RESUMEN
Background: The Indian Armed Forces, on entry, vaccinates all cadets and recruits with varicella vaccine for the prevention of varicella. This health technology assessment (HTA) report puts forth evidence for HTA of varicella vaccination in the Armed Forces in various domains namely clinical, societal, ethical, economic, and legal. Methods: The policy question under each domain has been developed according to best-practice methods for HTA. The costs included were hospitalization cost due to varicella infection; training lost cost; the varicella vaccine cost; cost of the side effects of vaccine; and the outbreak investigation cost. The incremental cost-effectiveness ratio (ICER) for varicella cases averted and man-days saved, and quality-adjusted life years (QALYs) gained due to varicella vaccination strategy were calculated. Results: Evidence suggests a reduction of 81% in hospitalization rates with 19392 man-days saved per 1 lakh population due to varicella vaccination strategy. The ICER for varicella cases averted is estimated to be Rs 56732/- per case averted and Rs 5687/- per man-day saved. QALYs gained due to two-dose varicella vaccination strategy is estimated to be 1152 per 1 lakh population with cost per QALY gained Rs 95735/-. Conclusion: The study showed a large reduction in hospitalizations and consequently man-days lost after the introduction of the vaccination strategy. The QALYs was another aspect of importance brought out by this study. Thus, a two-dose vaccination strategy for varicella-zoster virus (VZV) for the Armed Forces trainees is a cost-effective policy.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Osteoartritis de la Rodilla/cirugía , Pérdida de Peso , Artroplastia de Reemplazo de Rodilla/métodos , Índice de Masa Corporal , Femenino , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos , Osteoartritis de la Rodilla/etiología , Sobrepeso/complicaciones , Factores de RiesgoAsunto(s)
Anticonvulsivantes/efectos adversos , Fenitoína/análogos & derivados , Deficiencia de Vitamina D/complicaciones , Vitamina D/análogos & derivados , Anticonvulsivantes/uso terapéutico , Humanos , Hipocalcemia/etiología , Lactante , Masculino , Fenitoína/efectos adversos , Fenitoína/uso terapéutico , Convulsiones/etiología , Vitamina D/metabolismoRESUMEN
A 1-year-old male child with isosexual central (gonadotropin-dependent) precocious puberty caused by hypothalamic hamartoma is reported. Details of the diagnosis based solely on neuromaging characteristics, and satisfactory results of medical treatment with gonadotropin releasing hormone agonist analogues, are highlighted.