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Economische evaluatie. Diana De Graeve Faculteit Toegepaste economische Wetenschappen Universiteit Antwerpen. Inhoud. Situering en definitie van economische evaluatie Methodologie Soorten Kosten Verdisconteren Data en Sensitiviteitsanalyse - PowerPoint PPT Presentation

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  • Economische evaluatie

  • Diana De Graeve

    Faculteit Toegepaste economische WetenschappenUniversiteit Antwerpen

  • InhoudSituering en definitie van economische evaluatieMethodologie SoortenKostenVerdisconterenData en SensitiviteitsanalyseWenselijkheid van het gebruik van evaluatiestudies

  • Gezondheids-economieEconomische evaluatie

  • Financieel belang van de sectorBelangrijke mate van overheidsfinanciering

    + specifieke karakteristieken van gezondheidszorg

    Onzekerheid Informatie asymmetrieExternaliteitenMeer dan ooit nodig dat toegekeken wordt dat men waarde krijgt voor zijn geld, dat is de best mogelijke gezondheid en gezondheidszorg met de beschikbare middelen

  • Economische analyse houdt in Identificatie van alternatieven hun gevolgen en hun kosten de waardes daarvan en hoe ze vergelijken om het beleid te kunnen informeren bij beslissing wat te kiezen

  • Beoordelingscriteria voor nieuwe therapienKan een therapie werken? EfficacyHeeft een therapie aanvaardbare neveneffecten? VeiligheidWerkt een therapie? EffectiviteitGeeft een therapie waarde voor zijn geld? Efficintie (kosten-effectiviteit)Economische evaluatie

    Ont-wik-kelingEBMBeleid

  • Economische evaluatie = comparatieve analyse van alternatieve interventies in termen van hun kosten en effectenKosten BKeuzeKosten AProgramma AAlternatief BEffecten AEffecten BPERSPECTIEf ...

  • Basiskenmerkenzowel kosten (K) als effecten (E) opnemen vergelijkend (incrementeel) tussen alternatievenK1 - K0

    E1 - E0

  • Vergelijking van alternatieven: welke?Alle relevante alternatieven Alternatieven om resistentie te verminderen: reclamecampagne om gebruik AB te verminderen;richtlijnen voor gepast gebruik AB; isolatie om verspreiding resistente kiemen te verminderen.Alternatieven voor behandeling pneumokokkeninfectie in het ziekenhuis of thuis met een vroegtijdige overstap naar een oraal antibioticumMet nieuw antibioticum Met het standaard product . Vanuit praktische overwegingen vaak slechts twee tot drie alternatieven Niets doen is ook een alternatief

  • Welk standpunt aannemen voor de analyse?Alles kanZiekenhuisRIZIVpatintwerkgever...Wel steeds uitdrukkelijk vermeldenMaatschappelijk standpunt verdient de voorkeur

  • Situering en definitie van economische evaluatieMethodologie SoortenKostenVerdisconterenData en SensitiviteitsanalyseWenselijkheid van het gebruik van evaluatiestudies

  • Soorten economische evaluatiestudiesKosten-minimeringsanalyseeffecten zijn identiekKosten-effectiviteitsanalyseeffecten gemeten in natuurlijke eenheden (bv levensjaren)Kosten-batenanalyseeffecten gemeten in geldKosten-nutsanalyseeffecten gemeten in nutseenheden (bv Qualy)

  • Kosten-minimeringsanalyseeffecten zijn identiek voor de verschillende alternatieven, dus kunnen we ons beperken tot een vergelijking van de kosten

  • welke kosten?directe kosten medische : organisatie- en uitvoeringskost voor gezondheidssector en patintenniet-medische : buiten de gezondheidssector, m.n. patinten en familie en andere sectorenindirecte kosten medische : med. kost tijdens gewonnen levensjarenniet-medische : opportuniteitskost van tijdontastbare kosten (intangibles)Pijn, ongemak

  • Kosten van antimicrobile resistentieExtra onderzoek en behandelingLangere ligduur en langere afwezigheid op het werkKosten van isolatie, verhoogde surveillantie Kosten van vroegtijdige mortaliteit

    Voorbeeld

  • Belang van het standpunt van de analyseWelke kosten opgenomen worden hangt af van het standpunt van de analyse

    Riziv: directe medische kosten van verschillende behandelingenPatint: remgelden en verplaatsingskostenMaatschappelijk standpunt: alle kosten

  • Alternatieven behandeling CAP 1) gebruik makend van een kritisch pad (pneumonie ernstscore, criteria voor overschakeling van IV naar oraal AB (Levofloxacine), criteria voor ontslag uit het ziekenhuis 2) conventionele behandelingVoorbeeldRef. Palmer, CS., Zhan, C., Elixhauser, A., Economic assessment of the community-acquired pneumonia intervention trial employing levofloxacin. Clinical Therapeutics, 2000; 22(2): 250-264.

  • Belang van het standpunt van de analyse (bedragen in Can$, 1998)Ref. Palmer, Zhan, Elixhauser, Clinical Therapeutics, 2000.

  • Hoe kosten waarderen?opportuniteitskost : waarde beste alternatieve aanwendingprijsmarginale kostconstante waarde : effect van inflatie wegnemen aanpassen voor tijdsvoorkeur: verdisconteren

  • Kosten of tarieven (Cohen et al, 1993)

  • Kosten versus tarieven ligdagKostenopname0ligdagenontslagHotelkostenhligdagprijsd1

  • Fine M.J., Pratt H.M.; Obrosky D.S.; Lave J.R.; McIntosh L.J.; Singer D.E.; Coley C.M.; Kapoor W.N., Relation between length of hospital stay and costs of care for patients with community-acquired pneumonia, The American Journal of Medicine, 2000(109): 378-85Totale ziekenhuiskost is hoogst op dag 0, daalt snel tot dag 1 of 2 en daalt nadien geleidelijk verderMediaan ziekenhuiskost per dag: $849Gemiddelde besparingen van een reductie in ligduur met 1 dag: $680 met 2 dagen: $1 408Voorbeeld

  • Jorissen, De Graeve, Vivet, An empirical analysis into the drivers of resource consumption in Intensive Care Units.

