Journal of Preventive Medicine and Public Health

Original Article

COVID-19 Vaccination and Clinical Outcomes at a Secondary Referral Hospital During the Delta Variant-dominant Period in West Sumatra, Indonesia: Didan Ariadapa Rahadi, Elfira Yusri, Syandrez Prima Putra, Rima Semiarty, Dian Pertiwi, Cimi Ilmiawati; J Prev Med Public Health. 2023;56(3):221-230. Published online May 31, 2023; DOI: https://doi.org/10.3961/jpmph.23.077

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Objectives
The second wave of coronavirus disease 2019 (COVID-19) cases in Indonesia, during which the Delta variant predominated, took place after a vaccination program had been initiated in the country. This study was conducted to assess the impact of COVID-19 vaccination on unfavorable clinical outcomes including hospitalization, severe COVID-19, intensive care unit (ICU) admission, and death using a real-world model.
Methods
This single-center retrospective cohort study involved patients with COVID-19 aged ≥18 years who presented to the COVID-19 emergency room at a secondary referral teaching hospital between June 1, 2021 and August 31, 2021. We used a binary logistic regression model to assess the effect of COVID-19 vaccination on unfavorable clinical outcomes, with age, sex, and comorbidities as confounding variables.
Results
A total of 716 patients were included, 32.1% of whom were vaccinated. The elderly participants (≥65 years) had the lowest vaccine coverage among age groups. Vaccination had an effectiveness of 50% (95% confidence interval [CI], 25 to 66) for preventing hospitalization, 97% (95% CI, 77 to 99) for preventing severe COVID-19, 95% (95% CI, 56 to 99) for preventing ICU admission, and 90% (95% CI, 22 to 99) for preventing death. Interestingly, patients with type 2 diabetes had a 2-fold to 4-fold elevated risk of unfavorable outcomes.
Conclusions
Among adults, COVID-19 vaccination has a moderate preventive impact on hospitalization but a high preventive impact on severe COVID-19, ICU admission, and death. The authors suggest that relevant parties increase COVID-19 vaccination coverage, especially in the elderly population.

Summary

Citations

Citations to this article as recorded by

Changes in the intrinsic severity of severe acute respiratory syndrome coronavirus 2 according to the emerging variant: a nationwide study from February 2020 to June 2022, including comparison with vaccinated populations
Boyeong Ryu, Eunjeong Shin, Dong Hwi Kim, HyunJu Lee, So Young Choi, Seong-Sun Kim, Il-Hwan Kim, Eun-Jin Kim, Sangwon Lee, Jaehyun Jeon, Donghyok Kwon, Sungil Cho
BMC Infectious Diseases.2024;[Epub] CrossRef

Special Article

Cost Effectiveness of Interventions to Promote Screening for Colorectal Cancer: A Randomized Trial: Swati Misra, David R. Lairson, Wenyaw Chan, Yu-Chia Chang, L. Kay Bartholomew, Anthony Greisinger, Amy McQueen, Sally W. Vernon; J Prev Med Public Health. 2011;44(3):101-110. Published online May 17, 2010; DOI: https://doi.org/10.3961/jpmph.2011.44.3.101

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Abstract PDF

Objectives

Screening for colorectal cancer is considered cost effective, but is underutilized in the U.S. Information on the efficiency of "tailored interventions" to promote colorectal cancer screening in primary care settings is limited. The paper reports the results of a cost effectiveness analysis that compared a survey-only control group to a Centers for Disease Control (CDC) web-based intervention (screen for life) and to a tailored interactive computer-based intervention.

Methods

A randomized controlled trial of people 50 and over, was conducted to test the interventions. The sample was 1224 partcipants 50-70 years of age, recruited from Kelsey-Seybold Clinic, a large multi-specialty clinic in Houston, Texas. Screening status was obtained by medical chart review after a 12-month follow-up period. An "intention to treat" analysis and micro costing from the patient and provider perspectives were used to estimate the costs and effects. Analysis of statistical uncertainty was conducted using nonparametric bootstrapping.

Results

The estimated cost of implementing the web-based intervention was $40 per person and the cost of the tailored intervention was $45 per person. The additional cost per person screened for the web-based intervention compared to no intervention was $2602 and the tailored intervention was no more effective than the web-based strategy.

