New adjuvant treatments are being developed for patients with resected non-small cell lung cancer (NSCLC). Due to scarcity of real-world data available for treatment costs and resource utilization, health technology and cost-effectiveness assessments can be limited. We estimated the burden and cost-of-illness associated with completely resected stage IB-IIIA NSCLC in France, Germany and the United Kingdom (UK). Eligible patients were aged ≥18 years with completely resected stage IB-IIIA NSCLC between August 2009 and July 2012. Patients (living or deceased) were enrolled at clinical sites by a systematic sampling method. Data were obtained from medical records and patient surveys. Direct, indirect and patient out-of-pocket expenses were estimated by multiplying resource use by country-specific unit costs. National annual costs were estimated based on disease prevalence data available from published sources. 39 centers provided data from 831 patients of whom patient surveys were evaluable in 306 patients. Median follow-up was 26 months. The mean total direct costs per patient during follow-up were: €19,057 (France), €14,185 (Germany), and €8377 (UK). The largest cost drivers were associated with therapies received (€12,375 France; €3694 UK), and hospitalization/emergency costs (€7706 Germany). Monthly direct costs per patient were the highest during the distant metastasis/terminal illness phase in France (€15,562) and Germany (€6047) and during the adjuvant treatment period in the UK (€2790). Estimated mean total indirect costs per patient were: €696 (France), €2476 (Germany), and €1414 (UK). Estimates for the annual national direct cost were €478.4 million (France), €574.6 million (Germany) and €325.8 million (UK). To our knowledge, this is the first comprehensive study describing the burden of illness for patients with completely resected stage IB-IIIA NSCLC. The economic burden was substantial in all three countries. Treatment of NSCLC is associated with large annual national costs, mainly incurred during disease progression.

To inform health-technology assessments of new adjuvant treatments, we describe treatment patterns in patients with complete resection of stage IB-IIIA non-small cell lung cancer (NSCLC) in France, Germany, and the United Kingdom (UK). Data were collected via medical record abstraction. Patients were aged ≥18 years with completely resected stage IB-IIIA NSCLC, diagnosed between 01 January 2009 and 31 December 2011. Median follow-up was 26 months. Adjuvant treatment patterns and clinical outcomes were summarized descriptively. Among the 831 patients studied, 239 (29%) had stage IB disease, 179 (22%) had stage IIA disease, 165 (20%) had stage IIB disease, and 248 (30%) had stage IIIA disease. Adjuvant systemic therapy was received by 402 patients (48.4%), (France, 61.8%; Germany, 51.9%; UK, 33.4%). Use of adjuvant therapy increased with increasing stage of disease. Cisplatin/vinorelbine and carboplatin/vinorelbine were the most frequently prescribed adjuvant regimens. Median disease-free survival was 48.0 months (95% confidence interval [CI] 42.3-not estimable); the 25th percentile was 13.2 months (95% CI, 11.0-15.3). 204 patients (24%) died during the follow-up period. The median overall survival was not reached, the 25th percentile was 31.2 months (95% CI 26.8-36.0 months). 272 patients (33%) had disease recurrence during the follow-up period. For 86 of those patients, the first recurrence was local or regional with no distant metastasis and 14 had further progression to metastatic disease during the follow-up time. For the other 186 patients, the first recurrence involved distant metastases. A total of 200 patients had metastatic disease at any time during study follow-up. Less than half the patients with stage IB-IIIA NSCLC in this observational study received adjuvant systemic therapy. A high rate of first recurrence with distant metastatic disease was observed, emphasising the need for more effective systemic adjuvant therapies in this population.

The United States Advisory Committee on Immunization Practices (ACIP) recommends vaccination against meningococcal serogroups A, C, W, and Y (MenACWY) for all 11-12-year-olds, with a booster dose for 16-year-olds, and against meningococcal serogroup B (MenB) for 16-23-year-olds under shared clinical decision-making (SCDM). However, uptake of the MenB vaccine and the MenACWY booster dose is low. This study investigated United States physicians' knowledge, attitudes, and practices regarding recommending MenB and MenACWY vaccines to non-high-risk older adolescents and young adults. An online survey was conducted in April-May 2022 among pediatricians, family physicians (FPs), general practitioners (GPs), and internists who had recommended the MenB and/or the MenACWY vaccine(s) to at least one 16-23-year-old in the past year. Among 407 participants, 50% correctly identified MenB as the leading cause of meningococcal disease among adolescents and young adults. Furthermore, 46% of physicians (47% of pediatricians, 40% of FPs and GPs, 53% of internists) answered correctly that MenB vaccination is recommended under SCDM, and 82% of physicians (96% of pediatricians, 70% of FPs and GPs, 65% of internists) answered correctly that MenACWY vaccination is routinely recommended. Among MenB-vaccinators, 78% reported having received some training or other information on implementing SCDM, and 65% rated recommending MenB vaccination as very important. Knowledge gaps, which varied by specialty, were identified regarding meningococcal disease and vaccine recommendations, particularly regarding MenB. Targeted education of physicians may facilitate discussions about MenB vaccination.