  • Marginale en incrementele kostenhoeveelheidMKProgramma AProgramma BQ1MK B,Q1MK B,Q2MK A,Q1MK A,Q2IKA-B, Q1IKA-B, Q2

  • Tijdsverschillen: verdisconterenkosten in de toekomst minder zwaar wegen: reden tijdsvoorkeur economische groei en risico-aversie opportuniteitskostbasis discontovoet = 3% (?)methode: AW= Fn(1+r)-n Met: AW= actuele waarde Fn = toekomstige kost in jaar n r = discontovoet

  • Actuele waarde van 100 Euro op verschillende tijdstippen

  • Verdisconteren en resistentieWanneer de kosten van resistentie zich in de (verre) toekomst voordoen, wordt hun actuele waarde klein na verdisconteren

    MaarHet gebruik van verdisconteren wordt ter discussie gesteld bij intergenerationele billijkheidDe gevolgen van resistentie zijn er ook nu al

  • Waar kosten verzamelen: gebruik van klinische proevenklinische omgevingprotocolvergelijkingstherapiesteekproefgrootteobservatieperiodeadditionele variabelenbetrouwbare informatiestatistische analyse van kosten mogelijkclinici + economisten = verhoogde geloofwaar -digheid en impactminimum additionele inspanning voor maximum informatie problemenvoordelen

  • methodologische aspecten opnemen en waarderen van de indirecte medische kosten (tijdens gewonnen levensjaren) en niet-medische kosten (verloren productiviteit door morbiditeit en mortaliteit) methode van het menselijk kapitaalfrictiekostenmethode

  • Kosten-effectiviteitsanalysekosten worden gemeten (in geld) en effecten worden gemeten en uitgedrukt in unidimensionele natuurlijke eenheden

  • Welke Effecten?Mortaliteitgered levengered levensjaarClinische resultaten % stijging in fev1 (asthma) % verlaging cholesterolniveau (hypercholesterolemie)aantal ontdekte kankersSamenvattende maatstaven voor klinische resultatensymptoom-vrije dagepisode-vrije dagsuccessvolle behandelingsweekverminderding asthma aanvallen

  • Waar worden de effectiviteitsdata gehaald?medische literatuurgrote dubbel blind gerandomiseerde trials (RCTs)kleine RCTsniet-gerandomiseerde studies met controlegroepniet-gerandomiseerde studies met historische controlegroepgeen controlegroep

  • Verdisconteren van effectenneenlevensjaren nu kunnen niet verhandeld worden in de tijd; het zou toekomstige generaties benadelenjainconsistentiesmen kan wel gezondheid nu verlagen om daarna langer te levenZelfde discontovoet?

  • Resultaten van de evaluatie: Kosten-effectiviteitsratio (CE-ratio)Incrementele vergelijking van de kosten en effecten van de alternatievenstandaardbehandeling: K1 E1nieuwe therapie:K2E2CE-ratio: K2 - K1 = Kost per eenheid effect E2 - E1

  • kosten effect (LY)A

  • Ref: Hunter, P. Moxifloxacin IV-to-oral switch proves cost effective in patients with CAP. Inpharma, 2002; 1(1343): 5-6. (2) IV amoxicillin/clavulanic acid 1.2g 3x daily followed by oral amoxicillin/clavulanic acid 625mg 3x daily clarithromycin voor beide alternatieven omschakeling naar orale therapie bepaald door de arts(1) IV Moxifloxacin 400mg once daily followed by oral Behandeling van ernstig zieke patinten met CAP die parenterale therapie nodig hebben Voorbeeld

  • Directe medische kosten van beide alternatievenHunter, 20023377205237261870

  • effectenHunter, 2002

  • duurderminder duureffectieverminder effectiefDominantie nieuwe therapie (Moxifloxacine)vergelijking nieuwe therapie (Moxifloxacine) t.o.v. standaard (Amoxicilline clavulaanzuur)

  • tAgeSurvivalprobability1.0with treatment 1 with treatment 0 t refers to current age and Fs to the probability that the individual is still alive at age s, r refers to the discount rate

  • Average CE ratioC1/E1 Equivalent to an incremental analysis where the alternative is costless and causes immediate death.In general, the use of average ratios will not result in a correct ranking of (mutually exclusive) treatments.

  • Marginale (syn: incrementele) of gemiddelde analyse?Een analyse van verschillende doses van een cholesterol verlagend middel toont dat 80mg per dag een kosten-effectiviteit geeft van 35,000 per gewonnen levensjaar (LYG)40mg per dag kost 21,000 per LYGDus is het zinvol om 80mg per dag te geven omdat de gemiddelde kost per gewonnen levensjaar redelijk is?Wel...

  • Marginale analyse = wat is de extra kost Om een extra eenheid effectiveit te behalen?i.e. Verschil in kosten Verschil in effectiviteit

  • 35,000/LYG21,000/LYG85,000/LYG

  • Strict dominanceandExtended dominanceCalculate incremental ratios for each possible pair: Time consuming.Tricks reduce the number of comparisons.

  • Pet and Thallium eliminated by strict dominance.Strictly dominated alternatives are more expensive and less efficient than at least one alternative.Garber (1999).

  • Extended dominance: A linear combination of two alternatives strictly dominates a third alternative.Thallium is dominated by at least one point on a line from ECHO to SPECT.Garber (1999).

  • CEA van combinatie beta 2-agonist /corticosteroid therapie (BA + CS) met combinatie beta 2-agonist/anticholinergische therapie (BA + AC) in vgl met beta 2-agonist/ placebo therapie (BA + PL) bij volwassenenref.: Rutten-van Mlken M, Van Doorslaer E, Jansen C et. al. Cost-effectiveness of inhaled corticosteroid and bronchodilator therapy in asthma and COPD. Am Rev Respir Crit Care Med 1995; 51:975-82.Voorbeeld

  • CEA inhaled steroids and bronchodilators inadults with moderate asthma: direct costsRutten-van Mlken et al. Am Rev Respir Crit Care Med 1995710509671

  • CEA inhaled steroids and bronchodilators inadults with moderate asthma: effects*Rutten-van Mlken et al. Am Rev Respir Crit Care Med 1995

  • CE ratioKosten BA+CS - Kosten BA+PL Symptoomvrije dagen BA+CS - Symptoom-vrije dagen BA+PL 710 $US- 509 $US121 - 84201 $US37==5.43 $US/Sv dag

  • duurderminder duureffectieverminder effectiefDominantie Ba + AC beta 2-agonist /corticosteroid therapie (BA + CS) in vgl met combinatie beta 2-agonist/anticholinergische therapie (BA + AC): vergelijking nieuwe therapie t.o.v. standaardcombinatie beta 2-agonist/ anticholinergische therapie (BA + AC) in vgl met beta 2-agonist/ placebo therapie (BA + PL) bij volwassenen5.43 $US per symptoomvrije dag

  • methodologische aspecten Meten en waarderen van effectenWat betekent een verbetering v/e klinische parameter? Hoe kunnen we vergelijken?Meten en waarderen van indirecte kosten

  • Andere CE ratios voor BA+CS vs BA+PL

  • CEA inhaled steroids and bronchodilators inadults with moderate asthma: direct + indirect costsRutten-van Mlken et al. Am Rev Respir Crit Care Med 1995106371011885091554671

  • WellDeadDeadSickWellSicktt+1TimeThree-State Markov Modela11a12a13a33a23a22a21Where aij represents the transition probability of transitioning from state i to state j.

