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Article ; Online: Impact and cost-effectiveness analyses of vaccination for prevention of respiratory syncytial virus disease among older adults in Ontario: A Canadian Immunization Research Network (CIRN) study.

Shoukat, Affan / Bawden, Carolyn E / Röst, Gergely / LeBlanc, Jason J / Galvani, Alison P / Langley, Joanne M / Moghadas, Seyed M

Vaccine

2024 Volume 42, Issue 7, Page(s) 1768–1776

Abstract: Background: Two prefusion F protein-based vaccines, Arexvy and Abrysvo, have been approved by Health Canada for protecting older adults against respiratory syncytial virus (RSV)-associated lower respiratory tract disease. We estimated the health ... ...

Abstract	Background: Two prefusion F protein-based vaccines, Arexvy and Abrysvo, have been approved by Health Canada for protecting older adults against respiratory syncytial virus (RSV)-associated lower respiratory tract disease. We estimated the health benefits and cost-effectiveness of these vaccines under a publicly funded single-dose vaccination program in Ontario that targets residents of long-term care homes (LTCHs). Additionally, we evaluated an extended program that broadens vaccination to include community-dwelling older adults. Methods: A discrete-event simulation model was parameterised with the burden of RSV disease including outpatient care, hospitalisation, and death among adults aged 60 years or older in Ontario, Canada. Accounting for direct and indirect costs (in 2023 Canadian dollars) associated with RSV-related outcomes, we calculated the net monetary benefit using quality-adjusted life-year (QALY) gained, and determined the range of price-per-dose (PPD) for vaccination programs to be cost-effective from both healthcare and societal perspectives over two RSV seasons. The incremental cost-effectiveness ratio (ICER) was calculated to estimate the additional costs required to gain one QALY. Results: Using a willingness-to-pay of $50,000 per QALY gained, we found that vaccinating 90% of residents in LTCHs with Arexvy would be cost-effective from a societal perspective for a PPD up to $163, producing a mean ICER value of $49,984 (95% CI: $47,539 to $52,704) per QALY gained with a two-year budget impact of $463,468 per 100,000 older adults. The reduction of hospitalizations was estimated at 7.0% compared to the no-vaccination scenario. Extending the program to include community-dwelling older adults with a 74% coverage akin to influenza vaccination, Arexvy remains cost-effective for a PPD up to $139, with a mean ICER value of $49,698 (95% CI: 48,022 to 51,388) per QALY gained and a two-year budget impact of $8.63 million. Compared to the no-vaccination scenario, the extended program resulted in a 57.3% reduction in RSV-related hospitalisations. Conclusions: Vaccinating residents of LTCHs against RSV disease would be cost-effective depending on PPD; extending the program to community-dwelling older adults would provide substantial health benefits, averting significant direct healthcare costs and productivity losses.
MeSH term(s)	Humans ; Aged ; Cost-Benefit Analysis ; Ontario ; Respiratory Syncytial Virus Infections/prevention & control ; Vaccination ; Communicable Diseases ; Respiratory Syncytial Virus, Human ; Vaccines ; Quality-Adjusted Life Years ; Viral Vaccines ; Respiratory Syncytial Virus Vaccines
Chemical Substances	abrysvo ; arexvy ; Vaccines ; Viral Vaccines ; Respiratory Syncytial Virus Vaccines
Language	English
Publishing date	2024-02-16
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	605674-x
ISSN	1873-2518 ; 0264-410X
ISSN (online)	1873-2518
ISSN	0264-410X
DOI	10.1016/j.vaccine.2024.02.041
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Article: Timing is everything: the relationship between COVID outcomes and the date at which mask mandates are relaxed.

Shoukat, Affan / Galvani, Alison P / Fitzpatrick, Meagan C

medRxiv : the preprint server for health sciences

2021

Abstract: Importance: Several states including Texas and Mississippi have lifted their mask mandates, sparking concerns that this policy change could lead to a surge in cases and hospitalizations.: Objective: To estimate the increase in incidence, ... ...

