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Background Trivalent influenza vaccines encompass one influenza B lineage; however, predictions have been unreliable on which of two antigenically distinct circulating lineages will dominate. Quadrivalent seasonal influenza vaccines contain strains from both lineages. This analysis assesses the cost effectiveness of switching from trivalent inactivated influenza vaccination (TIV) in Finland to quadrivalent vaccination, using inactivated (QIV) or live-attenuated (Q-LAIV) vaccines. Methods A transmission model simulated the dynamics of influenza infection while accounting for indirect (herd) protection. Prior distributions for key transmission parameters were repeatedly sampled and simulations that fitted the available information on influenza in Finland were recorded. The resulting posterior parameter distributions were used in a probabilistic sensitivity analysis in which economic parameters were sampled, simultaneously encompassing uncertainty in the transmission and economic parameters. The cost effectiveness of a range of trivalent and quadrivalent vaccine policies over a 20-year time horizon was assessed from both a societal and payer perspective in 2014 Euros. Results The simulated temporal incidence pattern of symptomatic infections corresponded well with case surveillance data. A switch from the current TIV to Q-LAIV in children (2 to <18 years) and to QIV in other ages was estimated to annually avert approximately 76,100 symptomatic infections (95 % range 36,700–146,700), 11,500 primary care consultations (6100–20,000), 540 hospitalisations (240–1180), and 72 deaths (32–160), and was cost-saving relative to TIV (€374 million averted [€161–€752], in 2014 Euros, discounted at 3 %). This scenario had the highest probability of being the most cost-effective scenario considered. Conclusions This analysis demonstrates that quadrivalent vaccination is expected to be highly cost effective, reducing the burden of influenza-related disease.

Purpose To explore symptoms and disease impacts of Crohn’s disease and to develop a new patient-reported outcomes (PRO) measure according to industry best practices. Methods A conceptual model of relevant symptoms experienced by patients with Crohn’s disease was developed following a literature review. Three rounds of combined qualitative semi-structured concept elicitation and cognitive debriefing interviews with 36 patients (≥ 16 years) with Crohn’s disease and 4 clinicians were conducted to further explore the most commonly reported and most bothersome symptoms to patients. Interview results were used to update the conceptual model as well as items and response options included in The Crohn’s Disease Diary, a new PRO measure. Results All patients ( N  = 36) reported abdominal pain, loose or liquid bowel movements, and high or increased frequency of bowel movements, with most reporting these symptoms spontaneously (100%, 92%, and 75%, respectively). All patients reported bowel movement urgency, but 61% reported this symptom only when probed. Most also reported that symptoms impacted activities of daily living, work/school, and emotional, social, and physical functioning (overall, 78%–100%; spontaneously, 79% – 92%). Data regarding core symptoms of Crohn’s disease from clinician concept elicitation interviews supported patient data. The 17-item Crohn’s Disease Diary assesses core symptoms and impacts of Crohn’s disease over 24 h, and extraintestinal manifestations over 7 days. The content validity of the diary was confirmed during cognitive debriefing interviews. Conclusion The Crohn’s Disease Diary is a new PRO measure for the assessment of Crohn’s disease symptoms and impacts, developed according to industry best practices.