  • A decision tree

  • Kosten-nutsanalyseKosten worden gemeten (in geld) en gezondheidseffecten worden gemeten en gewaardeerd in nutseenheden

  • Meten van de effectenDe kosten-nutsanalyse houdt gelijktijdig rekening met de kwantiteit en de kwaliteit van het leven. Dit gebeurt door levensjaren te wegen met kaliteitsgewichten1 gezond levensjaar = 1 QALY1 levensjaar in minder goede gezondheid = fractie van een QALYdood = 0 QALY

  • U(z, T) = 0.5 30 = 15 = No. of QALYs if T = 30.

  • Voordelen van kosten-nutsanalyse laat toe om een brede waaier van relevante resultaten (levenswinst en diverse aspecten van levenskwaliteit) te beschouwenlaat toe om de uitkomsten te waarderen zodat meer belangrijke resultaten een groter gewicht krijgenlaat toe om een brede vergelijking te maken tussen zeer uiteenlopende gezondheids-programmas

  • Voorbeeld van een QALY berekeningGewonnen QALYs

  • Welke techniek?Rating Scale, Category scaling,Visual Analog Scale

    Waardering van de gezondheidstoestand middels een kruisje op een thermometer,

    0 1I-----------------------------X---------------------------------Idoodgezond

    ratio scaling

    Waarderen hoeveel keer meer of minder gewenst een gezondheids-toestand is t.o.v. een standaard;

  • Welke techniek?Equivalentie

    bv equivalentie in termen van aantal te genezen patinten (1 gezonde patint redden is equivalent aan het genezen van 10 rolstoelpatinten)

  • Welke techniek?Standard gamble

    Men stelt het individu voor de keuze tussen:- gok met kans 1-p op dood en kans p op genezing (perfecte gezondheid)- verder leven gedurende een bepaalde tijd in een omschreven gezondheidstoestand XMen zoekt de kans p waarbij men juist indifferent is tussen de 2 alternatieven; die kans is de waarde van toestand Xleven in toestand X gedurende y jareninterventie met kans 1-p op doodkans p op leven in perfecte gezondheidgedurende y jarenKeuze:

  • Welke techniek?Time Trade-off

    Men stelt het individu voor de keuze tussen:- een tijdsperiode t leven in een omschreven gezondheids- toestand- een fractie van die tijdsperiode leven in perfecte gezondheid

    Men zoekt de fractie waarbij men juist indifferent is tussen de tweealternatieven; de verhouding tussen die fractie en t is de waarde vantoestand xtijdsperiode t in gezondheids-toestand xfractie van t leven in perfecte gezondheidkeuze:

  • Methoden voor het meten van preferenties

  • Bestaande classificaties als alternatief voor het meten van gezondheidspreferentiesEuroquol (Dolan et al 1996): time trade-off meetmethode op een aseleccte steekproef van de algemene bevolkingQuality of Well-Being classification system (Kaplan and Anderson, 1996): category scaling meetmethode op een steekproef van de algemene bevolkingHealth Utilities Index mark 1 (2 and 3) classification system...

  • Een voorbeeldEuroquol

  • Dimensies en TTO coefficintMobiliteitgeen problemen met rondwandelenenige problemen met rondwandelen (0.074)bedlegerig (0.148)Zelfzorggeen problemen om voor zichzelf te zorgenenige problemen met zichzelf te wassen of aan te kleden (0.083)niet in staat om zichzelf te wassen of aan te kleden (0.166)Dagelijkse activiteiten (bv werk, studie, huishouden, gezins- en vrijetijdsactiviteiten)Geen problemen ... Enige problemen (0.031)Niet in staat uit te voeren (0.062)

  • vervolgPijn/klachtenGeen pijn of andere klachtenMatige pijn of andere klachten (0.084)Zeer ernstige ... (0.168)Angst/depressieniet angstig of depressief Matig angstig of depressief... (0.103)Erg angstig of depressief... (0.206)

    Constante term indien er een niet optimale toestand is: 0.152Term indien er een dimensie is op niveau 3: 0.256

  • Berekening Euroquol scorepersoon met toestand 12321Geen problemen met rondwandelen (0)Enige problemen met zichzelf te wassen of aan te kleden (0.083)Enige problemen met dagelijkse activiteiten (0.062)Matige pijn of andere klachten (0.084)Niet angstig of depressief score: 1.00 - 0.083 - 0.062 - 0.084 - 0.152 - 0.256 = 0.363

  • Disability Adjusted Life Years: DALYsProposed by the World Bank in the early 1990s.http://www.worldbank.org/html/extdr/hnp/hddflash/workp/wp_00068.htmlValues included in the Daly Indicator.Duration of time lost due to a death.Disability weights.Age-weights.Time preference (discounting).Health is simply added across individuals.

  • DALY formula: DALYs lost because of health at age aWith D(x) = disability weight; w(x) = productivity weighting factor for different ages, r = discount rate (0.03), L = assumed life expectancy measure (80 years for men; 82.5 for women)

  • Age-weighting function.reflects the dependence of the young and the elderly on the adults.

    http://www.worldbank.org/html/extdr/hnp/hddflash/workp/wp_00068.htmlC = 0.16243 = 0.04.AgeCxe-x

  • 50,000/QALYWorthwhile to undertake?League tables.Compile a league table of incremental CE/CU ratios of other interventions.If the ratio of our intervention is relatively low: Recommend it.Problem: Methodological differences between the studies in the table.Also: How do we choose the cut-off ratio?

  • methodologische aspecten Meten en waarderen van effectenMeten qalys de sociale waarde van een gezondheidsprogramma dan wel de productie van gezonde jaren?Hoe worden te beoordelen gezondheidstoestanden voorgesteld?Wie moet waarderen?Welke techniek moet gebruikt worden?