Abstract	Importance: Several states including Texas and Mississippi have lifted their mask mandates, sparking concerns that this policy change could lead to a surge in cases and hospitalizations. Objective: To estimate the increase in incidence, hospitalizations, and deaths in Texas and Mississippi following the removal of mask mandates, and to evaluate the relative reduction of these outcomes if policy change is delayed by 90 days. Design setting and participants: This study uses an age-stratified compartmental model parameterized to incidence data in Texas and Mississippi to simulate increased transmission following policy change in March or June 2021, and to estimate the resulting number of incidence, hospitalizations, and deaths. Main outcomes and measures: The increase in incidence, hospitalizations, and deaths if mask mandates are lifted on March 14 compared to lifting on June 12. Results: If transmission is increased by 67% when mask mandates are lifted, we projected 11.39 (CrI: 11.22 - 11.55) million infections, 170,909 (CrI: 167,454 - 174,379) hospitalizations, and 5647 (5511 - 5804) deaths (Figure 1) in Texas from March 14 through the end of 2021. Delaying NPI lift until June reduces the average number of infections, hospitalizations, and deaths by 36%, 65%, and 62%, respectively. Proportionate differences were similar for the state of Mississippi. Peak hospitalization rates would be reduced by 79% and 63% in Texas and Mississippi, respectively. Conclusions and relevance: Removal of mask mandates in March 2021 is premature. Delaying this policy change until June 2021, when a larger fraction of the population has been vaccinated, will avert more than half of the expected COVID-19 hospitalizations and deaths, and avoid an otherwise likely strain on healthcare capacity.
Language	English
Publishing date	2021-04-06
Publishing country	United States
Document type	Preprint
DOI	10.1101/2021.03.31.21254646
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Article ; Online: Cost-effectiveness analysis of nirsevimab and maternal RSVpreF vaccine strategies for prevention of Respiratory Syncytial Virus disease among infants in Canada: a simulation study.

Shoukat, Affan / Abdollahi, Elaheh / Galvani, Alison P / Halperin, Scott A / Langley, Joanne M / Moghadas, Seyed M

Lancet regional health. Americas

2023 Volume 28, Page(s) 100629

Abstract: Background: The cost-effectiveness of immunisation strategies with a long-acting monoclonal antibody (nirsevimab) and/or a protein-based maternal vaccine (RSVpreF) for protecting infants from Respiratory Syncytial Virus (RSV)-associated illness has not ... ...

Abstract	Background: The cost-effectiveness of immunisation strategies with a long-acting monoclonal antibody (nirsevimab) and/or a protein-based maternal vaccine (RSVpreF) for protecting infants from Respiratory Syncytial Virus (RSV)-associated illness has not been previously determined for Canada. We estimated the health benefits and cost-effectiveness of nirsevimab for immunising the entire birth cohort, regardless of gestational age or other risk factors. Additionally, we evaluated the health benefits and cost-effectiveness of a combined strategy of year-round vaccination of pregnant women with RSVpreF and immunisation of infants at high risk, including those born preterm or with chronic conditions, with nirsevimab during the RSV season. Methods: We developed a discrete-event simulation model, parameterized with the data on medically-attended RSV infections among infants under one year of age from 2010 to 2019, including outpatient care, hospitalisations, and deaths. Intervention scenarios targeting twelve monthly birth cohorts and pregnant women, reflecting the 2021 census data for Ontario, Canada were evaluated over a follow-up time horizon of one year from birth. Taking into account the costs (in 2023 Canadian dollars) associated with RSV-related outcomes, we calculated the net monetary benefit using the quality-adjusted life-year (QALY) gained. Further, we determined the range of price-per-dose (PPD) for nirsevimab and RSVpreF within which the program was cost-effective. Cost-effectiveness analyses were conducted from both healthcare and societal perspectives. Findings: Using a willingness-to-pay of CAD$50,000 per QALY gained, we found that immunising the entire birth cohort with nirsevimab would be cost-effective from a societal perspective for a PPD of up to $290, with an annual budget impact of $83,978 for 1113 infants per 100,000 population. An alternative, combined strategy of vaccinating pregnant women and immunising only infants at high risk of severe disease would lead to a lower budget impact of $49,473 per 100,000 population with a PPD of $290 and $195 for nirsevimab and RSVpreF vaccine, respectively. This combined strategy would reduce infant mortality by 76%-85%, comparable to a 78% reduction achieved through a nirsevimab-only program of the entire birth cohort. The PPD for cost-effective programs with nirsevimab was sensitive to the target population among infants. Interpretation: Passive immunisation of infants under 6 months of age with nirsevimab and vaccination of pregnant women with RSVpreF could be a cost-effective strategy for protecting infants during their first RSV season. Funding: This study was supported by the Canadian Immunisation Research Network (CIRN) and the Canadian Institutes of Health Research (CIHR). Seyed M. Moghadas acknowledges support from the Natural Sciences and Engineering Research Council of Canada (MfPH and Discovery grants). Alison P. Galvani acknowledges support from the The Notsew Orm Sands Foundation.
Language	English
Publishing date	2023-11-09
Publishing country	England
Document type	Journal Article
ISSN	2667-193X
ISSN (online)	2667-193X
DOI	10.1016/j.lana.2023.100629
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Article: Dynamics of HSV-2 infection with a therapeutic vaccine.

