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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p class="elsevierStyleSimplePara elsevierViewall">La gripe es la mayor causa de morbimortalidad en el mundo&#46; Actualmente&#44; las vacunas contra la gripe son efectivas y seguras&#46; Las intervenciones que reduzcan la carga de la enfermedad deben analizarse desde el punto de vista cl&#237;nico y econ&#243;mico&#46;</p> <span class="elsevierStyleSectionTitle">Objetivos</span><p class="elsevierStyleSimplePara elsevierViewall">Evaluar la eficiencia de un programa de vacunaci&#243;n contra la gripe en la poblaci&#243;n laboral espa&#241;ola&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Modelo te&#243;rico de an&#225;lisis de costes y beneficios en t&#233;rminos de ahorro para una cohorte de 1&#46;000 trabajadores entre 16 y 65 a&#241;os de edad vacunada&#44; y otra no vacunada&#44; a 1 a&#241;o desde la perspectiva social&#46; Intervenciones&#58; vacunaci&#243;n contra la gripe respecto a no vacunaci&#243;n&#46; Mediciones principales datos epidemiol&#243;gicos y cl&#237;nicos de incidencia de gripe y efectividad de la vacuna&#46; Datos de uso de recursos directos &#40;de atenci&#243;n primaria y especializada&#41; e indirectos obtenidos por consenso de 5 expertos en medicina preventiva&#44; microbiolog&#237;a&#44; medicina del trabajo y econom&#237;a de la salud&#46; Datos de costes unitarios &#40;euros de 2003&#41;&#46; Se realiz&#243; un an&#225;lisis de sensibilidad con la incidencia de gripe&#44; la efectividad de la vacuna y los d&#237;as de ausencia del trabajo por gripe&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">En el escenario base&#44; la vacuna permite ahorrar 35 euros netos por trabajador &#40;el 88&#37; corresponde al ahorro en p&#233;rdidas de productividad evitadas&#41;&#46; El an&#225;lisis de sensibilidad indica que los valores umbral de incidencia de gripe y de ausencia del trabajo son del 6&#37; y de 1&#44;5 d&#237;as&#44; respectivamente&#44; a partir de los cuales la vacunaci&#243;n se asocia con el ahorro neto&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Vacunar contra la gripe a la poblaci&#243;n laboral espa&#241;ola puede comportar un ahorro neto a la sociedad&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStyleSimplePara elsevierViewall">Influenza is a major cause of morbidity and mortality worldwide&#46; Currently&#44; licensed influenza vaccines are safe and effective&#46; Any intervention aimed at reducing the burden of illness is worth analyzing from a clinical and economic perspective&#46;</p> <span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">To assess the costs and benefits of an influenza vaccination program in the Spanish working population&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStyleSimplePara elsevierViewall">A theoretical model of costs and benefits in terms of productivity savings was developed to compare 2 strategies &#40;vaccination and non-vaccination&#41; in 2 cohorts of 1&#44;000 workers each&#46; The time horizon was 1 year and the study&#8217;s perspective was societal&#46; Main outcome measures&#58; epidemiological and clinical data on the incidence of influenza and the effectiveness of the vaccine&#46; Data on the use of direct and indirect resources were obtained from an expert panel of 5 experts in preventive medicine&#44; microbiology&#44; occupational health&#44; and health economics&#46; Unit costs &#40;euros 2003&#41; were extracted from local databases&#46; A sensitivity analysis was performed with the data on incidence&#44; effectiveness&#44; and work absenteeism due to influenza&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">In the base case scenario&#44; influenza vaccine saved 35 Euros per worker&#44; of which 88&#37; were savings in work loss days avoided&#46; Threshold values in the sensitivity analysis were 6&#37; for the incidence of influenza and 1&#46;5 days for absence from work&#44; above which the vaccine leads to net savings&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Influenza vaccination in the Spanish working population might result in net resource savings to society at large&#46;</p>"
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                        "paginaInicial" => "60"
                        "paginaFinal" => "62"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention and control of influenza&#46; Recommendations of the Advisory Committee on Immunization Practices &#40;ACIP&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "K&#46; Fukuda"
                            1 => "C&#46;B&#46; Bridges"
                            2 => "T&#46;L&#46; Brammer"
                            3 => "H&#46;S&#46; Izurieta"
                            4 => "N&#46;J&#46; Cox"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "MMWR"
                        "fecha" => "1999"
                        "volumen" => "48"
                        "paginaInicial" => "1"
                        "paginaFinal" => "28"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12412613"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Instituto Nacional de Estad&#237;stica 2003&#46; Base de datos tempus&#46; Resultados de 1999 &#91;citado Dic 2003&#93;&#46; Disponible en&#58; <a class="elsevierStyleInterRef" href="http://www.ine.es/">http&#58;&#47;&#47;www&#46;ine&#46;es</a>"
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influenza&#58; the role of burden of illness research"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "T&#46;D&#46; Szucs"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pharmacoeconomics"
                        "fecha" => "1999"
                        "volumen" => "16"
                        "paginaInicial" => "27"