  • Kosten-batenanalyseKosten en effecten worden uitgedrukt in monetaire eenheden

  • Toekennen van een monetaire waarde aan gezondheidhet toekennen van een monetaire waarde aan menselijk leven en levenskwaliteit is onethisch zulke waarderingen gebeuren toch, impliciet dan wanneer keuzes gemaakt worden

  • Methoden om effecten om te zetten in monetaire waardenHuman capital method= waarde van de productiviteitswinst op de marktrevealed preference= op basis van waargenomen gedragcontingent valuation = op basis van enqute met vragen naar betalingsbereidheid voor hypothetische scenarios

  • loon-risico voorbeeld: revealed preferencejob A: job-gerelateerde jaarlijkse fataliteitsrisico bij ongeval = 2/10.000 en loon is $30.500job B: identiek A, maar fataliteitsrisico bij ongeval is 1/10.000 en loon is $30.000impliciete waarde van leven = $500 * 10.000 = 5.000.000

  • WTP verzekering: voorbeeld contingent valuation Optie AUw verzekering dekt chemotherapie- veronderstel dat uw kans op kanker in de volgende 5 jaren = 1 op 100- u behoudt uw verzekeringWanneer u kanker krijgt:- krijgt u chemotherapie maar niet GCSF- uw kans op neutropenic fever is 20%- u kan GCFS niet kopen

  • vervolgOptie B: uw verzekering dekt chemotherapie en GCFS (tegen een additionele premie)- veronderstel dat uw kans op kanker in de volgende 5 jaren = 1 op 100- u behoudt uw verzekeringWanneer u kanker krijgt:- krijgt u chemotherapie met GCSF- uw kans op neutropenic fever is 10%

  • vervolgWanneer GCSF momenteel niet opgenomen wordt door uw verzekering, bent u dan bereid een additionele premie te betalen?Indien ja, tegen welk bod:1 $1...7$100

  • Payment card

    Amount for medicine A per month in Euro

    I am willing to pay this amount monthly for medicine A

    DEFINITELY NOT

    PROBABLY NOT

    YES, PROBABLY

    YES, DEFINITELY

    2.5 per month

    5 per month

    7.5 per month

    10 per month

    .

    .

    .

    72.5 per month

    75 per month

    More than 75 per month

    How much are you then willing to pay ? .

  • Methodologie: onzekerheidBronnen van onzekerheidvariabiliteit in steekproef data (variabiliteit binnen verschillende bevolkingsgroepen m.b.t. middelengebruik en gezondheidsresultaten)Veralgemening van resultaten (bv van klinische proef naar dagdagelijkse praktijk)Extrapolatie (bv van een intermediair klinisch eindpunt naar finaal (cholesterol) of van een beperkte tijdshorizon naar langere horizonAnalytische methoden (bv tijdsvoorkeur, bepalen qualy gewichten)

  • Omgaan met onzekerheid: sensitiviteits-analyse en statistische benaderingenEenvoudige Sensitiviteitsanalyse : hoe gevoelig veranderen de resultaten wanneer we de waarden van onzekere parameters veranderenIndividuele parameterwaarden worden veranderd; andere op basiswaardeMeervoudige sensitiviteitsanalyseWorst-case; best case (combinatie van meest ongunstige (gunstige) veronderstellingen en parameter waarden)

    Ranges gebruikt in de sensitiviteitsanalyse verantwoorden!

  • Sensitiviteitsanalyse pneumo-kokken-vaccinatieDe Graeve, Verhagen et al

    Chart2

    29632.946540326519246.496381925931040.851264059732392.42465852620039.03182211.69721845.749732922933598.648980914719708.276064244639557.617016408421463.184567834335554.534237807

    basis

    mortaliteit 20%;30%;40%

    ligduur 11,5;14,1;15,7

    theoretische protectie vaccin = 0,88

    Effectiviteit vaccin beter

    Effectiviteit vaccin slechter

    Vaccin aankoopprijs 13

    Vaccin aankoopprijs 22

    Vaccin toediening 0

    Vaccin toediening 15,2

    discontovoet 0%

    discontovoet 5%

    Figuur 1: Kosten-effectiviteitsratio voor + 65-jarigen(kosten per qaly in ECU 1995)

    Calculation

    StructurePopulationMortalityHosp rateHospitalCountry1

    at31-Dec-94Rateper Agemortality rateHospital

    [MRG](HAI)per Agecost per

    Age1-Jan-95(MRI)[HM][X]person

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    72906670.03024253590.00028330.1280.00003626240.03020736891.2507280957

    73894030.03276176410.00028330.1280.00003626240.03272668851.2507280957

    74859150.03563987660.00028330.1280.00003626240.03560490531.2507280957

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    9617800.42528089890.00065360.2630.00017189680.42518208953.6200517249

    9711790.45547073790.00065360.2630.00017189680.4553771193.6200517249

    988180.45110024450.00065360.2630.00017189680.45100587423.6200517249

    995080.48425196850.00065360.2630.00017189680.48416329783.6200517249

    1003420.50.00065360.2630.00017189680.49991403683.6200517249

    1012000.50.00065360.2630.00017189680.49991403683.6200517249

    1021200.50.00065360.2630.00017189680.49991403683.6200517249

    103700.50.00065360.2630.00017189680.49991403683.6200517249

    104500.50.00065360.2630.00017189680.49991403683.6200517249

    10500.50.00065360.2630.00017189680.49991403683.6200517249

    10600.50.00065360.2630.00017189680.49991403683.6200517249

    10700.50.00065360.2630.00017189680.49991403683.6200517249

    108010.00065360.2630.000171896813.6200517249

    109010.00065360.2630.000171896813.6200517249

    Jan van Emmerik:Country numbers:1=Belgium2=France3=Scotland4=Spain5=Sweden

    Yweight

    66676869707172737475767778798081828384858687888990919293949596979899100101102103104105106107108109

    Age at1234567891011121314151617181920212223242526272829303132333435363738394041424344

    31 dec. 1994dec. 1995dec. 1996dec. 1997dec. 1998dec. 1999dec. 2000dec. 2001dec. 2002dec. 2003dec. 2004dec. 2005dec. 2006dec. 2007dec. 2008dec. 2009dec. 2010dec. 2011dec. 2012dec. 2013dec. 2014dec. 2015dec. 2016dec. 2017dec. 2018dec. 2019dec. 2020dec. 2021dec. 2022dec. 2023dec. 2024dec. 2025dec. 2026dec. 2027dec. 2028dec. 2029dec. 2030dec. 2031dec. 2032dec. 2033dec. 2034dec. 2035dec. 2036dec. 2037dec. 2038

    650.73786407770.71637289090.69550766110.67525015640.63833050040.61973834990.60168771840.58416283340.56714838190.52086574040.50569489360.49096591610.4766659380.46278246410.40437302690.39259517170.38116036090.37005860280.35928019690.28237463460.27415013070.26616517550.25841279170.25088620550.24357884030.2364843110.22959641840.22290914410.21641664480.21011324740.2039934440.19805188740.19228338580.18668289890.18124553290.17596653680.17084129780.16586533770.16103430850.15634398880.15179028040.14736920430.14307689730.1389096091

    660.73786407770.71637289090.69550766110.65748041550.63833050040.61973834990.60168771840.58416283340.53649171260.52086574040.50569489360.49096591610.4766659380.41650421770.40437302690.39259517170.38116036090.37005860280.29084587370.28237463460.27415013070.26616517550.25841279170.25088620550.24357884030.2364843110.22959641840.22290914410.21641664480.21011324740.2039934440.19805188740.19228338580.18668289890.18124553290.17596653680.17084129780.16586533770.16103430850.15634398880.15179028040.14736920430.14307689730