Background Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) are oral alternatives to current standard-of-care treatments for anaemia in chronic kidney disease (CKD). We conducted network meta-analyses to indirectly compare clinical outcomes for three HIF-PHIs in dialysis and non-dialysis populations with anaemia in CKD. Methods The evidence base comprised phase III, randomised, controlled trials evaluating daprodustat, roxadustat, or vadadustat. Three outcomes were evaluated: efficacy [change from baseline in haemoglobin (Hgb)], cardiovascular safety [time to first major adverse cardiovascular event (MACE)] and quality of life [change from baseline in 36-Item Short Form Health Survey (SF-36) Vitality score]. Analyses were performed separately for all patients and for erythropoiesis-stimulating agent (ESA) non-users at baseline (non-dialysis population) or prevalent dialysis patients (dialysis population). Bayesian Markov Chain Monte Carlo methods with non-informative priors were used to estimate the posterior probability distribution and generate pairwise treatment comparisons. Point estimates (medians of posterior distributions) and 95% credible intervals (CrI) were calculated. Results Seventeen trials were included. In non-dialysis patients, there were no clinically meaningful differences between the three HIF-PHIs with respect to Hgb change from baseline [all patients analysis (total n = 7907): daprodustat vs. roxadustat, 0.09 g/dL (95% CrI −0.14, 0.31); daprodustat vs. vadadustat, 0.09 g/dL (−0.04, 0.21); roxadustat vs. vadadustat, 0.00 g/dL (−0.22, 0.22)] or risk of MACE [all patients analysis (total n = 7959): daprodustat vs. roxadustat, hazard ratio (HR) 1.16 (95% CrI 0.76, 1.77); daprodustat vs. vadadustat, 0.88 (0.71, 1.09); roxadustat vs. vadadustat, 0.76 (0.50, 1.16)]. Daprodustat showed a greater increase in SF-36 Vitality compared with roxadustat [total n = 4880; treatment difference 4.70 points (95% CrI 0.08, 9.31)]. In dialysis patients, Hgb change from baseline was higher with daprodustat and roxadustat compared with vadadustat [all patients analysis (total n = 11 124): daprodustat, 0.34 g/dL (0.22, 0.45); roxadustat, 0.38 g/dL (0.27, 0.49)], while there were no clinically meaningful differences in the risk of MACE between the HIF-PHIs [all patients analysis (total n = 12 320): daprodustat vs. roxadustat, HR 0.89 (0.73, 1.08); daprodustat vs. vadadustat, HR 0.99 (0.82, 1.21); roxadustat vs. vadadustat, HR 1.12 (0.92, 1.37)]. Results were similar in analyses of ESA non-users and prevalent dialysis patients. Conclusions In the setting of anaemia in CKD, indirect treatment comparisons suggest that daprodustat, roxadustat, and vadadustat are broadly clinically comparable in terms of efficacy and cardiovascular safety (precision was low for the latter), while daprodustat may be associated with reduction in fatigue to a greater extent than roxadustat. Graphical Abstract Graphical Abstract

Influenza poses a significant burden on healthcare systems and society, with under-recognition in the paediatric population. Existing vaccination policies (largely) target the elderly and other risk groups where complications may arise. The goal of this study was to evaluate the cost-effectiveness of annual paediatric vaccination (in 2-17-year-olds) with live attenuated influenza vaccination (LAIV), as well as the protective effect on the wider population in England and Wales (base). The study aimed to demonstrate broad applications of the model in countries where epidemiological and transmission data is limited and that have sophisticated vaccination policies (Brazil, Spain, and Taiwan). The direct and indirect impact of LAIV in the paediatric cohort was simulated using an age-stratified dynamic transmission model over a 5-year time horizon of daily cycles and applying discounting of 3.5% in the base case. Pre-existing immunity structure was based on a 1-year model run. Sensitivity analyses were conducted. In the base case for England and Wales, the annual paediatric strategy with LAIV was associated with improvements in influenza-related events and quality-adjusted life years (QALYs) lost, yielding an incremental cost per QALY of £6,208. The model was robust to change in the key input parameters. The probabilistic analysis demonstrated LAIV to be cost effective in more than 99% of iterations, assuming a willingness-to-pay threshold of £30,000. Incremental costs per QALY for Brazil were £2,817, and for the cases of Spain and Taiwan the proposed strategy was dominant over the current practice. In addition to existing policies, annual paediatric vaccination using LAIV provides a cost-effective strategy that offers direct and indirect protection in the wider community. Paediatric vaccination strategies using LAIV demonstrated clinical and economic benefits over alternative (current vaccination) strategies in England and Wales as well as Brazil, Spain, and Taiwan.

The Coronavirus Disease (COVID-19) is a disease with diverse effects on multiple organ systems, leading to varying presentations and severe complications. As the pandemic progresses, the challenges faced by those who recovered from the disease evolved as various coping strategies were adopted post recovery. This study investigated the coping strategies used by individuals recovering from COVID-19 to manage the physical, psychological, and social impacts of the disease. It further explored the factors influencing these strategies and their correlation with post-recovery quality of life. This cross-sectional quantitative study involved 150 participants who attended the Ghana Infectious Disease Centre's post-COVID-19 review clinic between January and June 2021. Coping mechanisms were evaluated using the Brief-COPE questionnaire, which covers 28 strategies across three styles: Problem-focused coping, emotional-focused coping, and avoidant coping. Participants rated their coping strategies on a 4-point Likert scale. Analysis of variance was used to determine differences in use of coping strategies. Quality of life was assessed with the EuroQol Group Association five-domain, five-level questionnaire (EQ-5D-5L) and the EQ-VAS scale. Spearman correlation analyzed the relationship between coping strategies and quality of life. Majority of the study participants used problem-focused (2.71 ± 0.64 SD) type of coping strategy, followed by emotional-focused coping (2.32 ± 0.43 SD). The least strategy used was avoidant coping (1.57 ± 0.39 SD). Older participants, non-healthcare workers, and those with complications or persistent symptoms exhibited higher scores in avoidant and problem-focused coping. Those with persistent symptoms had higher emotional-focused coping scores. Better quality of life was associated with less reliance on all types of coping strategies.