Venturino, Ezio / Shoukat, Affan / Moghadas, Seyed M

Heliyon

2020 Volume 6, Issue 7, Page(s) e04368

Abstract: Herpes-Simplex Virus type 2 (HSV-2) is a lifelong infection, which has infected over 400 million individuals aged 15-49 years, worldwide. While the disease can be treated with episodic and suppressive antiviral drugs to reduce the rate of recurrence (i.e. ...

Abstract	Herpes-Simplex Virus type 2 (HSV-2) is a lifelong infection, which has infected over 400 million individuals aged 15-49 years, worldwide. While the disease can be treated with episodic and suppressive antiviral drugs to reduce the rate of recurrence (i.e., symptomatic disease) and viral shedding, none of the currently available therapies can clear the virus from the body of an infected person. A number of therapeutic vaccine platforms are currently in development in order to achieve similar effects to treatment. Due to the inadequate data from clinical trials of therapeutic vaccines, modeling efforts to quantify the impact of vaccination have been limited. In this study, we propose a compartmental deterministic model for the dynamics of HSV-2 to evaluate the effect of a potential vaccine candidate with the inclusion of a booster dose. Despite its simplicity that may not address the complexity of HSV-2 disease, the model shows that targeting symptomatic infection for vaccination is the most effective strategy in the long-term. This conclusion is based on the assumption of an optimal vaccine efficacy, conferring immunity levels that prevent viral shedding and recurrence transiently. Our model provides a framework for developing a computational system to include more heterogeneous characteristics of the disease and individuals, and investigate effectiveness and cost-effectiveness of vaccination scenarios when clinical data become available.
Language	English
Publishing date	2020-07-15
Publishing country	England
Document type	Journal Article
ZDB-ID	2835763-2
ISSN	2405-8440
ISSN	2405-8440
DOI	10.1016/j.heliyon.2020.e04368
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Article ; Online: Effectiveness and cost-effectiveness of a Clostridium difficile vaccine candidate in a hospital setting.

Champredon, David / Shoukat, Affan / Moghadas, Seyed M

Vaccine

2020 Volume 38, Issue 11, Page(s) 2585–2591

Abstract: Toxoid vaccines against Clostridium difficile infections (CDI) appear promising in reducing the risk of developing toxin-mediated symptoms. We sought to evaluate the effectiveness and cost-effectiveness of a vaccine candidate in a hospital setting. We ... ...

Abstract	Toxoid vaccines against Clostridium difficile infections (CDI) appear promising in reducing the risk of developing toxin-mediated symptoms. We sought to evaluate the effectiveness and cost-effectiveness of a vaccine candidate in a hospital setting. We developed an agent-based simulation model of nosocomial CDI in a 300-bed hospital. Targeting high-risk patients for vaccination, we estimated the reduction of symptomatic CDI. Using the net reduction of CDI-associated isolation days, we evaluated the vaccine's cost-effectiveness from a healthcare provider perspective over a 2-year period with an average monthly incidence of 5 cases per 10,000 patient-days pre-vaccination. Assuming a vaccine efficacy in the range 60-90%, vaccinating 40% of high-risk patients pre-admission reduced symptomatic CDI by 16.6% (95% CI: 15.2, 17.9). When the vaccine coverage increased to 80%, the reduction of symptomatic CDI was 34.6% (95% CI: 33.7, 35.9). For a willingness to pay (WTP) of CDN$1000 (corresponding to the average costs of case isolation per day), vaccine was cost-effective for vaccination costs per individual (VCPI) up to CDN$111 in the scenario of 40% vaccine coverage. With the same WTP, vaccine was cost-effective for VCPI up to CDN$121 when the vaccine coverage increased to 80%. A significant portion (~80%) of hospital colonization is caused by environmental transmission of C. difficile, which markedly reduced the effectiveness of vaccine below its assumed efficacy. However, due to the number of CDI-associated isolation days averted, vaccination of high-risk patients can be cost-effective depending on the WTP and the VCPI.
MeSH term(s)	Bacterial Vaccines/economics ; Bacterial Vaccines/immunology ; Clostridioides difficile ; Clostridium Infections/economics ; Clostridium Infections/prevention & control ; Cost-Benefit Analysis ; Cross Infection/economics ; Cross Infection/prevention & control ; Hospitals ; Humans
Chemical Substances	Bacterial Vaccines
Language	English
Publishing date	2020-02-01
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	605674-x
ISSN	1873-2518 ; 0264-410X
ISSN (online)	1873-2518
ISSN	0264-410X
DOI	10.1016/j.vaccine.2020.01.073
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Article: Cost-Effectiveness of Prefusion F Protein-Based Vaccines Against Respiratory Syncytial Virus Disease for Older Adults in the United States.

