Analyzing Adult Pneumococcal Vaccination Implementation in the Underserved

分析服务欠缺地区成人肺炎球菌疫苗的实施情况

• 批准号: 9172236
• 负责人: KENNETH J SMITH
• 金额: $ 30.9万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-11-01 至 2019-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9172236
• 关键词: Address; Adult; Affordable Care Act; Age; Area; Centers for Disease Control and Prevention (U.S.); Cessation of life; Characteristics; Childhood; Chronic; Clinical Trials; Combined Vaccines; Comorbidity; Complex; Cost Effectiveness Analysis; Data; Decision Making; Decision Modeling; Economics; Epidemiology; Evaluation; Future; Healthcare; Herd Immunity; Insurance; Insurance Coverage; Intervention; Medical; Minority; Modeling; Patient risk; Patients; Persons; Pneumococcal Infections; Pneumococcal conjugate vaccine; Pneumococcal vaccine; Policies; Polyvalent pneumococcal vaccine; Population; Public Health; Race; Recommendation; Regimen; Research; Resource Allocation; Resources; Risk; Serotyping; Subgroup; Techniques; To specify; Uncertainty; Vaccinated; Vaccination; Vaccines; base; cohort; cost; cost effectiveness; disorder risk; epidemiologic data; evidence base; high risk; improved; innovation; markov model; models and simulation; outreach; prevent; programs; public health relevance; racial disparity; routine care; theories; treatment choice; trial comparing; underserved minority; uptake; vaccination strategy; vaccine effectiveness; vaccine efficacy

 DESCRIPTION (provided by applicant): Pneumococcal vaccination is underused in underserved minorities, who are at greater pneumococcal disease risk. Two vaccines are available, the older pneumococcal polysaccharide vaccine (PPSV) and the 13-valent pneumococcal conjugate vaccine (PCV13). However, the optimally protective vaccination regimen is unclear, due to changing epidemiology and uncertain vaccine effectiveness; both should become clearer soon. Current CDC vaccination recommendations are complex and may not optimally protect the underserved, due multiple barriers to effective implementation. Vaccine uptake could improve with either better implementation of cur- rent recommendations or broader CDC recommendations that are easier to implement, which could have pro-portionately greater effects on the underserved. Clinical trials comparing these strategies are unlikely and, due to the "moving target" of vaccination-related epidemiologic changes and US Affordable Care Act (ACA) effects on vaccination rates, could be unhelpful. To investigate these issues, a systematic synthesis of available data and evidence-based projections with rigor- ous modeling of uncertainty is planned to assist policymaking and inform research resource allocation. Potential changes to decrease the complexity of pneumococcal vaccination recommendations (using PPSV and/or PCV13) will be modeled and compared to current recommendations implemented under programs to improve vaccination rates. Specific aims are to: 1) compare the public health impact on underserved minority populations of potential CDC adult pneumococcal vaccination recommendations, specifically addressing age-based vs. the more complex comorbidity-based use of vaccine; and 2) determine the public health impact and cost- effectiveness of implementation programs to improve vaccination rates in underserved minorities and persons <65 with high risk conditions, compared to potential CDC vaccination recommendations from Aim 1. Vaccination strategies will be compared via Markov model-based cost-effectiveness analysis, with probabilistic sensitivity analysis and value of information analysis to determine favored strategies and identify the most valuable areas for future research. Analyses will also innovatively use the CDC-recommended RE-AIM framework to evaluate implementation program options and explore interactions between ACA effects, potential CDC recommendations, and race-specific pneumococcal disease characteristics. Since CDC vaccination recommendation evaluations increasingly consider economic analyses, analysis results can be used, as they have previously, to assist vaccination recommendation decisions and potentially change vaccination policy to better protect the underserved.

 描述（由适用提供）：在服务不足的少数族裔中，肺炎球菌疫苗的风险较高。有两种疫苗可获得较早的肺炎球菌多糖疫苗（PPSV）和13个价值的肺炎球菌结合物疫苗（PCV13）。但是，由于流行病学和不确定的疫苗有效性，最佳保护的疫苗方案尚不清楚。两者都应该很快变得更加清晰。当前的CDC疫苗接种建议是复杂的，并且可能无法最佳地保护服务欠佳，这是由于有效实施的多个障碍。疫苗的摄取可以通过更好地实施Cur租赁建议或更容易实施的更广泛的CDC建议来改善，这可能会对服务不足的效果产生更大的影响。比较这些策略的临床试验不太可能，并且由于疫苗接种相关的流行病学变化的“移动目标”以及美国负担得起的护理法（ACA）对疫苗率的影响可能无济于事。为了调查这些问题，计划对可用数据和基于证据的项目进行系统综合，并计划对不确定性进行严格的建模，以协助决策并为研究资源分配提供信息。可能会建模肺炎球菌疫苗建议（使用PPSV和/或PCV13）的复杂性的潜在变化，并将其与计划中针对特定目的实施的当前建议进行比较：1）比较公共健康对潜在的CDC成人Pneumococciccal疫苗的潜在少数群体的影响，该建议是基于年龄的COMPELSE COMPELSE VISIDE Comorbs MOLE COMPELSE Comorbs; 2）确定实施计划的公共卫生影响和成本效益，以提高服务不足的少数群体和<65人的疫苗率，与AIM 1的潜在CDC疫苗建议相比，将通过Markov基于Markov Model-Model-Optiffectionality分析进行疫苗接种策略，并通过基于Markov的成本效益分析进行疫苗接种策略，并通过概率敏感性分析和确定最有价值的策略的价值来确定最有价值的策略。分析还将创新使用CDC抢断的RE-AIM框架来评估实施程序选项，并探索ACA效应，潜在的CDC建议和特定种族特异性肺炎球菌疾病特征之间的相互作用。由于CDC疫苗推荐评估越来越多地考虑经济分析，因此可以像以前一样使用分析结果来协助疫苗建议决策并可能改变疫苗政策以更好地保护贫困服务。