                        "paginaFinal" => "32"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10623373"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Nguyen-Van-Tam&#46; Zanamivir for influenza&#58; a public health perspective&#46; BMJ&#46; 1999&#59;319&#58;655-6"
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influenza"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "N&#46;J&#46; Cox"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Infect Dis Clin North Am"
                        "fecha" => "1998"
                        "volumen" => "12"
                        "paginaInicial" => "27"
                        "paginaFinal" => "38"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9494827"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A pharmacoeconomic model for the treatment of influenza"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;A Mauskopf"
                            1 => "C Cates"
                            2 => "A&#46;D&#46; Griffin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pharmacoeconomics"
                        "fecha" => "1999"
                        "volumen" => "16"
                        "paginaInicial" => "73"
                        "paginaFinal" => "84"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10623380"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "French economic evaluations of influenza and influenza vaccination"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "E&#46; Levy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pharmacoeconomics"
                        "fecha" => "1996"
                        "volumen" => "9"
                        "paginaInicial" => "62"
                        "paginaFinal" => "66"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10160489"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The socio-economic burden of influenza"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "T&#46; Szucs"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Antimicrob Chemother"
                        "fecha" => "1999"
                        "volumen" => "44"
                        "paginaInicial" => "11"
                        "paginaFinal" => "15"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10877457"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incapacidad temporal entre profesionales administrativos y enfermeras"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46; Buitrago"
                            1 => "L&#46; Lozano"
                            2 => "C&#46; Fern&#225;ndez Lozano"
                            3 => "F&#46; Bonino"
                            4 => "M&#46; Candela"
                            5 => "J&#46; Altimiras"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gac Sanit"
                        "fecha" => "1993"
                        "volumen" => "7"
                        "paginaInicial" => "190"
                        "paginaFinal" => "195"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8375971"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effectiveness of influenza vaccine in health care professionals&#58; a randomised trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; Wide"
                            1 => "J&#46;A&#46; McMillan"
                            2 => "J&#46; Serwint"
                            3 => "J&#46; Butta"
                            4 => "M&#46;A&#46; O&#8217;Riordan"
                            5 => "M&#46;C&#46; Steinhoff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "1999"
                        "volumen" => "281"
                        "paginaInicial" => "908"
                        "paginaFinal" => "913"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10078487"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effectiveness and cost-benefit of influenza vaccination of healthy working adults&#58; a randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;B&#46; Bridges"
                            1 => "W&#46;W&#46; Thomson"
                            2 => "M&#46;I&#46; Meltzer"
                            3 => "G&#46;R&#46; Rev&#233;"
                            4 => "W&#46;J&#46; Talamonti"
                            5 => "N&#46;J&#46; Cox"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2000"
                        "volumen" => "284"
                        "paginaInicial" => "1655"
                        "paginaFinal" => "1663"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11015795"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Immunogenicity and efficacy of Russian live attenuated and US inactivated influenza vaccines used alone and in combination in nursing home residents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;G&#46; Rudenko"
                            1 => "N&#46;H&#46; Arden"
                            2 => "E&#46; Grigorieva"
                            3 => "A&#46; Naychin"
                            4 => "A&#46; Rekstin"
                            5 => "A&#46;I&#46; Klimov"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Vaccine"
                        "fecha" => "2000"
                        "volumen" => "19"
                        "paginaInicial" => "308"
                        "paginaFinal" => "318"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10930686"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effectiveness of vaccination against influenza in healthy working adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;L&#46; Nichol"
                            1 => "A&#46; Lind"
                            2 => "K&#46;L&#46; Margolis"
                            3 => "M&#46; Murdoch"
                            4 => "R&#46; McFadden"
                            5 => "M&#46; Hauge"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199510053331401"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1995"
                        "volumen" => "333"
                        "paginaInicial" => "889"
