Vaccines and Economics

Medical topics with questions, information and discussion related to Lyme disease and other tick-borne diseases.
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hv808ct
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Joined: Wed 30 Jul 2008 4:11

Vaccines and Economics

Post by hv808ct » Fri 2 Oct 2015 1:20

Most of this is, obviously, a review of LD clinical features, diagnostics, prior vaccines, etc. But there are a few points worth noting.

Šmit R, Postma MJ. Lyme borreliosis: reviewing potential vaccines, clinical aspects and health economics. Expert Rev Vaccines. 2015 Sep 28:1-13.

In some patients, it takes several months to fully and completely recover following appropriate treatment. Still, some patients report persistent symptoms after they completed the recommended course of antibiotic therapy even beyond several months. Reasons may be failure to eradicate the organism, reinfection, residual damage or immune-mediated inflammation that persists after spirochetal eradication. These persistent symptoms in properly treated patients, again, are rare.

In the USA, the Infectious Disease Society of America published the updated treatment guideline for LB in 2006. In Europe, there is no consensus on the treatment. In the various European countries, the choice of the specific antibiotic treatment depends on the clinical manifestation of the disease, availability of antibiotics, economic situation, national treatment recommendation and guidelines. The guidelines from the Czech Republic, Denmark, Finland, France, the Netherlands, Norway, Poland, Slovenia, Sweden and Switzerland show great similarities in antibiotic choice and minor differences in dosing and duration of LB treatment. In general, patients respond well to oral antibiotics.

So far, persistent infection with viable borrelia has not been documented after standard antibiotic treatment for stage and manifestation of disease and neither is it proven that persistent borrelia infection is the unequivocal cause of persistent symptoms if benefit from prolonged treatment with antibiotics is not shown.

Results of the [1999 cost effectiveness] study showed that with a probability of contracting the disease of 1%, the societal net costs of vaccination amount to approximately US$4500 per case averted with yearly boosters. Obviously, economic benefit would be highest in persons whose probability of contracting the disease would be higher than 1%. In 2001, the clinical effectiveness and cost–effectiveness of vaccination against LB was evaluated using a Markov model. Arthritic, cardiac and neurologic sequelae, as well as a post-treatment Lyme disease syndrome, were included in the model. The latter state included arthralgia, fatigue and difficulties to concentrate. Results of the study showed that at a probability of contracting the disease of 1%, the incremental cost–effectiveness ratio would be US$62,300 per quality-adjusted life year gained from the societal perspective, corresponding with US$5300 per case averted during a 10-years period (excluding annual boosters). Again, it was concluded that from an economic point of view, vaccination against LB seems most attractive in persons with probabilities of contracting the disease above 1%.

Despite some differences among these three studies,* all three studies have a similar conclusion that vaccination against LB may be cost-effective if the risk of contracting the disease exceeds 1%.


*Meltzer, 1999; Shadick, 2001; Hsia, 2002.

X-member
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Re: Vaccines and Economics

Post by X-member » Fri 2 Oct 2015 1:51

A quote from the post above:
These persistent symptoms in properly treated patients, again, are rare.
In that case the study that is planned (mentioned in the thread/post/quote below) on cases with early (stage 2) neuroborreliosis in Norway must be useless.

Chronic Lyme disease ≠ Late Lyme disease

http://www.lymeneteurope.org/forum/view ... =20#p43059

A quote:
Work Package 2: To improve the knowledge-based treatment practices of neuroborreliosis

Research Question: Are short-term treatment (two weeks) of doxycycline tablets least as effective as long-term treatment (six weeks) to prevent distress and functional impairment at six-month follow-up?

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Posts: 7650
Joined: Mon 30 Jul 2007 18:18

Re: Vaccines and Economics

Post by X-member » Fri 2 Oct 2015 2:00

From the first post:
The guidelines from the Czech Republic, Denmark, Finland, France, the Netherlands, Norway, Poland, Slovenia, Sweden and Switzerland show great similarities in antibiotic choice and minor differences in dosing and duration of LB treatment. In general, patients respond well to oral antibiotics.
Do you know what they say in Norway?

Chronic Lyme; diagnostic and therapeutic challenges
U. Ljøstad1,* and Å. Mygland1,2,3
Article first published online: 29 NOV 2012

DOI: 10.1111/ane.12048


http://onlinelibrary.wiley.com/doi/10.1 ... 12048/full

A quote:
These recommendations are considered to be good practice points, and not heavily evidence based, as treatment trials on chronic Lyme are scarce.
Ps! Chronic Lyme (borreliosis) = late Lyme disease. Ds.

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