance systems were used to estimate age specific physician consultation, hospitalisation, and mortality rates. Unit costs, taken from standard sources, were applied to the predicted health outcomes. RESULTS: In England and Wales, the annual burden of VZV related disease is substantial, with an estimated 651 000 cases of varicella and 189 000 cases of zoster, resulting in approximately 18 000 QALYs lost. The model predicts that although the overall burden of varicella will significantly be reduced following mass infant vaccination, these benefits will be offset by a significant rise in zoster morbidity. Under base case assumptions, infant vaccination is estimated to produce an overall loss of 54 000 discounted QALYs over 80 years and to result in a net cost from the health provider (NHS) and the societal perspectives. These results rest heavily on the impact of vaccination on zoster. Adolescent vaccination is estimated to cost approximately 18 000 pounds sterling per QALY gained from the NHS perspective. CONCLUSION: Routine infant varicella vaccination is unlikely to be cost-effective and may produce an increase in overall morbidity. Adolescent vaccination is the safest and most cost-effective strategy, but has the least overall impact on varicella. (ïîäðîñòêè - íå âçðîñëûå, íî òåì íå ìåíåå...) |
#20
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Tusia, Âû, âåðîÿòíî, íåâåðíî ìåíÿ ïîíÿëè.
ß âûäâèíóë òåçèñ, ÷òî ÏÎÂÒÎÐÍÎÉ âàêöèíàöèè âçðîñëûõ (èëè ïîäðîñòêîâ, âñå ðàâíî) íå òðåáóåòñÿ. Èíà÷å ãîâîðÿ, ïîñëå îäíîêðàòíîé èëè ëó÷øå äâóêðàòíîé (ïî ñõåìå MMR, òî åñòü 1-6) âàêöèíàöèè äåòåé ïîâòîðíàÿ âàêöèíàöèÿ âçðîñëûõ (íàïîäîáèå âàêöèíàöèè DTP 1 ðàç â 10 ëåò) áóäåò íå íóæíà. Òå èññëåäîâàíèÿ, êîòîðûå Âû ïðèâîäèòå, ñîâñåì ïðî äðóãîå. Ïåðâàÿ è âòîðàÿ ñòàòüÿ èññëåäóþò ýêîíîìè÷åñêóþ öåëåñîîáðàçíîñòü îáñëåäîâàíèÿ âçðîñëûõ (ðàíåå íå ïðèâèòûõ è íå áîëåâøèõ âåòðÿíîé îñïîé) ïåðåä âàêöèíàöèåé îò ýòîé èíôåêöèè. Òðåòüÿ - îáñóæäàåò íàèáîëåå öåëåñîîáðàçíûé (îïÿòü æå ñ òî÷êè çðåíèÿ ýêîíîìèêè) âîçðàñò äëÿ âàêöèíàöèè ïðîòèâ âåòðÿíîé îñïû. Àâòîðû îòìå÷àþò, òåì íå ìåíåå, ÷òî âàêöèíàöèÿ ïîäðîñòêîâ íå áóäåò ñïîñîáñòâîâàòü èñêîðåíåíèþ âåòðÿíîé îñïû. Õî÷ó ïðåäîñòåðå÷ü îò ïðèäàíèÿ ïîäîáíûì èññëåäîâàíèÿì èçëèøíåãî çíà÷åíèÿ. Ýêîíîìè÷åñêàÿ öåëåñîîáðàçíîñòü - ýòî î÷åíü õîðîøî, íî íå äëÿ êîíêðåòíîãî ðåáåíêà, êîòîðûé óìåð îò âåòðÿíî÷íîãî ìåíèíãîýíöåôàëèòà, íå äîæäàâøèñü, ïîêà åãî ïðèâüþò â ïîäðîñòêîâîì âîçðàñòå. Ê òîìó æå, èñêîðåíåíèå èíôåêöèè â äîëãîñðî÷íîé ïåðñïåêòèâå ãîðàçäî âûãîäíåå äëÿ ÷åëîâå÷åñòâà, ÷åì åæåãîäíàÿ íåïðåêðàùàþùàÿñÿ áîðüáà ñ íèì (êîòîðàÿ áîëåå âûãîäíà èçãîòîâèòåëÿì âàêöèí). Êñòàòè ãîâîðÿ, èìåííî ïîýòîìó ìíå íå íðàâèòñÿ àöåëëþëÿðíàÿ âàêöèíà ïðîòèâ êîêëþøà è äèôòåðèéíûé àíàòîêñèí. Òàêèå âàêöèíû íå âåäóò ê èñêîðåíåíèþ êîêëþøà è äèôòåðèè. |
#21
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#22
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#23
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#24
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#25
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Îðõèò: ïðèâèâêà MMR - 1 ñëó÷àé íà 3 ìëí. äîç., íàòóðàëüíûé ïàðîòèò - ó 14-35% çàáîëåâøèõ ïîäðîñòêîâ è ìóæ÷èí. Ïî òÿæåñòè òå÷åíèÿ, ëåòàëüíîñòè è õðîíè÷åñêèì ïîñëåäñòâèÿì ñëó÷àè ýíöåôàëèòà è îðõèòà ïîñëå ïðèâèâêè è íàòóðàëüíûõ èíôåêöèè òàêæå ðàçëè÷àþòñÿ. Öèòàòà:
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#26
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Ãäå æå ëîãèêà!? Öèòàòà:
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#27
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Íî òî, ÷òî òàêàÿ âàêöèíàöèÿ ñåé÷àñ íå ïðîâîäèòñÿ, êàê ìíå êàæåòñÿ, ýòî åùå íå çíà÷èò, ÷òî îíà íå ïîòðåáóåòñÿ â áóäóùåì. Íåèçâåñòíî, ÷òî íàñ îæèäàåò ëåò ÷åðåç 20-30. Èíòåðåñíî, êàêèå îêîí÷àòåëüíûå âûâîäû áóäóò ñäåëàíû íà îñíîâå âñïûøêè ïàðîòèòà â ÑØÀ?... [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#28
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#29
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#30
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