                        "paginaFinal" => "893"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7666874"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Sociedad Espa&#241;ola de Medicina Familiar y Comunitaria&#46; Programa de Actividades Preventivas y de Promoci&#243;n de Salud de la SEMFyC&#58; calendario vacunal del adulto &#91;en l&#237;nea&#93; PAPPS-SEMFyC&#44; 2003 &#91;citado 2 Feb 2004&#93;&#46; Disponible en&#58; <a class="elsevierStyleInterRef" href="http://www.papps.org/publicaciones/calendario_vacunal.pdf">http&#58;&#47;&#47;www&#46;papps&#46;org&#47;publicaciones&#47;calendario&#95;vacunal&#46;pdf</a>"
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Circular 2001&#46; Campa&#241;a de vacunaci&#243;n antigripal 2001-2002&#46; Santiago de Compostela&#58; Xunta de Galicia&#44; Conseller&#237;a de Sanidade&#44; Direcci&#243;n Xeral de Sanidade P&#250;blica&#59; 2001&#46;"
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment Guidelines for the economic evaluation of pharmaceuticals"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Canadian Coordinating Office for Health Technology"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1998"
                        "editorial" => "CCOHTA"
                        "editorialLocalizacion" => "Ottawa"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The friction cost method for measuring indirect costs of disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;A&#46; Koopmanschap"
                            1 => "F&#46;F&#46; Rutten"
                            2 => "B&#46;M&#46; Van Ineveld"
                            3 => "L&#46; Van Roijen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Health Economics"
                        "fecha" => "1995"
                        "volumen" => "14"
                        "paginaInicial" => "171"
                        "paginaFinal" => "189"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "SOIKOS&#46; Base de datos de costes sanitarios&#46; Barcelona&#58; Centro de estudios en Econom&#237;a de la Salud y Pol&#237;tica Social&#59; 2003&#46;"
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "CGCOF&#58; Base de datos de Medicamentos&#46; Consejo General de Colegios Oficiales de Farmac&#233;uticos&#46; Disponible en&#58; <a class="elsevierStyleInterRef" href="http://www.portalfarma.com/">www&#46;portalfarma&#46;com</a>"
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "INE&#46;es &#91;en l&#237;nea&#93;&#46; Madrid&#58; Instituto Nacional de Estad&#237;stica&#59; 2004 &#91;citado 28 Feb 2005&#93;&#46; Disponible en&#58; <a class="elsevierStyleInterRef" href="http://www.ine.es/">http&#58;&#47;&#47;www&#46;ine&#46;es</a>"
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy of vaccination against influenza among working people- results of epidemiological studies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "W&#46; Hanke"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Pr"
                        "fecha" => "2000"
                        "volumen" => "51"
                        "paginaInicial" => "475"
                        "paginaFinal" => "484"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11199177"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influenza in Singapore&#58; assessing the burden of illness in the community"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46;P&#46; Ng"
                            1 => "K&#46;H&#46; Pwee"
                            2 => "M&#46; Niti"
                            3 => "L&#46;G&#46; Goh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Acad Med Singapore"
                        "fecha" => "2002"
                        "volumen" => "31"
                        "paginaInicial" => "182"
                        "paginaFinal" => "188"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11957555"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effectiveness and cost-benefit of influenza vaccination of healthy working adults&#58; a randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;B&#46; Bridges"
                            1 => "W&#46;W&#46; Thompson"
                            2 => "M&#46;I&#46; Meltzer"
                            3 => "G&#46;R&#46; Reeve"
                            4 => "W&#46;J&#46; Talamonti"
                            5 => "N&#46;J&#46; Cox"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2000"
                        "volumen" => "284"
                        "paginaInicial" => "1655"
                        "paginaFinal" => "1663"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11015795"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effectiveness of influenza vaccination in healthy adults&#58; a fourfold decrease in influenza morbidity during one influenza season"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Chilbek"
                            1 => "J&#46; Beran"
                            2 => "M&#46; Splino"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Epidemiol Mikrobiol Imunol"
                        "fecha" => "2002"
                        "volumen" => "51"
                        "paginaInicial" => "47"
                        "paginaFinal" => "51"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11987579"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effectiveness of influenza vaccine in health care professionals&#58; a randomized trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; Wilde"
                            1 => "J&#46;A&#46; McMillan"
                            2 => "J&#46; Serwint"
                            3 => "J&#46; Butta"
                            4 => "M&#46;A&#46; O&#8217;Riordan"
                            5 => "M&#46;C&#46; Steinhoff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "1999"
                        "volumen" => "281"
                        "paginaInicial" => "908"