    670.73786407770.71637289090.67720482790.65748041550.63833050040.61973834990.60168771840.5525864640.53649171260.52086574040.50569489360.49096591610.42899934420.41650421770.40437302690.39259517170.38116036090.29957124990.29084587370.28237463460.27415013070.26616517550.25841279170.25088620550.24357884030.2364843110.22959641840.22290914410.21641664480.21011324740.2039934440.19805188740.19228338580.18668289890.18124553290.17596653680.17084129780.16586533770.16103430850.15634398880.15179028040.147369204300

    680.73786407770.69752097280.67720482790.65748041550.63833050040.61973834990.56916405790.5525864640.53649171260.52086574040.50569489360.44186932450.42899934420.41650421770.40437302690.39259517170.30855838740.29957124990.29084587370.28237463460.27415013070.26616517550.25841279170.25088620550.24357884030.2364843110.22959641840.22290914410.21641664480.21011324740.2039934440.19805188740.19228338580.18668289890.18124553290.17596653680.17084129780.16586533770.16103430850.15634398880.1517902804000

    690.71844660190.69752097280.67720482790.65748041550.63833050040.58623897970.56916405790.5525864640.53649171260.52086574040.45512540430.44186932450.42899934420.41650421770.40437302690.3178151390.30855838740.29957124990.29084587370.28237463460.27415013070.26616517550.25841279170.25088620550.24357884030.2364843110.22959641840.22290914410.21641664480.21011324740.2039934440.19805188740.19228338580.18668289890.18124553290.17596653680.17084129780.16586533770.16103430850.15634398880000

    700.71844660190.69752097280.67720482790.65748041550.60382614910.58623897970.56916405790.5525864640.53649171260.46877916640.45512540430.44186932450.42899934420.41650421770.32734959320.3178151390.30855838740.29957124990.29084587370.28237463460.27415013070.26616517550.25841279170.25088620550.24357884030.2364843110.22959641840.22290914410.21641664480.21011324740.2039934440.19805188740.19228338580.18668289890.18124553290.17596653680.17084129780.16586533770.161034308500000

    710.71844660190.69752097280.67720482790.62194093350.60382614910.58623897970.56916405790.5525864640.48284254140.46877916640.45512540430.44186932450.42899934420.3371700810.32734959320.3178151390.30855838740.29957124990.29084587370.28237463460.27415013070.26616517550.25841279170.25088620550.24357884030.2364843110.22959641840.22290914410.21641664480.21011324740.2039934440.19805188740.19228338580.18668289890.18124553290.17596653680.17084129780.1658653377000000

    720.71844660190.69752097280.64059916150.62194093350.60382614910.58623897970.56916405790.49732781760.48284254140.46877916640.45512540430.44186932450.34728518340.3371700810.32734959320.3178151390.30855838740.29957124990.29084587370.28237463460.27415013070.26616517550.25841279170.25088620550.24357884030.2364843110.22959641840.22290914410.21641664480.21011324740.2039934440.19805188740.19228338580.18668289890.18124553290.17596653680.17084129780000000

    730.71844660190.65981713640.64059916150.62194093350.60382614910.58623897970.51224765210.49732781760.48284254140.46877916640.45512540430.35770373890.34728518340.3371700810.32734959320.3178151390.30855838740.29957124990.29084587370.28237463460.27415013070.26616517550.25841279170.25088620550.24357884030.2364843110.22959641840.22290914410.21641664480.21011324740.2039934440.19805188740.19228338580.18668289890.18124553290.175966536800000000

    740.67961165050.65981713640.64059916150.62194093350.60382614910.52761508170.51224765210.49732781760.48284254140.46877916640.36843485110.35770373890.34728518340.3371700810.32734959320.3178151390.30855838740.29957124990.29084587370.28237463460.27415013070.26616517550.25841279170.25088620550.24357884030.2364843110.22959641840.22290914410.21641664480.21011324740.2039934440.19805188740.19228338580.18668289890.1812455329000000000

    750.67961165050.65981713640.64059916150.62194093350.54344353420.52761508170.51224765210.49732781760.48284254140.37948789660.36843485110.35770373890.34728518340.3371700810.32734959320.3178151390.30855838740.29957124990.29084587370.28237463460.27415013070.26616517550.25841279170.25088620550.24357884030.2364843110.22959641840.22290914410.21641664480.21011324740.2039934440.19805188740.19228338580.18668289890000000000

    760.67961165050.65981713640.64059916150.55974684020.54344353420.52761508170.51224765210.49732781760.39087253350.37948789660.36843485110.35770373890.34728518340.3371700810.32734959320.3178151390.30855838740.29957124990.29084587370.28237463460.27415013070.26616517550.25841279170.25088620550.24357884030.2364843110.22959641840.22290914410.21641664480.21011324740.2039934440.19805188740.192283385800000000000

    770.67961165050.65981713640.57653924540.55974684020.54344353420.52761508170.51224765210.40259870950.39087253350.37948789660.36843485110.35770373890.34728518340.3371700810.32734959320.3178151390.30855838740.29957124990.29084587370.28237463460.27415013070.26616517550.25841279170.25088620550.24357884030.2364843110.22959641840.22290914410.21641664480.21011324740.2039934440.1980518874000000000000

    780.67961165050.59383542280.57653924540.55974684020.54344353420.52761508170.41467667080.40259870950.39087253350.37948789660.36843485110.35770373890.34728518340.3371700810.32734959320.3178151390.30855838740.29957124990.29084587370.28237463460.27415013070.26616517550.25841279170.25088620550.24357884030.2364843110.22959641840.22290914410.21641664480.21011324740.2039934440000000000000

    790.61165048540.59383542280.57653924540.55974684020.54344353420.42711697090.41467667080.40259870950.39087253350.37948789660.36843485110.35770373890.34728518340.3371700810.32734959320.3178151390.30855838740.29957124990.29084587370.28237463460.27415013070.26616517550.25841279170.25088620550.24357884030.2364843110.22959641840.22290914410.21641664480.210113247400000000000000

    800.61165048540.59383542280.57653924540.55974684020.439930480.42711697090.41467667080.40259870950.39087253350.37948789660.36843485110.35770373890.34728518340.3371700810.32734959320.3178151390.30855838740.29957124990.29084587370.28237463460.27415013070.26616517550.25841279170.25088620550.24357884030.2364843110.22959641840.22290914410.2164166448000000000000000

    810.61165048540.59383542280.57653924540.45312839440.439930480.42711697090.41467667080.40259870950.39087253350.37948789660.36843485110.35770373890.34728518340.3371700810.32734959320.3178151390.30855838740.29957124990.29084587370.28237463460.27415013070.26616517550.25841279170.25088620550.24357884030.2364843110.22959641840.22290914410000000000000000