Moghadas, Seyed M / Shoukat, Affan / Bawden, Carolyn E / Langley, Joanne M / Singer, Burton H / Fitzpatrick, Meagan C / Galvani, Alison P

medRxiv : the preprint server for health sciences

2023

Abstract: Background: Two prefusion F protein-based vaccines, Arexvy and Abrysvo, have been authorized by the US Food and Drug Administration for protecting older adults against Respiratory Syncytial Virus (RSV)-associated lower respiratory tract illness. We ... ...

Abstract	Background: Two prefusion F protein-based vaccines, Arexvy and Abrysvo, have been authorized by the US Food and Drug Administration for protecting older adults against Respiratory Syncytial Virus (RSV)-associated lower respiratory tract illness. We evaluated the health benefits and cost-effectiveness of these vaccines. Methods: We developed a discrete-event simulation model, parameterized with the burden of RSV disease including outpatient care, hospitalization, and death for adults aged 60 years or older in the US. Taking into account the costs associated with these RSV-related outcomes, we calculated the net monetary benefit using quality-adjusted life-years (QALY) gained as a measure of effectiveness, and determined the range of price-per-dose (PPD) for Arexvy and Abrysvo vaccination programs to be cost-effective from a societal perspective. Results: Using a willingness-to-pay of $95,000 per QALY gained, we found that vaccination programs could be cost-effective for a PPD under $120 with Arexvy and $111 with Abrysvo over the first RSV season. Achieving an influenza-like vaccination coverage of 66% for the population of older adults in the US, the budget impact of these programs at the maximum PPD ranged from $5.74 to $6.10 billion. If the benefits of vaccination extend to a second RSV season as reported in clinical trials, we estimated a maximum PPD of $250 for Arexvy and $233 for Abrysvo, with two-year budget impacts of $11.59 and $10.89 billion, respectively. Conclusions: Vaccination of older adults would provide substantial direct health benefits by reducing outcomes associated with RSV-related illness in this population.
Language	English
Publishing date	2023-08-16
Publishing country	United States
Document type	Preprint
DOI	10.1101/2023.08.14.23294076
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Article ; Online: Cost-effectiveness of Prefusion F Protein-based Vaccines Against Respiratory Syncytial Virus Disease for Older Adults in the United States.

Moghadas, Seyed M / Shoukat, Affan / Bawden, Carolyn E / Langley, Joanne M / Singer, Burton H / Fitzpatrick, Meagan C / Galvani, Alison P

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2023

Abstract: Background: Two prefusion F protein-based vaccines, Arexvy and Abrysvo, have been authorized by the US Food and Drug Administration for protecting older adults against respiratory syncytial virus (RSV)-associated lower respiratory tract illness. We ... ...

Abstract	Background: Two prefusion F protein-based vaccines, Arexvy and Abrysvo, have been authorized by the US Food and Drug Administration for protecting older adults against respiratory syncytial virus (RSV)-associated lower respiratory tract illness. We evaluated the health benefits and cost-effectiveness of these vaccines. Methods: We developed a discrete-event simulation model, parameterized with the burden of RSV disease including outpatient care, hospitalization, and death for adults aged 60 years or older in the United States. Taking into account the costs associated with these RSV-related outcomes, we calculated the net monetary benefit using quality-adjusted life-year (QALY) gained as a measure of effectiveness and determined the range of price-per-dose (PPD) for Arexvy and Abrysvo vaccination programs to be cost-effective from a societal perspective. Results: Using a willingness-to-pay of $95 000 per QALY gained, we found that vaccination programs could be cost-effective for a PPD up to $127 with Arexvy and $118 with Abrysvo over the first RSV season. Achieving an influenza-like vaccination coverage of 66% for the population of older adults in the United States, the budget impact of these programs at the maximum PPD ranged from $6.48 to $6.78 billion. If the benefits of vaccination extend to a second RSV season as reported in clinical trials, we estimated a maximum PPD of $235 for Arexvy and $245 for Abrysvo, with 2-year budget impacts of $11.78 and $12.25 billion, respectively. Conclusions: Vaccination of older adults would provide substantial direct health benefits by reducing outcomes associated with RSV-related illness in this population.
Language	English
Publishing date	2023-11-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciad658
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Book ; Online: Agent-Based Modelling