                        "paginaFinal" => "913"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10078487"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The efficacy&#44; effectiveness and cost-effectiveness of inactivated influenza virus vaccines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "K&#46;L&#46; Nichol"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Vaccine"
                        "fecha" => "2003"
                        "volumen" => "21"
                        "paginaInicial" => "1769"
                        "paginaFinal" => "1775"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12686092"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib35"
              "etiqueta" => "35&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anti-influenza vaccination for active persons &#40;25-64&#41;&#58; a cost-benefit study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
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                            1 => "P&#46; Levy"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Epidemiol Sante Publique"
                        "fecha" => "1992"
                        "volumen" => "40"
                        "paginaInicial" => "285"
                        "paginaFinal" => "295"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1480805"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib36"
              "etiqueta" => "36&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost-effectiveness of the influenza vaccine in a healthy&#44; working-age population"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;S&#46; Campbell"
                            1 => "M&#46;H&#46; Rumley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JOEM"
                        "fecha" => "1997"
                        "volumen" => "39"
                        "paginaInicial" => "408"
                        "paginaFinal" => "414"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9172085"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib37"
              "etiqueta" => "37&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Introducci&#243;n a la evaluaci&#243;n econ&#243;mica de medicamentos y otras tecnolog&#237;as sanitarias"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "X&#46; Badia"
                            1 => "J&#46; Rovira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1995"
                        "editorial" => "Luz&#225;n S&#46;A&#46;"
                        "editorialLocalizacion" => "Madrid"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib38"
              "etiqueta" => "38&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estudio de prescripciones m&#233;dicas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "International Marketing Services"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1999"
                        "editorial" => "IMS Ib&#233;rica&#44; S&#46;A&#46;"
                        "editorialLocalizacion" => "Madrid"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib39"
              "etiqueta" => "39&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prescripci&#243;n antibi&#243;tica en las infecciones respiratorias agudas del adulto&#58; su variabilidad e idoneidad en diez hospitales espa&#241;oles"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Inglada"
                            1 => "J&#46;M&#46; Eiros"
                            2 => "C&#46; Ochoa"
                            3 => "A&#46; Vallano"
                            4 => "L&#46;I&#46; Armadans"
                            5 => "J&#46;B&#46; Vidal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "1999"
                        "volumen" => "199"
                        "paginaInicial" => "59"
                        "paginaFinal" => "65"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10216395"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib40"
              "etiqueta" => "40&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The socio-economic aspects and behavioral effects of influenza"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Smith"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:2 [
                        "titulo" => "Influenza&#58; strategies for prevention"
                        "serieFecha" => "1988"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib41"
              "etiqueta" => "41&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Productivity losses without absence&#58; measurement validation and empirical evidence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "W&#46;B&#46; Brouwer"
                            1 => "M&#46;A&#46; Koopmanschap"
                            2 => "F&#46;F&#46; Rutten"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Health Policy"
                        "fecha" => "1999"
                        "volumen" => "48"
                        "paginaInicial" => "13"
                        "paginaFinal" => "27"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10539583"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
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                ]
              ]
            ]
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Vol. 20. Núm. 2.
Páginas 101-107 (marzo - abril 2006)
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Vol. 20. Núm. 2.
Páginas 101-107 (marzo - abril 2006)
Originales
Open Access
Evaluación de la eficiencia de la vacunación antigripal en la población laboral española
Efficiency of influenza vaccination in the working population in Spain
Visitas
972
José Ramón de Juanesa,
, Ramón Cisternab, Javier Sanzc, Sol Magazd, Xavier Badiad
a Servicio de Medicina Preventiva, Hospital 12 de Octubre, Madrid, España
b Servicio de Microbiología, Hospital de Basurto, Vizcaya, España
c Servicio Médico Deloitte, Madrid, España
d Health Outcomes Research Europe Group, Barcelona, España
Este artículo ha recibido