The Coronavirus Disease (COVID-19) is a disease with diverse effects on multiple organ systems, leading to varying presentations and severe complications. As the pandemic progresses, the challenges faced by those who recovered from the disease evolved as various coping strategies were adopted post recovery. This study investigated the coping strategies used by individuals recovering from COVID-19 to manage the physical, psychological, and social impacts of the disease. It further explored the factors influencing these strategies and their correlation with post-recovery quality of life. This cross-sectional quantitative study involved 150 participants who attended the Ghana Infectious Disease Centre's post-COVID-19 review clinic between January and June 2021. Coping mechanisms were evaluated using the Brief-COPE questionnaire, which covers 28 strategies across three styles: Problem-focused coping, emotional-focused coping, and avoidant coping. Participants rated their coping strategies on a 4-point Likert scale. Analysis of variance was used to determine differences in use of coping strategies. Quality of life was assessed with the EuroQol Group Association five-domain, five-level questionnaire (EQ-5D-5L) and the EQ-VAS scale. Spearman correlation analyzed the relationship between coping strategies and quality of life. Majority of the study participants used problem-focused (2.71 ± 0.64 SD) type of coping strategy, followed by emotional-focused coping (2.32 ± 0.43 SD). The least strategy used was avoidant coping (1.57 ± 0.39 SD). Older participants, non-healthcare workers, and those with complications or persistent symptoms exhibited higher scores in avoidant and problem-focused coping. Those with persistent symptoms had higher emotional-focused coping scores. Better quality of life was associated with less reliance on all types of coping strategies. Patients recovering from COVID-19 at the Ghana Infectious Disease Centre used positive coping mechanisms effectively. Key predictors of coping strategies included age, persistent symptoms, and complications. Improved quality of life is correlated with reduced use of coping strategies.

The Coronavirus Disease (COVID-19), initially thought to be a respiratory disease, is now known to affect multiple organ systems with variable presentation and devastating or fatal complications. Despite the large numbers of people who have suffered this disease globally, the mid- to long-term impact of COVID-19 on a person's general well-being and physical function has not been fully investigated in Ghana. This study sought to determine the Quality of Life (QoL) and associated factors among Ghanaian patients following clinical recovery from COVID-19 infection. This was a cross-sectional quantitative study involving 150 COVID-19 recovered patients attending the review clinic of the Ghana Infectious Disease Centre. Quality of life was estimated using the EuroQol Group Association five-domain, five-level questionnaire (EQ-5D-5L) while participants' overall health status was measured on a visual analogue scale (EQ-VAS): a scale ranging from 0 (worst health) to 100 (best health). Kruskal-Wallis tests were used to assess differences in domain and overall QoL scores while quantile regression was used to determine demographic and clinical factors associated with QoL scores. The mean QoL from the EQ-5D-5L assessment tool was (81.5 ± 12.0) %, while the self-reported QoL from the EQ-VAS tool (75.6 ± 22.0) %. Persistence of symptoms after 30 days was significantly associated with EQ-5D-5L QoL (Adjusted median difference [95% CI] = -9.40 [-14.19, -4.61], p<0.001) while access to rehabilitative centres was significantly associated with EQ-VAS QoL (Adjusted median difference [95% CI] = -29.60 [-48.92, -10.29], p = 0.003). Quality of life was relatively good among the COVID-19 recovered patients. Persistence of symptoms and access to rehabilitative centres significantly predicted one's QoL.