Conclusions

The tailored intervention was less cost-effective than the web-based intervention for colorectal cancer screening promotion. The web-based intervention was less cost-effective than previous studies of in-reach colorectal cancer screening promotion. Researchers need to continue developing and evaluating the effectiveness and cost-effectiveness of interventions to increase colorectal cancer screening.

Summary

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Extending analytic methods for economic evaluation in implementation science
Meghan C. O’Leary, Kristen Hassmiller Lich, Leah Frerichs, Jennifer Leeman, Daniel S. Reuland, Stephanie B. Wheeler
Implementation Science.2022;[Epub] CrossRef
Interventions for increasing colorectal cancer screening uptake among African-American men: A systematic review and meta-analysis
Charles R. Rogers, Phung Matthews, Lei Xu, Kenneth Boucher, Colin Riley, Matthew Huntington, Nathan Le Duc, Kola S. Okuyemi, Margaret J. Foster, Joseph Telfair
PLOS ONE.2020; 15(9): e0238354. CrossRef
Economic Evaluation of Tailored Web versus Tailored Telephone-Based Interventions to Increase Colorectal Cancer Screening among Women
David R. Lairson, Tong Han Chung, Danmeng Huang, Timothy E. Stump, Patrick O. Monahan, Shannon M. Christy, Susan M. Rawl, Victoria L. Champion
Cancer Prevention Research.2020; 13(3): 309. CrossRef
Economics of Multicomponent Interventions to Increase Breast, Cervical, and Colorectal Cancer Screening: A Community Guide Systematic Review
Giridhar Mohan, Sajal K. Chattopadhyay, Donatus U. Ekwueme, Susan A. Sabatino, Devon L. Okasako-Schmucker, Yinan Peng, Shawna L. Mercer, Anilkrishna B. Thota
American Journal of Preventive Medicine.2019; 57(4): 557. CrossRef
Colorectal cancer screening interventions in 2 health care systems serving disadvantaged populations: Screening uptake and cost‐effectiveness
Christen L. Lara, Kelly L. Means, Krystal D. Morwood, Westley R. Lighthall, Sonja Hoover, Florence K.L. Tangka, Cynthia French, Krystal D. Gayle, Amy DeGroff, Sujha Subramanian
Cancer.2018; 124(21): 4130. CrossRef
The cost of implementing two small media interventions to promote HPV vaccination
Siddharth S. Karanth, David R. Lairson, Danmeng Huang, Lara S. Savas, Sally W. Vernon, María E. Fernández
Preventive Medicine.2017; 99: 277. CrossRef
An Economic Evaluation of Colorectal Cancer Screening in Primary Care Practice
Richard T. Meenan, Melissa L. Anderson, Jessica Chubak, Sally W. Vernon, Sharon Fuller, Ching-Yun Wang, Beverly B. Green
American Journal of Preventive Medicine.2015; 48(6): 714. CrossRef
Optimising colorectal cancer screening acceptance: a review
Carlo Senore, John Inadomi, Nereo Segnan, Cristina Bellisario, Cesare Hassan
Gut.2015; 64(7): 1158. CrossRef
Get Screened: A Randomized Trial of the Incremental Benefits of Reminders, Recall, and Outreach on Cancer Screening
Robert J. Fortuna, Amna Idris, Paul Winters, Sharon G. Humiston, Steven Scofield, Samantha Hendren, Patricia Ford, Shirley X. L. Li, Kevin Fiscella
Journal of General Internal Medicine.2014; 29(1): 90. CrossRef
Public Awareness of Colorectal Cancer Screening: Knowledge, Attitudes, and Interventions for Increasing Screening Uptake
Antonio Z. Gimeno Garcia, Noemi Hernandez Alvarez Buylla, David Nicolas-Perez, Enrique Quintero
ISRN Oncology.2014; 2014: 1. CrossRef
Cost‐effectiveness of a standard intervention versus a navigated intervention on colorectal cancer screening use in primary care
David R. Lairson, Melissa DiCarlo, Ashish A. Deshmuk, Heather B. Fagan, Randa Sifri, Nora Katurakes, James Cocroft, Jocelyn Sendecki, Heidi Swan, Sally W. Vernon, Ronald E. Myers
Cancer.2014; 120(7): 1042. CrossRef
Communication preference moderates the effect of a tailored intervention to increase colorectal cancer screening among African Americans
Ken Resnicow, Yan Zhou, Sarah Hawley, Masahito Jimbo, Mack T. Ruffin, Rachel E. Davis, Deirdre Shires, Jennifer Elston Lafata
Patient Education and Counseling.2014; 97(3): 370. CrossRef
A lesson in business: cost-effectiveness analysis of a novel financial incentive intervention for increasing physical activity in the workplace
Mary Anne T Dallat, Ruth F Hunter, Mark A Tully, Karen J Cairns, Frank Kee
BMC Public Health.2013;[Epub] CrossRef
Personalised risk communication for informed decision making about taking screening tests
Adrian GK Edwards, Gurudutt Naik, Harry Ahmed, Glyn J Elwyn, Timothy Pickles, Kerry Hood, Rebecca Playle
Cochrane Database of Systematic Reviews.2013;[Epub] CrossRef
Colorectal Cancer in the Kingdom of Saudi Arabia: Need for Screening
Mahmoud H. Mosli, Mahmoud S. Al-Ahwal
Asian Pacific Journal of Cancer Prevention.2012; 13(8): 3809. CrossRef