    820.61165048540.59383542280.46672224630.45312839440.439930480.42711697090.41467667080.40259870950.39087253350.37948789660.36843485110.35770373890.34728518340.3371700810.32734959320.3178151390.30855838740.29957124990.29084587370.28237463460.27415013070.26616517550.25841279170.25088620550.24357884030.2364843110.229596418400000000000000000

    830.61165048540.48072391370.46672224630.45312839440.439930480.42711697090.41467667080.40259870950.39087253350.37948789660.36843485110.35770373890.34728518340.3371700810.32734959320.3178151390.30855838740.29957124990.29084587370.28237463460.27415013070.26616517550.25841279170.25088620550.24357884030.236484311000000000000000000

    840.49514563110.48072391370.46672224630.45312839440.439930480.42711697090.41467667080.40259870950.39087253350.37948789660.36843485110.35770373890.34728518340.3371700810.32734959320.3178151390.30855838740.29957124990.29084587370.28237463460.27415013070.26616517550.25841279170.25088620550.24357884030000000000000000000

    850.49514563110.48072391370.46672224630.45312839440.439930480.42711697090.41467667080.40259870950.39087253350.37948789660.36843485110.35770373890.34728518340.3371700810.32734959320.3178151390.30855838740.29957124990.29084587370.28237463460.27415013070.26616517550.25841279170.250886205500000000000000000000

    860.49514563110.48072391370.46672224630.45312839440.439930480.42711697090.41467667080.40259870950.39087253350.37948789660.36843485110.35770373890.34728518340.3371700810.32734959320.3178151390.30855838740.29957124990.29084587370.28237463460.27415013070.26616517550.2584127917000000000000000000000

    870.49514563110.48072391370.46672224630.45312839440.439930480.42711697090.41467667080.40259870950.39087253350.37948789660.36843485110.35770373890.34728518340.3371700810.32734959320.3178151390.30855838740.29957124990.29084587370.28237463460.27415013070.26616517550000000000000000000000

    880.49514563110.48072391370.46672224630.45312839440.439930480.42711697090.41467667080.40259870950.39087253350.37948789660.36843485110.35770373890.34728518340.3371700810.32734959320.3178151390.30855838740.29957124990.29084587370.28237463460.274150130700000000000000000000000

    890.49514563110.48072391370.46672224630.45312839440.439930480.42711697090.41467667080.40259870950.39087253350.37948789660.36843485110.35770373890.34728518340.3371700810.32734959320.3178151390.30855838740.29957124990.29084587370.2823746346000000000000000000000000

    900.49514563110.48072391370.46672224630.45312839440.439930480.42711697090.41467667080.40259870950.39087253350.37948789660.36843485110.35770373890.34728518340.3371700810.32734959320.3178151390.30855838740.29957124990.29084587370000000000000000000000000

    910.49514563110.48072391370.46672224630.45312839440.439930480.42711697090.41467667080.40259870950.39087253350.37948789660.36843485110.35770373890.34728518340.3371700810.32734959320.3178151390.30855838740.299571249900000000000000000000000000

    920.49514563110.48072391370.46672224630.45312839440.439930480.42711697090.41467667080.40259870950.39087253350.37948789660.36843485110.35770373890.34728518340.3371700810.32734959320.3178151390.3085583874000000000000000000000000000

    930.49514563110.48072391370.46672224630.45312839440.439930480.42711697090.41467667080.40259870950.39087253350.37948789660.36843485110.35770373890.34728518340.3371700810.32734959320.3178151390000000000000000000000000000

    940.49514563110.48072391370.46672224630.45312839440.439930480.42711697090.41467667080.40259870950.39087253350.37948789660.36843485110.35770373890.34728518340.3371700810.327349593200000000000000000000000000000

    950.49514563110.48072391370.46672224630.45312839440.439930480.42711697090.41467667080.40259870950.39087253350.37948789660.36843485110.35770373890.34728518340.337170081000000000000000000000000000000

    960.49514563110.48072391370.46672224630.45312839440.439930480.42711697090.41467667080.40259870950.39087253350.37948789660.36843485110.35770373890.34728518340000000000000000000000000000000

    970.49514563110.48072391370.46672224630.45312839440.439930480.42711697090.41467667080.40259870950.39087253350.37948789660.36843485110.357703738900000000000000000000000000000000

    980.49514563110.48072391370.46672224630.45312839440.439930480.42711697090.41467667080.40259870950.39087253350.37948789660.3684348511000000000000000000000000000000000

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    1000.49514563110.48072391370.46672224630.45312839440.439930480.42711697090.41467667080.40259870950.390872533500000000000000000000000000000000000

    1010.49514563110.48072391370.46672224630.45312839440.439930480.42711697090.41467667080.4025987095000000000000000000000000000000000000

    1020.49514563110.48072391370.46672224630.45312839440.439930480.42711697090.41467667080000000000000000000000000000000000000

    1030.49514563110.48072391370.46672224630.45312839440.439930480.427116970900000000000000000000000000000000000000

    1040.49514563110.48072391370.46672224630.45312839440.43993048000000000000000000000000000000000000000

    1050.49514563110.48072391370.46672224630.45312839440000000000000000000000000000000000000000

    1060.49514563110.48072391370.466722246300000000000000000000000000000000000000000

    1070.49514563110.4807239137000000000000000000000000000000000000000000

    1080.49514563110000000000000000000000000000000000000000000

    10900000000000000000000000000000000000000000000

    Mortrate

    NO VACCINATIONMortality rate

    Age at

    31 dec. 19941995199619971998199920002001

    650.01625050291

    660.01645980520.0164598052

    670.01878832090.01878832090.0187883209

    680.01886829710.01886829710.01886829710.0188682971

    690.02168736850.02168736850.02168736850.02168736850.0216873685

    700.02332373420.02332373420.02332373420.02332373420.02332373420.0233237342

    710.02654895090.02654895090.02654895090.02654895090.02654895090.02654895090.0265489509

    720.03024253590.03024253590.03024253590.03024253590.03024253590.03024253590.0302425359

    730.03276176410.03276176410.03276176410.03276176410.03276176410.03276176410.0327617641

    740.03563987660.03563987660.03563987660.03563987660.03563987660.03563987660.0356398766

    750.05322852330.05322852330.05322852330.05322852330.05322852330.05322852330.0532285233

    760.06478531690.06478531690.06478531690.06478531690.06478531690.06478531690.0647853169

    770.05087600230.05087600230.05087600230.05087600230.05087600230.05087600230.0508760023

    780.04860574560.04860574560.04860574560.04860574560.04860574560.04860574560.0486057456

    790.04922184550.04922184550.04922184550.04922184550.04922184550.04922184550.0492218455

    800.05807339110.05807339110.05807339110.05807339110.05807339110.05807339110.0580733911

