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）：肺炎球菌疫苗接种在服务不足的少数民族中使用不足，他们面临更大的肺炎球菌疾病风险。目前有两种疫苗可供使用，即较老的肺炎球菌多糖疫苗（PPSV）和13价肺炎球菌结合疫苗（PCV 13）。然而，由于流行病学的变化和疫苗有效性的不确定性，最佳的保护性疫苗接种方案尚不清楚;两者都应该很快变得更加清晰。目前CDC的疫苗接种建议很复杂，可能无法最佳地保护服务不足的人群，因为有效实施存在多重障碍。通过更好地执行当前的建议或更广泛的更容易执行的CDC建议，可以改善疫苗接种，这可能对服务不足的人产生更大的影响。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，可能没有帮助。为了调查这些问题，计划对现有数据和循证预测进行系统综合，并对不确定性进行严格建模，以协助决策并为研究资源分配提供信息。将对降低肺炎球菌疫苗接种建议（使用PPSV和/或PCV 13）复杂性的潜在变化进行建模，并将其与根据提高疫苗接种率的计划实施的当前建议进行比较。具体目标是：1）比较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，特别是针对基于年龄的疫苗使用与更复杂的基于合并症的疫苗使用; 2）确定实施方案的公共卫生影响和成本效益，以提高服务不足的少数民族和65岁以下高危人群的疫苗接种率，与Aim 1的潜在CDC疫苗接种建议相比。疫苗接种策略将通过基于马尔可夫模型的成本效益分析进行比较，并进行概率敏感性分析和信息价值分析，以确定有利的策略并确定未来研究最有价值的领域。分析还将创新性地使用CDC推荐的RE-AIM框架来评估实施方案，并探索ACA效应、潜在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，分析结果可以像以前一样用于帮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。