Under a Creative Commons license
Información del artículo
Resumen
Introducción

La gripe es la mayor causa de morbimortalidad en el mundo. Actualmente, las vacunas contra la gripe son efectivas y seguras. Las intervenciones que reduzcan la carga de la enfermedad deben analizarse desde el punto de vista clínico y económico.

Objetivos

Evaluar la eficiencia de un programa de vacunación contra la gripe en la población laboral española.

Métodos

Modelo teórico de análisis de costes y beneficios en términos de ahorro para una cohorte de 1.000 trabajadores entre 16 y 65 años de edad vacunada, y otra no vacunada, a 1 año desde la perspectiva social. Intervenciones: vacunación contra la gripe respecto a no vacunación. Mediciones principales datos epidemiológicos y clínicos de incidencia de gripe y efectividad de la vacuna. Datos de uso de recursos directos (de atención primaria y especializada) e indirectos obtenidos por consenso de 5 expertos en medicina preventiva, microbiología, medicina del trabajo y economía de la salud. Datos de costes unitarios (euros de 2003). Se realizó un análisis de sensibilidad con la incidencia de gripe, la efectividad de la vacuna y los días de ausencia del trabajo por gripe.

Resultados

En el escenario base, la vacuna permite ahorrar 35 euros netos por trabajador (el 88% corresponde al ahorro en pérdidas de productividad evitadas). El análisis de sensibilidad indica que los valores umbral de incidencia de gripe y de ausencia del trabajo son del 6% y de 1,5 días, respectivamente, a partir de los cuales la vacunación se asocia con el ahorro neto.

Conclusiones

Vacunar contra la gripe a la población laboral española puede comportar un ahorro neto a la sociedad.

Palabras clave:
Gripe
Vacunación
Costes
Productividad
Abstract
Introduction

Influenza is a major cause of morbidity and mortality worldwide. Currently, licensed influenza vaccines are safe and effective. Any intervention aimed at reducing the burden of illness is worth analyzing from a clinical and economic perspective.

Objective

To assess the costs and benefits of an influenza vaccination program in the Spanish working population.

Methods

A theoretical model of costs and benefits in terms of productivity savings was developed to compare 2 strategies (vaccination and non-vaccination) in 2 cohorts of 1,000 workers each. The time horizon was 1 year and the study’s perspective was societal. Main outcome measures: epidemiological and clinical data on the incidence of influenza and the effectiveness of the vaccine. Data on the use of direct and indirect resources were obtained from an expert panel of 5 experts in preventive medicine, microbiology, occupational health, and health economics. Unit costs (euros 2003) were extracted from local databases. A sensitivity analysis was performed with the data on incidence, effectiveness, and work absenteeism due to influenza.

Results

In the base case scenario, influenza vaccine saved 35 Euros per worker, of which 88% were savings in work loss days avoided. Threshold values in the sensitivity analysis were 6% for the incidence of influenza and 1.5 days for absence from work, above which the vaccine leads to net savings.

Conclusions

Influenza vaccination in the Spanish working population might result in net resource savings to society at large.