This study aimed to evaluate the attitudes and practices of US healthcare professionals (HCPs) regarding the Advisory Committee on Immunization Practices (ACIP) vaccination recommendations on HepA and HepB for adult patients at risk of contracting these infections or experiencing complications of hepatitis disease. This cross-sectional, web-based survey of 400 US HCPs, which included nurse practitioners and family medicine, internal medicine, infectious disease, emergency department, and gastroenterology physicians, assessed HCPs’ attitudes and practices regarding the ACIP recommendations for adult patients at risk for hepatitis disease. HCP participants were identified via a survey research panel. A recruitment quota of 400 HCPs was set, including 50 NPs, 100 FMs, 100 IMs, 50 GIs, 50 EDs, and 50 IDs. The most frequently reported reasons for not recommending either HepA or HepB vaccines were “I think the risk of HepA infection is low in this patient population” and “I am uncertain about what the guidelines say about vaccinating this population.” The most reported factors considered when determining eligibility for either vaccine were medical history and the patient’s willingness/motivation to be vaccinated. Most reported it was extremely or moderately important to prevent hepatitis disease by vaccinating adult patients at risk, and most also reported recommending a HepA vaccine or HepB vaccine to patients at risk. Although most HCPs reported recommending HepA and HepB vaccines to patients at risk, these findings contrast with the low reported vaccination rates among these populations, and improved awareness of the ACIP recommendations among HCPs is needed. Although hepatitis A and hepatitis B are vaccine-preventable diseases, not enough adults at risk are vaccinated in the United States (US). The Advisory Committee on Immunization Practices (ACIP) makes recommendations on the use of vaccines in the US. The ACIP recommendations identify groups of people at risk of contracting hepatitis A infection or experiencing complications of hepatitis A disease (e.g., people with chronic liver disease) and hepatitis B infection or its related complications (e.g., people with diabetes). To identify potential barriers to vaccination, we surveyed 400 US healthcare professionals to evaluate their views about the ACIP recommendations on hepatitis A and hepatitis B vaccination for patients at risk of infection or complications. Most reported it was extremely or moderately important to prevent hepatitis A or hepatitis B infection by vaccinating these adult patients. The most commonly reported reasons for not recommending either vaccine were “I am uncertain about what the guidelines say about vaccinating this population” and “I think the risk of hepatitis A or hepatitis B infection is low in this patient population”. Our findings show that improved awareness of the guidelines among healthcare professionals is needed, particularly of the importance of hepatitis A vaccination, and hepatitis B vaccination in adults with diabetes. In addition to helping the ongoing multi-state hepatitis A outbreaks, this could aid in the successful implementation of the recent ACIP recommendation for hepatitis B vaccination in all adults that is expected to reduce barriers to vaccination.

Primary care providers (PCPs) play a key role in vaccine recommendations and uptake, but limited information exists about PCP knowledge, attitudes, and practices regarding herpes zoster (HZ) vaccination. Clinical trials have shown that recombinant zoster vaccine (RZV) significantly reduces the risk of developing HZ. Hence, RZV is recommended by the US Advisory Committee on Immunization Practices (ACIP) for adults aged ≥50 years and immunocompromised adults aged ≥19 years. However, RZV uptake varies across age groups, and is lower for adults aged 50-59 compared to those aged ≥60 years. Using a cross-sectional web-based survey, this study described provider knowledge of HZ risk factors, ACIP recommendations, attitudes toward HZ vaccination, and HZ vaccination practices/barriers. Among 301 licensed PCPs in the US, knowledge of HZ risk factors was high, but only 29% were fully aware of the ACIP recommendations. PCPs indicated that HZ vaccination was important for patients aged 50-59, 60-69, and ≥70 years, with importance increasing with advancing age. During a typical week, an average of 44% (standard deviation = 32%) of PCPs reported initiating a conversation about HZ vaccination among adults aged 50-59 years. Key perceived barriers to recommending HZ vaccines to adults were contraindications and insufficient time to assess risk factors, while perceived HZ vaccine administration challenges included patients' out-of-pocket costs and lack of motivation. Results suggest that PCPs may benefit from updated information about ACIP recommendations, while both patients and providers may benefit from streamlining the vaccination process and educational efforts focused on addressing perceived barriers.

Introduction The burden of respiratory syncytial virus (RSV) disease is substantial among adults aged ≥ 60 years and adults with risk factors for severe RSV. This study assessed the knowledge, attitudes, and practices of healthcare professionals (HCPs) related to RSV disease and vaccination, with a focus on adults aged ≥ 60 years. Methods During November 14–30, 2023, a cross-sectional, web-based survey was administered to HCPs, targeting a total of 600 primary care physicians (PCPs), specialist physicians, nurse practitioners (NPs)/physician assistants (PAs), and pharmacists. Survey questions evaluated knowledge about RSV disease, vaccines, and vaccination recommendations; RSV-related attitudes and perceptions; and RSV vaccination practices. Responses were analyzed descriptively, overall and by HCP subgroup. Multivariable logistic regression models were used to explore HCP characteristics associated with RSV vaccination knowledge and practices. Results Of the 603 respondents (148 PCPs, 151 specialist physicians, 150 NPs/PAs, and 154 pharmacists), 63.0% were very familiar with RSV disease in patients aged ≥ 60 years. Although most HCPs recognized the benefits of RSV vaccination within this patient population, many HCPs were not fully knowledgeable about RSV vaccine recommendations, and 33.5% had not recommended, prescribed, or administered any RSV vaccine to patients aged ≥ 60 years in the previous 3 months. In multivariable regression analyses, HCP familiarity with RSV disease (among other factors) was consistently associated with RSV vaccination knowledge and practices. Conclusions This study characterized RSV disease- and vaccine-related knowledge, attitudes, and practices among HCPs in the United States during the first season of RSV vaccine availability for adults aged ≥ 60 years. These findings can help to inform HCP and patient education efforts to address potential RSV vaccination knowledge gaps and ensure equitable access to RSV vaccines among older adults.