English Abstracts

Current State and Challenges of Pharmacoeconomic Evaluation in Korea.: Sang Eun Choi; J Prev Med Public Health. 2008;41(2):74-79.; DOI: https://doi.org/10.3961/jpmph.2008.41.2.74

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Abstract PDF

Since the positive listing system for prescription drug reimbursement has been introduced in Korea, the number of pharmacoeconomic evaluation studies has increased. However it is not clear if the quality of pharmacoeconomic evaluation study has improved. Due to the lack of randomized clinical studies in Korean health care setting, Korean economic evaluation studies have typically integrated the local cost data and foreign clinical data. Therefore methodological issues can be raised in regard to data coherence and consistency. But the quality of data was not questiened and the potential bias has not been investigated yet. Even though changes in policy have encouraged the undertaking of pharmacoeconomic evaluations, there is few public-side funding for validation study of cost-effectiveness models and data. Several companies perform economic evaluation studies to be submitted on behalf of their own products, but do not want the study results to be disclosed to the academic community or public. To improve the present conduct of pharmacoeconomic evaluations in Korea, various funding sources need to be developed, and, like other multidisciplinary areas, the experts in different fields of study should collaborate to ensure the validity and credibility of pharmacoeconomic evaluations.

Summary

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Barriers and Facilitators of Pharmacoeconomic Studies: A Review of Evidence from the Middle Eastern Countries
Abdulaziz Ibrahim Alzarea, Yusra Habib Khan, Abdullah Salah Alanazi, Muhammad Hammad Butt, Ziyad Saeed Almalki, Abdullah K. AlAhmari, Saud Alsahali, Tauqeer Hussain Mallhi
International Journal of Environmental Research and Public Health.2022; 19(13): 7862. CrossRef
Barriers to implementing pharmacoeconomics: interview study
Qais Alefan, Esra’a Hamdouni, Hamza Alhamad, Tareq Mukattash, Karen Rascati
Expert Review of Pharmacoeconomics & Outcomes Research.2021; 21(1): 93. CrossRef
Pharmaceutical Policy Reforms to Regulate Drug Prices in the Asia Pacific Region: The Case of Australia, China, India, Malaysia, New Zealand, and South Korea
Syed Shahzad Hasan, Chia Siang Kow, Dalia Dawoud, Omneya Mohamed, Darrin Baines, Zaheer-Ud-Din Babar
Value in Health Regional Issues.2019; 18: 18. CrossRef

Use of Economic Evaluation in the Listing and Pricing of Pharmaceuticals.: Tae Jin Lee; J Prev Med Public Health. 2008;41(2):69-73.; DOI: https://doi.org/10.3961/jpmph.2008.41.2.69