Key words:
Influenza
Vaccination
Costs
Productivity
El Texto completo está disponible en PDF
Bibliografía
[1.]
D.M. Fleming.
The impact of three influenza epidemics on primary care in England and Wales.
Pharmacoeconomics, 9 (1996), pp. 38-45
[2.]
P. Farreras, C Rozman.
Medicina interna.
14.a ed., Ediciones Harcourt, (2000),
[3.]
M.I. Meltzer, N.J. Cox, K. Fukuda.
The economic impact of pandemic influenza in the United States: priorities for intervention.
Emerg Infect Dis, 5 (1999), pp. 659-671
[4.]
R.G. Webster.
1918 Spanish influenza: the secrets remain elusive.
Proc Natl Acad Sci, 96 (1999), pp. 1164-1166
[5.]
J. Vidal.
La gripe, un problema pendiente.
Med Clin (Barc), 96 (1991), pp. 60-62
[6.]
I. Almuzara.
Análisis económico del coste de la gripe aplicado a la provincia de Huesca.
Rev San Hig Pub, 61 (1987), pp. 1017-1028
[7.]
A.S. Monto.
Individual and community impact of influenza.
Pharmacoeconomics, 16 (1999), pp. 1-16
[8.]
J. Vidal.
La gripe, un problema pendiente.
Med Clin (Barc), 96 (1991), pp. 60-62
[9.]
K. Fukuda, C.B. Bridges, T.L. Brammer, H.S. Izurieta, N.J. Cox.
Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP).
MMWR, 48 (1999), pp. 1-28
[10.]
Instituto Nacional de Estadística 2003. Base de datos tempus. Resultados de 1999 [citado Dic 2003]. Disponible en: http://www.ine.es
[11.]
T.D. Szucs.
Influenza: the role of burden of illness research.
Pharmacoeconomics, 16 (1999), pp. 27-32
[12.]
Nguyen-Van-Tam. Zanamivir for influenza: a public health perspective. BMJ. 1999;319:655-6
[13.]
N.J. Cox.
Influenza.
Infect Dis Clin North Am, 12 (1998), pp. 27-38
[14.]
J.A Mauskopf, C Cates, A.D. Griffin.
A pharmacoeconomic model for the treatment of influenza.
Pharmacoeconomics, 16 (1999), pp. 73-84
[15.]
E. Levy.
French economic evaluations of influenza and influenza vaccination.
Pharmacoeconomics, 9 (1996), pp. 62-66
[16.]
T. Szucs.
The socio-economic burden of influenza.
J Antimicrob Chemother, 44 (1999), pp. 11-15
[17.]
F. Buitrago, L. Lozano, C. Fernández Lozano, F. Bonino, M. Candela, J. Altimiras.
Incapacidad temporal entre profesionales administrativos y enfermeras.
Gac Sanit, 7 (1993), pp. 190-195
[18.]
J.A. Wide, J.A. McMillan, J. Serwint, J. Butta, M.A. O’Riordan, M.C. Steinhoff.
Effectiveness of influenza vaccine in health care professionals: a randomised trial.
JAMA, 281 (1999), pp. 908-913
[19.]
C.B. Bridges, W.W. Thomson, M.I. Meltzer, G.R. Revé, W.J. Talamonti, N.J. Cox, et al.
Effectiveness and cost-benefit of influenza vaccination of healthy working adults: a randomised controlled trial.
JAMA, 284 (2000), pp. 1655-1663
[20.]
L.G. Rudenko, N.H. Arden, E. Grigorieva, A. Naychin, A. Rekstin, A.I. Klimov, et al.
Immunogenicity and efficacy of Russian live attenuated and US inactivated influenza vaccines used alone and in combination in nursing home residents.
Vaccine, 19 (2000), pp. 308-318
[21.]
K.L. Nichol, A. Lind, K.L. Margolis, M. Murdoch, R. McFadden, M. Hauge, et al.
The effectiveness of vaccination against influenza in healthy working adults.
N Engl J Med, 333 (1995), pp. 889-893
[22.]
Sociedad Española de Medicina Familiar y Comunitaria. Programa de Actividades Preventivas y de Promoción de Salud de la SEMFyC: calendario vacunal del adulto [en línea] PAPPS-SEMFyC, 2003 [citado 2 Feb 2004]. Disponible en: http://www.papps.org/publicaciones/calendario_vacunal.pdf