    810.0749081810.0749081810.0749081810.0749081810.0749081810.0749081810.074908181

    820.08428992390.08428992390.08428992390.08428992390.08428992390.08428992390.0842899239

    830.10064743970.10064743970.10064743970.10064743970.10064743970.10064743970.1006474397

    840.1059827620.1059827620.1059827620.1059827620.1059827620.1059827620.105982762

    850.12107855850.12107855850.12107855850.12107855850.12107855850.12107855850.1210785585

    860.1322852620.1322852620.1322852620.1322852620.1322852620.1322852620.132285262

    870.14480182080.14480182080.14480182080.14480182080.14480182080.14480182080.1448018208

    880.17537765150.17537765150.17537765150.17537765150.17537765150.17537765150.1753776515

    890.19798982020.19798982020.19798982020.19798982020.19798982020.19798982020.1979898202

    900.20414572860.20414572860.20414572860.20414572860.20414572860.20414572860.2041457286

    910.24154388880.24154388880.24154388880.24154388880.24154388880.24154388880.2415438888

    920.26153846150.26153846150.26153846150.26153846150.26153846150.26153846150.2615384615

    930.28179901620.28179901620.28179901620.28179901620.28179901620.28179901620.2817990162

    940.34986945170.34986945170.34986945170.34986945170.34986945170.34986945170.3498694517

    950.37444279350.37444279350.37444279350.37444279350.37444279350.37444279350.3744427935

    960.42528089890.42528089890.42528089890.42528089890.42528089890.42528089890.4252808989

    970.45547073790.45547073790.45547073790.45547073790.45547073790.45547073790.4554707379

    980.45110024450.45110024450.45110024450.45110024450.45110024450.45110024450.4511002445

    990.48425196850.48425196850.48425196850.48425196850.48425196850.48425196850.4842519685

    1000.50.50.50.50.50.50.5

    1010.50.50.50.50.50.50.5

    1020.50.50.50.50.50.50.5

    1030.50.50.50.50.50.50.5

    1040.50.50.50.50.50.50.5

    1050.50.50.50.50.50.50.5

    1060.50.50.50.50.50.50.5

    1070.50.50.50.50.50.50.5

    1081111111

    VaccinationMortality rate[MRV]

    Age at

    31 dec. 19941995199619971998199920002001

    650.01622363

    660.01643293810.0164344761

    670.01876151740.01876305170.018764586

    680.01884149580.018843030.01884456420.0188460984

    690.02166064420.0216621740.02166370380.02166523360.0216667634

    700.02329705460.02329858190.02330010910.02330163630.02330316350.0233046907

    710.02652235940.02652388160.02652540380.0265269260.02652844810.02652997030.0265489509

    720.03021604530.03021756170.03021907810.03022059450.03022211090.03022362730.0302425359

    730.03273534240.03273685480.03273836730.03273987970.03274139220.03274290470.0327617641

    740.03561353350.03561504140.03561654940.03561805730.03561956530.03562107330.0356398766

    750.05317659160.05318205810.05318752460.05319299110.05319845760.05320392410.0532285233

    760.06473401910.06473941890.06474481860.06475021840.06475561820.06476101790.0647853169

    770.05082394150.05082942160.05083490170.05084038180.05084586190.0508513420.0508760023

    780.04855356030.04855905350.04856454670.04857003990.04857553310.04858102620.0486057456

    790.0491696940.04917518360.04918067330.04918616290.04919165250.04919714220.0492218455

    800.05802172510.05802716360.05803260220.05803804070.05804347920.05804891770.0580733911

    810.07485743840.07486277970.07486812110.07487346240.07487880370.0748841450.074908181

    820.08423969590.08424498310.08425027030.08425555740.08426084460.08426613170.0842899239

    830.10059810890.10060330160.10060849440.10061368710.10061887980.10062407250.1006474397

    840.10593372390.10593888580.10594404770.10594920960.10595437150.10595953340.105982762

    850.12099677790.12101406480.12103135180.12104863870.12106592570.12107855850.1210785585

    860.13220452410.13222159060.13223865720.13225572370.13227279030.1322852620.132285262

    870.14472224750.14473906790.14475588820.14477270860.1447895290.14480182080.1448018208

    880.17530092320.17531714220.17533336120.17534958010.17536579910.17537765150.1753776515

    890.1979151960.19793097020.19794674440.19796251870.19797829290.19798982020.1979898202

    900.20407167720.20408733030.20410298350.20411863660.20413428980.20414572860.2041457286

    910.24147331710.24148823470.24150315230.24151806990.24153298750.24154388880.2415438888

    920.26146975020.26148427460.26149879890.26151332330.26152784760.26153846150.2615384615

    930.281732190.28174631590.28176044170.28177456760.28178869340.28179901620.2817990162

    940.34980895930.34982174630.34983453330.34984732030.34986010730.34986945170.3498694517

    950.37438458750.37439689120.37440919490.37442149860.37443380230.37444279350.3744427935

    960.42522742330.4252387270.42525003080.42526133460.42527263840.42528089890.4252808989

    970.45542007130.45543078140.45544149140.45545220140.45546291140.45547073790.4554707379

    980.45104917130.45105996720.45107076320.45108155920.45109235510.45110024450.4511002445

    990.48420397990.48421412390.48422426780.48423441170.48424455560.48425196850.4842519685

    1000.49995347670.49996331090.49997314510.49998297930.49999281350.50.5

    1010.49995347670.49996331090.49997314510.49998297930.49999281350.50.5

    1020.49995347670.49996331090.49997314510.49998297930.49999281350.50.5

    1030.49995347670.49996331090.49997314510.49998297930.49999281350.50.5

    1040.49995347670.49996331090.49997314510.49998297930.49999281350.50.5

    1050.49995347670.49996331090.49997314510.49998297930.49999281350.50.5

    1060.49995347670.49996331090.49997314510.49998297930.49999281350.50.5

    1070.49995347670.49996331090.49997314510.49998297930.49999281350.50.5

    1081111111

    Cohortmeth

    NO VACCINATIONSurvivars

    Age at1234567891011121314151617181920212223242526272829303132333435363738394041424344

    31 dec. 1994dec. 1995dec. 1996dec. 1997dec. 1998dec. 1999dec. 2000dec. 2001dec. 2002dec. 2003dec. 2004dec. 2005dec. 2006dec. 2007dec. 2008dec. 2009dec. 2010dec. 2011dec. 2012dec. 2013dec. 2014dec. 2015dec. 2016dec. 2017dec. 2018dec. 2019dec. 2020dec. 2021dec. 2022dec. 2023dec. 2024dec. 2025dec. 2026dec. 2027dec. 2028dec. 2029dec. 2030dec. 2031dec. 2032dec. 2033dec. 2034dec. 2035dec. 2036dec. 2037dec. 2038