The Coronavirus Disease (COVID-19), initially thought to be a respiratory disease, is now known to affect multiple organ systems with variable presentation and devastating or fatal complications. Despite the large numbers of people who have suffered this disease globally, the mid- to long-term impact of COVID-19 on a person's general well-being and physical function has not been fully investigated in Ghana. This study sought to determine the Quality of Life (QoL) and associated factors among Ghanaian patients following clinical recovery from COVID-19 infection. This was a cross-sectional quantitative study involving 150 COVID-19 recovered patients attending the review clinic of the Ghana Infectious Disease Centre. Quality of life was estimated using the EuroQol Group Association five-domain, five-level questionnaire (EQ-5D-5L) while participants' overall health status was measured on a visual analogue scale (EQ-VAS): a scale ranging from 0 (worst health) to 100 (best health). Kruskal-Wallis tests were used to assess differences in domain and overall QoL scores while quantile regression was used to determine demographic and clinical factors associated with QoL scores. The mean QoL from the EQ-5D-5L assessment tool was (81.5 ± 12.0) %, while the self-reported QoL from the EQ-VAS tool (75.6 ± 22.0) %. Persistence of symptoms after 30 days was significantly associated with EQ-5D-5L QoL (Adjusted median difference [95% CI] = -9.40 [-14.19, -4.61], p<0.001) while access to rehabilitative centres was significantly associated with EQ-VAS QoL (Adjusted median difference [95% CI] = -29.60 [-48.92, -10.29], p = 0.003). Quality of life was relatively good among the COVID-19 recovered patients. Persistence of symptoms and access to rehabilitative centres significantly predicted one's QoL.

The Coronavirus Disease (COVID-19), initially thought to be a respiratory disease, is now known to affect multiple organ systems with variable presentation and devastating or fatal complications. Despite the large numbers of people who have suffered this disease globally, the mid- to long-term impact of COVID-19 on a person's general well-being and physical function has not been fully investigated in Ghana. This study sought to determine the Quality of Life (QoL) and associated factors among Ghanaian patients following clinical recovery from COVID-19 infection. This was a cross-sectional quantitative study involving 150 COVID-19 recovered patients attending the review clinic of the Ghana Infectious Disease Centre. Quality of life was estimated using the EuroQol Group Association five-domain, five-level questionnaire (EQ-5D-5L) while participants' overall health status was measured on a visual analogue scale (EQ-VAS): a scale ranging from 0 (worst health) to 100 (best health). Kruskal-Wallis tests were used to assess differences in domain and overall QoL scores while quantile regression was used to determine demographic and clinical factors associated with QoL scores. The mean QoL from the EQ-5D-5L assessment tool was (81.5 ± 12.0) %, while the self-reported QoL from the EQ-VAS tool (75.6 ± 22.0) %. Persistence of symptoms after 30 days was significantly associated with EQ-5D-5L QoL (Adjusted median difference [95% CI] = -9.40 [-14.19, -4.61], p<0.001) while access to rehabilitative centres was significantly associated with EQ-VAS QoL (Adjusted median difference [95% CI] = -29.60 [-48.92, -10.29], p = 0.003). Quality of life was relatively good among the COVID-19 recovered patients. Persistence of symptoms and access to rehabilitative centres significantly predicted one's QoL.

The Coronavirus Disease (COVID-19) is a disease with diverse effects on multiple organ systems, leading to varying presentations and severe complications. As the pandemic progresses, the challenges faced by those who recovered from the disease evolved as various coping strategies were adopted post recovery. This study investigated the coping strategies used by individuals recovering from COVID-19 to manage the physical, psychological, and social impacts of the disease. It further explored the factors influencing these strategies and their correlation with post-recovery quality of life. This cross-sectional quantitative study involved 150 participants who attended the Ghana Infectious Disease Centre's post-COVID-19 review clinic between January and June 2021. Coping mechanisms were evaluated using the Brief-COPE questionnaire, which covers 28 strategies across three styles: Problem-focused coping, emotional-focused coping, and avoidant coping. Participants rated their coping strategies on a 4-point Likert scale. Analysis of variance was used to determine differences in use of coping strategies. Quality of life was assessed with the EuroQol Group Association five-domain, five-level questionnaire (EQ-5D-5L) and the EQ-VAS scale. Spearman correlation analyzed the relationship between coping strategies and quality of life. Majority of the study participants used problem-focused (2.71 ± 0.64 SD) type of coping strategy, followed by emotional-focused coping (2.32 ± 0.43 SD). The least strategy used was avoidant coping (1.57 ± 0.39 SD). Older participants, non-healthcare workers, and those with complications or persistent symptoms exhibited higher scores in avoidant and problem-focused coping. Those with persistent symptoms had higher emotional-focused coping scores. Better quality of life was associated with less reliance on all types of coping strategies.