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Abstract PDF

To curb a rapid increase in expenditures for pharmaceuticals, the Korean government introduced a positive list system and a negotiation process for drug prices at the end of 2006. Economic evaluation of pharmaceuticals has begun to have a pivotal role in the listing and pricing of drugs for the Korean National Health Insurance. There are some points to discuss regarding the use of economic evaluation in the listing and pricing in the context of the Korean system. First, the listing and pricing processes have been fragmented, evoking complaints from pharmaceutical companies and delaying the access of new drugs to patients. Second, there is a concern that the positive list system may limit the range and availability of drugs for patients to choose for treatment. Third, the time schedule for de-listing of existing drugs may not be realistic. Fourth, it is not always easy to provide reliable evidence of cost-effectiveness due to a lack of materials. Fifth, there is no consensus on the range of the ICER (incremental cost-effectiveness ratio) acceptable to the Korean society. In conclusion, in the near future, it will be necessary to evaluate the achievements that the economic evaluation has provided to the Korean society.

Summary

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Cost-effectiveness of rhythm control strategy: Ablation versus antiarrhythmic drugs for treating atrial fibrillation in Korea based on real-world data
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Policy Suggestions to Improve Patient Access to New Drugs in Korea
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Korean Journal of Clinical Pharmacy.2021; 31(1): 1. CrossRef
Consistency of new drug pricing in Korea: Bridging variations among personnel in price negotiations
Hye-Young Kwon, Jinhyun Kim
Health Policy.2020; 124(9): 965. CrossRef
How Much Amount of Socioeconomic Loss Is Caused by Digestive Diseases?
Kyung Sik Park
The Korean Journal of Gastroenterology.2011; 58(6): 297. CrossRef
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Controlled Clinical Trial

Economic Value of the Sirolimus Eluting Stent (CYPHER(TM)) in Treating Acute Coronary Heart Disease.: Hoo Yeon Lee, Eun cheol Park; Korean J Prev Med. 2003;36(4):339-348.

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Abstract PDF: OBJECTIVE
To quantify the economic value of the Sirolimus Eluting Stent (CYPHER(TM)) in treating acute coronary heart disease (CHD), and to assist in determining an adequate level of reimbursement for CYPHER(TM) in Korea. METHODS: A decision-analytical model, developed by the Belgium Health Economics Disease Management group, was used to investigate the incremental cost-effectiveness of CYPHER(TM) versus conventional stenting. The time horizon was five years. The probabilities for clinical events at each node of the decision model were obtained from the results of large, randomized, controlled clinical trials. The initial care and follow-up direct medical costs were analyzed. The initial costs consisted of those for the initial procedure and hospitalization. The follow-up costs included those for routine follow-up treatments, adverse reactions, revascularization and death. Depending on the perspective of the analysis, the costs were defined as insurance covered or total medical costs (=sum of insurance covered and uncovered medical costs). The cost data were obtained from the administrative data of 449 patients that received conventional stenting from five participating Korean hospitals during June 2002. Sensitivity analyses were performed for discount rates of 3, 5 and 7%. Since the major clinical advantage of CYPHER(TM) over conventional stenting was the reduction in the revascularization rates, the economic value of CYPHER(TM), in relation to the direct medical costs of revascularization, were evaluated. If the incremental cost of CYPHER(TM) per revascularization avoided, compared to conventional stenting, was no higher than that of a revascularization itself, CYPHER(TM) would be considered as being cost-effective. Therefore, the maximum acceptable level for the reimbursement price of CYPHER(TM) making the incremental cost-effectiveness ratio equal to the cost of a revascularization was identified. RESULTS: The average weighted initial insurance covered and total medical costs of conventional stenting were about 6, 275, 000 and 8, 058, 000 Won, respectively. The average weighted sum of the initial and 5-year follow-up insurance covered and total medical costs of conventional stenting were about 13, 659, 000 and 17, 353, 000 Won, respectively. The estimated maximum level of reimbursement price of CYPHER(TM) from the perspectives of the insurer and society were 4, 126, 897 ~ 4, 325, 161 and 4, 939, 939 ~ 5, 078, 781 Won, respectively. CONCLUSION: By evaluating the economic value of CYPHER(TM), as an alternative to conventional stenting, the results of this study are expected to provide a scientific basis for determining the acceptable level of reimbursement for CYPHER(TM).; Summary

Original Articles

Cost-Effectiveness Analysis of a Hyperlipidemia Mass Screening Program in Korea.: Yeon Soon Cha, Young Ho Khang, Moo Song Lee, Weechang Kang, Sung Hoon Jeon, Kee Lak Kim, Sang Il Lee; Korean J Prev Med. 2002;35(2):99-106.

