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（由申请人提供）：肺炎球菌疫苗在服务不足的少数群体中未得到充分利用，他们患肺炎球菌疾病的风险较高，有两种疫苗可用，即较旧的肺炎球菌多糖疫苗 (PPSV) 和 13 价肺炎球菌结合疫苗 (PCV13)。由于流行病学的变化和疫苗有效性的不确定，最佳的保护性疫苗接种方案尚不清楚；两者应该很快就会变得更加明确。目前的疾病预防控制中心疫苗接种建议很复杂，可能无法最佳地保护服务不足的人，因为有效实施存在多重障碍，可以通过更好地实施当前建议或更容易实施的更广泛的疾病预防控制中心建议来改善疫苗的采用，这可能会产生相应更大的效果。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”和美国平价医疗法案（ACA）对疫苗接种率的影响，可能对调查这些问题没有帮助。计划对现有数据和基于证据的预测进行系统综合，并进行严格的不确定性建模，以协助政策制定并为研究资源分配潜在变化进行建模，以降低肺炎球菌疫苗接种建议（使用 PPSV 和/或 PCV13）的复杂性。与目前在提高疫苗接种率计划中实施的建议相比，具体目标是：1) 比较潜在的 CDC 成人肺炎球菌疫苗接种建议对服务不足的少数群体的公共卫生影响，解决基于年龄的疫苗接种建议和基于年龄的疫苗接种建议。更复杂的基于合并症的疫苗使用；2) 与目标 1 中潜在的 CDC 疫苗接种建议相比，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 岁以下高危人群的疫苗接种率。将通过基于马尔可夫模型的成本效益分析、概率敏感性分析和信息价值分析来比较疫苗接种策略，以确定首选策略并确定未来研究最有价值的领域。 CDC 推荐的 RE-AIM 框架，用于评估实施计划选项并探索 ACA 效果、潜在的 CDC 建议和种族特异性肺炎球菌疾病特征之间的相互作用。由于 CDC 疫苗接种建议评估越来越多地考虑经济分析，因此可以使用分析结果，因为它们已经存在。此前，目的是协助疫苗接种建议决策，并可能改变疫苗接种政策，以更好地保护服务不足的人群。