Shoukat, Affan / Moghadas, Seyed M.

An Overview with Application to Disease Dynamics

2020

Abstract: Modelling and computational methods have been essential in advancing quantitative science, especially in the past two decades with the availability of vast amount of complex, voluminous, and heterogeneous data. In particular, there has been a surge of ... ...

Abstract	Modelling and computational methods have been essential in advancing quantitative science, especially in the past two decades with the availability of vast amount of complex, voluminous, and heterogeneous data. In particular, there has been a surge of interest in agent-based modelling, largely due to its capabilities to exploit such data and make significant projections. However, any well-established quantitative method relies on theoretical frameworks for both construction and analysis. While the computational aspects of agent-based modelling have been detailed in existing literature, the underlying theoretical basis has rarely been used in its construction. In this exposition, we provide an overview of the theoretical foundation of agent-based modelling and establish a relationship with its computational implementation. In addition to detailing the main characteristics of this computational methodology, we illustrate its application to simulating the spread of an infectious disease in a simple, dynamical process. As the use of agent-based models expands to various disciplines, our review highlights the need for directed research efforts to develop theoretical methods and analytical tools for the analysis of such models. Comment: review of agent-based systems
Keywords	Computer Science - Multiagent Systems ; Quantitative Biology - Quantitative Methods
Publishing date	2020-07-08
Publishing country	us
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Estimating COVID-19 Infections, Hospitalizations, and Deaths Following the US Vaccination Campaigns During the Pandemic.

Vilches, Thomas N / Moghadas, Seyed M / Sah, Pratha / Fitzpatrick, Meagan C / Shoukat, Affan / Pandey, Abhishek / Galvani, Alison P

JAMA network open

2022 Volume 5, Issue 1, Page(s) e2142725

MeSH term(s)	COVID-19/epidemiology ; COVID-19/prevention & control ; Computer Simulation ; Forecasting ; Hospitalization/trends ; Humans ; Immunization Programs/trends ; Mortality/trends ; SARS-CoV-2 ; United States/epidemiology
Language	English
Publishing date	2022-01-04
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2021.42725
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Article ; Online: Dynamics of HSV-2 infection with a therapeutic vaccine

Ezio Venturino / Affan Shoukat / Seyed M. Moghadas

Heliyon, Vol 6, Iss 7, Pp e04368- (2020)

2020

Abstract	Herpes-Simplex Virus type 2 (HSV-2) is a lifelong infection, which has infected over 400 million individuals aged 15-49 years, worldwide. While the disease can be treated with episodic and suppressive antiviral drugs to reduce the rate of recurrence (i.e., symptomatic disease) and viral shedding, none of the currently available therapies can clear the virus from the body of an infected person. A number of therapeutic vaccine platforms are currently in development in order to achieve similar effects to treatment. Due to the inadequate data from clinical trials of therapeutic vaccines, modeling efforts to quantify the impact of vaccination have been limited. In this study, we propose a compartmental deterministic model for the dynamics of HSV-2 to evaluate the effect of a potential vaccine candidate with the inclusion of a booster dose. Despite its simplicity that may not address the complexity of HSV-2 disease, the model shows that targeting symptomatic infection for vaccination is the most effective strategy in the long-term. This conclusion is based on the assumption of an optimal vaccine efficacy, conferring immunity levels that prevent viral shedding and recurrence transiently. Our model provides a framework for developing a computational system to include more heterogeneous characteristics of the disease and individuals, and investigate effectiveness and cost-effectiveness of vaccination scenarios when clinical data become available.
Keywords	Mathematical biosciences ; Epidemiology ; Public health ; Infectious disease ; Vaccines ; HSV-2 ; Science (General) ; Q1-390 ; Social sciences (General) ; H1-99
Subject code	610
Language	English
Publishing date	2020-07-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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