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Abstract PDF: OBJECTIVE
Until now, there have been no evidence-based guidelines produced for the mass screening of hyperlipidemia cases in Korea. This study was done to find the most efficient strategy for a hyperlipidemia-screening program among Korean adults. METHOD: Seven alternative strategies for hyperlipidemia screening were formulated and compared in terms of cost-effectiveness. Cost and effectiveness were estimated from social perspectives and using a two-stage screening process (initial testing and additional testing for positives from the first test). A computerized database (based on persons who had visited a health promotion center in one teaching hospital for a routine health check-up) was used to determine the cost and the outcome of various strategies. Official data was used in calculating direct and indirect costs. Effectiveness was measured according to the number of persons who needed clinical intervention for hyperlipidemia. A stratified analysis, considering age group and sex, was then done. Sensitivity analyses, focusing on several uncertain parameters, were also done. RESULTS: Of the seven test alternatives available, the most cost-effective strategy was a screening program, which consisted of an initial test of total cholesterol,high-density lipoprotein cholesterol and triglyceride. There was some variation in the rank of the cost-effectiveness ratios for the seven alternatives dependent on age group or gender. CONCLUSIONS: Current hyperlipidemia screening practice, for National Health Insurance beneficiaries, tests only the total cholesterol level with a cut-off value of 260mg/dl as an initial screening test. It is not the best strategy for cost-effectiveness, and should be modified. Different screening strategies taking age group and sex into account should be developed and used for the efficient mass screening of hyperlipidemia cases among Korean adults.; Summary

The Relationship of Organizational Culture and Organizational Effectiveness at the General Hospital.: Heuisug Jo, Sunhee Lee, Woohyun Cho, Kihong Chun, Okryun Moon; Korean J Prev Med. 1999;32(3):374-382.

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Abstract PDF: OBJECTIVES
Organizational culture has been important in field of organizational behavior research for the past decade. Although there has been a growing interest in the organizational culture and organizational effectiveness, there is few research in health care field. This study was carried out to investigate the relationship of organizational culture and organizational effectiveness at general hospital. METHODS: Data was collected by self-administrated questionares. Organizational cultures were measured by using Likert scale. A general hospital in Kyunggi-Do was selected and survey was conducted to 675 workers. Data was analyzed with computer package, PC- SPSS. RESULTS: There were four types of organizational culture in this hospital : consensual culture, developmental culture, hierarchical culture, rational culture. Many workers recognized their culture as rational culture and developmental culture. This finding showed that the hospital had both human related and task related climate. There were some differences in recognition of sub-organizational culture by occupational group, but perceived organizational culture was in accordance with sub-organizational culture in general. Multiple regression analysis and multiple logistic regression analysis were conducted to find the relationship of organizational culture and organizational effectiveness. As a result, developmental culture showed a strong relationship with organizational commitment and job-satisfaction. CONCLUSIONS: These results showed that types of organizational culture were significantly related to organizational effectiveness and understanding the existing culture is essential to develope their organizational effectiveness.; Summary

The Effect of Job Stress and Social Support on the Organizational Effectiveness of Hospital Employees.: Jong Wook Ko, Young Joon Seo, Ha Young Park; Korean J Prev Med. 1996;29(2):295-308.