[23.]
Circular 2001. Campaña de vacunación antigripal 2001-2002. Santiago de Compostela: Xunta de Galicia, Consellería de Sanidade, Dirección Xeral de Sanidade Pública; 2001.
[24.]
Canadian Coordinating Office for Health Technology.
Assessment Guidelines for the economic evaluation of pharmaceuticals.
CCOHTA, (1998),
[25.]
M.A. Koopmanschap, F.F. Rutten, B.M. Van Ineveld, L. Van Roijen.
The friction cost method for measuring indirect costs of disease.
J Health Economics, 14 (1995), pp. 171-189
[26.]
SOIKOS. Base de datos de costes sanitarios. Barcelona: Centro de estudios en Economía de la Salud y Política Social; 2003.
[27.]
CGCOF: Base de datos de Medicamentos. Consejo General de Colegios Oficiales de Farmacéuticos. Disponible en: www.portalfarma.com
[28.]
INE.es [en línea]. Madrid: Instituto Nacional de Estadística; 2004 [citado 28 Feb 2005]. Disponible en: http://www.ine.es
[29.]
W. Hanke.
Efficacy of vaccination against influenza among working people- results of epidemiological studies.
Med Pr, 51 (2000), pp. 475-484
[30.]
T.P. Ng, K.H. Pwee, M. Niti, L.G. Goh.
Influenza in Singapore: assessing the burden of illness in the community.
Ann Acad Med Singapore, 31 (2002), pp. 182-188
[31.]
C.B. Bridges, W.W. Thompson, M.I. Meltzer, G.R. Reeve, W.J. Talamonti, N.J. Cox, et al.
Effectiveness and cost-benefit of influenza vaccination of healthy working adults: a randomized controlled trial.
JAMA, 284 (2000), pp. 1655-1663
[32.]
R. Chilbek, J. Beran, M. Splino.
Effectiveness of influenza vaccination in healthy adults: a fourfold decrease in influenza morbidity during one influenza season.
Epidemiol Mikrobiol Imunol, 51 (2002), pp. 47-51
[33.]
J.A. Wilde, J.A. McMillan, J. Serwint, J. Butta, M.A. O’Riordan, M.C. Steinhoff.
Effectiveness of influenza vaccine in health care professionals: a randomized trial.
JAMA, 281 (1999), pp. 908-913
[34.]
K.L. Nichol.
The efficacy, effectiveness and cost-effectiveness of inactivated influenza virus vaccines.
Vaccine, 21 (2003), pp. 1769-1775
[35.]
E. Levy, P. Levy.
Anti-influenza vaccination for active persons (25-64): a cost-benefit study.
Rev Epidemiol Sante Publique, 40 (1992), pp. 285-295
[36.]
D.S. Campbell, M.H. Rumley.
Cost-effectiveness of the influenza vaccine in a healthy, working-age population.
JOEM, 39 (1997), pp. 408-414
[37.]
X. Badia, J. Rovira.
Introducción a la evaluación económica de medicamentos y otras tecnologías sanitarias.
Luzán S.A., (1995),
[38.]
International Marketing Services.
Estudio de prescripciones médicas.
IMS Ibérica, S.A., (1999),
[39.]
L. Inglada, J.M. Eiros, C. Ochoa, A. Vallano, L.I. Armadans, J.B. Vidal, et al.
Prescripción antibiótica en las infecciones respiratorias agudas del adulto: su variabilidad e idoneidad en diez hospitales españoles.
Rev Clin Esp, 199 (1999), pp. 59-65
[40.]
A. Smith.
The socio-economic aspects and behavioral effects of influenza.
Influenza: strategies for prevention,
[41.]
W.B. Brouwer, M.A. Koopmanschap, F.F. Rutten.
Productivity losses without absence: measurement validation and empirical evidence.
Health Policy, 48 (1999), pp. 13-27
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