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Abstract PDF: The purpose of this study is to investigate the effect of job stress and social support on the organizational effectiveness of hospital employees and to examine the role of social support in the experience of job stress among the employees. Previous studies have yielded mixed results regarding the role of social support. Some studies provide supporting evidence for the buffering effect of social support, while others do not. Still others report findings about reverse buffering effects. These inconsistent findings are, in part, accounted for by methodological problems such as poor measurement, small sample size, and the existence of high multicollinearity. To examine more rigorously the role of social support in relation to the negative effects of job stress, this study was carefully designed to overcome methodolgical shortcomings found in the past research. In addition, unlike the previous studies, which were concerned mostly with health-related variables as consequences of job stress, in this study, three work-related variables (job satisfaction, organizational commitment, and intent to stay) which had close relationships with organizational effectiveness were examined as output variables. The sample used in this study consisted of 353 employees from a university hospital in the suburbs of seoul. Data were collected with self-administered questionnaires and analyzed using canonical analysis and hierarchical regression analysis. The results of this study indicate that; (l) job stress has negative main effects on job satisfaction, organizational commitment, and intent to stay; (2) social support has positive main effects on the same three output variables, (3) social support does not moderate the harmful effects of job stress on the three outcome variables, and (4) the three-way interaction effects of (social support * job stress * gender) and of (social support * job stress * education) are not supported The implications of these findings for the management of human resources are discussed.; Summary

A study on results of short-course chemotherapy of patients with pulmonary tuberculosis registered at Seoul city health centers.: Hye Sook Park, Eun Hee Ha, Cha Hyung Wie; Korean J Prev Med. 1995;28(2):487-496.

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Abstract PDF: This study was performed for the comparison of the therapeutic efficiency between 6-month (2tHER/4HER) and 9-month (9HER) short-course chemotherapy under the programe conditions for pulmonary tuberculosis in terms of sputum AFB negative conversion rate, remedial interruption rate and cost effectiveness analysis. Two hundreds and ninty three patients treated with 9HER and 641 treated with 2HERZ/4HER had been discharged from 22 health centers in Seoul from May 1, 1993 to April 30, 1994. Seven hundreds and seventeen was subsequently analysed excluding 217 patients due to remedial interruption. The results: 1. Bacteriological negative conversion rate in 9HER regimen and 2HERZ/4HER regimen was 97.8% and 96.4% respectively (p>0.05). But the early treatment period, negative conversion rate in 2HERZ/4HER regimen was very higher than in 9HER regimen(p<0.01). 2. Remedial interruption rate for 9HER regimen and 2HERZ/4HER regimen was 34.1% and 13.6% respectively. The primary reason for the interruption was transfering to other clinics and this interruption was high within 3months. 3. Cost effectiveness for 2HERZ/4HER regimen was higher than 9HER regimen. The difference cost effectiveness ratio was 2.33 at the first sputum test and 1.69 at the last sputum test.; Summary

Cost analysis of hypertension screening program.: Eun Cheol Park, Seung Hum Yu; Korean J Prev Med. 1989;22(3):380-388.

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Abstract PDF: To evaluate the costs the hypertension screening program of the Korea Medical Insurance Corporation, the records of the screening examinations were used. The sample size was 49,983 of the 906,554 people insured by the Corporation and was obtained by two-stage stratification random sampling. The alternatives for efficiency of the screening program, which were divided into three categories: modification of the screening test package, application of other hypertension diagnostic criteria, and selective approach of tested groups by age, were evaluated according to the cost per patient detected. The results of this study were as follows: In the hypertension screening system, the cost per patient detected was Won 30,833. The most nonsensitive test for hypertension detection was ophthalmoscopy, which was examine during the second stage of screening. If the ophthalmoscope examination was excluded, only one person was not detected, which was 0.2% of detected persons, and the cost per patient detected decreased to Won 28,098. The most efficient modification of the screening test package was measurement of blood pressure through the first and second stages of screening. The cost per patient detected by this modification was Won 24,408. The application of other diagnostic criteria, which were more restricted criteria, increased the cost per patient detected by 3.7%-6.7%. The cost per patient detected were Won 170,582 for persons less than 39 years old, Won 20,032 for persons 40 to 59 years old, and Won 8,675 for persons 60 years old and over. In conclusion, the best alternative suggested with respect to efficiency and practical application excluded the ophthalmoscope examination of second stage screening and restricted the target population to persons greater than 40 years old. The application of this alternative decreased 54.9% of the screening costs and the cost per patient detected was Won 15,222. This study was limited in that measurement of effectiveness was not of the ultimate goal of screening, which is decreasing morbidity and mortality, but was of disease detection as the short-term objective.; Summary

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