    65105152103421.218560244101478.10752012699563.388436873197404.120538117295132.292715995892606.630143967689805.970809758286863.76877513183767.954773042279309.11024048574171.04439945770397.518173066366975.794314404963679.122113561159981.059551142155487.987487255550810.909243893345696.921321170740853.835384243235907.311888147431157.303728870726645.669419008921972.614494847817622.260500732214024.751290469710637.1583246877855.13230130735641.56374696843667.75293210222294.3892784771318.6293437539718.0322635199394.1277338881203.2706029108101.635301455450.817650727725.408825363812.70441268196.3522063413.17610317051.58805158520.79402579260

    66103016101080.50233621899173.285385709297022.477795594994759.551307377992243.7846287289454.098663021986523.424580675883439.740403686578998.366237336573880.432045031370121.691013456466713.373939542563429.618553849659746.045509230755270.577919727150611.825112269845517.87449767440693.764437629735766.62210100231035.225127072526541.268021026721886.522768852317553.214060091113969.800385763410595.48047519517824.35481245185619.45932419243653.38217160292285.39954568321313.4627726033715.2189143438392.5834872132202.474160728101.23708036450.61854018225.30927009112.65463504556.32731752283.16365876141.58182938070.7909146903

    679954097661.849705275495543.821177796893315.382483577990837.956972170688090.78679980785204.777219181882168.089471464577794.403406391672754.468327640869053.011828755765696.638703413362462.928902440658835.494804005454428.23491151549840.483132128244824.16611294440073.577183542235221.526225617830562.237402354926136.769780044621552.964479391417285.696916401313756.895724296810434.00163359727705.10889865645533.8167915863597.70334492142250.56925440111293.4451389058704.3187270378386.600377066199.388383447499.694191723749.847095861924.923547930912.46177396556.23088698273.11544349141.55772174570.77886087280

    689937097214.926187547194947.511084179792426.75427062989631.534838971886695.047634478183605.246833025979155.063003845274026.977161862470260.780500584766845.702878444963555.434018164559864.55444288255380.209564729350712.215914256345608.161222474240774.482325962835837.566783773431096.78487389926593.913804427321929.935658401117588.031639441813997.510105008110616.49708109667839.8747675795630.60577123383660.62881732962289.93273714081316.068084323716.637582812393.3621939885202.8757772146101.437888607350.718944303625.359472151812.67973607596.3398680383.1699340191.58496700950.79248350470

    699861096310.046565774293753.1158645790917.783894827487939.15690213284805.01619987680290.970418995475089.294455138271269.051336791267804.965958898464467.480399465760723.635197994756174.938143166551439.956881285946262.65692442941359.612765701436351.850473354331543.036410883826975.547306340522244.639173032117840.42706178114198.380079947610768.84814115147952.38016577335711.4072589043713.16033281222322.79420522131334.9541977199726.9216242037399.007101794205.7871273032102.893563651651.446781825825.723390912912.86169545646.43084772823.21542386411.60771193210.8038559660

    709564293102.805234295590287.140307117687329.174310903384216.773312940479734.038832274174568.443857761570774.699535611167334.642495599764020.307125018560302.43079199755785.285393040551083.147931820445941.759882178641072.725278309236099.698909377331324.240782600226788.433683406322090.341097843417716.678434762914099.894206560710694.15092861167897.21914728245671.79056115433687.40430738232306.68233790191325.6943998166721.8793932844396.2394224752204.3597021427102.179851071451.089925535725.544962767812.77248138396.3862406923.1931203461.5965601730.79828008650

    719283990031.313212083887081.728562819383978.146500788879508.113772953474357.155425007670574.160613650667143.850917461363838.906660464460131.564867563955627.218724197150938.404690466945811.58467747740956.34640134735997.411019073431235.484072660226712.529106670122027.748487509917666.478524097914059.942393236210663.84923164117874.84250951965655.71963789813676.9561092342300.14639225491321.9380670094719.8339601527395.1166847293203.7806523604101.890326180250.945163090125.47258154512.73629077256.36814538633.18407269311.59203634660.79601817330

    728792585044.421887408782013.449183931577647.994393006972617.544468587168923.054108271965572.997674829262345.373713464558724.766443492754325.801011070649746.683377358344739.807063333439998.158739009735155.239337631130504.719292709726087.580397402621512.401815153817253.165246764713731.005256062110414.3648497427690.60788904035523.4021522133590.93246971552246.33368462141291.0108760493702.9931996808385.8727954238199.013134647799.506567323949.753283661924.87664183112.43832091556.21916045773.10958022891.55479011440.77739505720

    738647483392.077308968278953.240178765973838.229492466370081.635558053366675.265409414363393.385795904159711.916910407555239.005832160950582.914233562345491.873424887140670.519030351935746.191214128331017.496945420926526.10691235721874.020579814517543.187177213513961.82044819710589.42804278067819.88532389965616.24933311693651.29525834492284.09406205531312.7124862262714.8103614565392.3592326332202.3585018699101.179250934950.589625467525.294812733712.64740636696.32370318343.16185159171.58092579590.79046289790

    748285378442.857158899573360.911798288969628.601879988866244.251771050662983.587444261859325.916938705954881.920416195650255.92752013945197.797086976140407.609714974235515.114579663630816.988344078426354.632321566621732.618800041217429.781510399713871.566063867110520.97405342077769.3346856035579.94381495873627.69193191832269.32883111091304.2266259699710.189562233389.8228770692201.0503814806100.525190740350.262595370125.131297685112.56564884256.28282442133.14141221061.57070610530.78535305270

    755901755193.564951737952385.537013615749839.298928806947386.116656464644634.244171897641290.774131818437810.377921956534004.860191141630400.931186353226720.03026231223185.364059576919828.081128804716350.67882756913113.410865638710436.3640494757915.52409230785845.3100989354198.10746388722729.31790733141707.3444858641981.2434882241534.3157925699293.285807902151.261578091275.630789045637.815394522818.90769726149.45384863074.72692431542.36346215771.18173107880.59086553940

    763933737335.690697031435520.961613492333772.554328485231811.267573044329428.343384661226947.830559895224235.600409370221667.044539037719043.630020051316524.438434246514131.669661958111653.29062550129346.05770931257438.09994830335641.47236170344166.01035941182992.03273880451945.21188501911216.8413129169699.3419455696380.8121535672209.0276979849107.805623763953.902811881926.95140594113.47570297056.73785148523.36892574261.68446287130.84223143570.42111571780

    773775935923.695652173934155.465054532132171.94137474729761.999767953227253.363072026624510.381856419521912.703889379919259.545290380516711.791296479814291.893488615811785.41477373259452.02262118567522.43257603155705.43495857964213.2442771053025.95618496221967.266553671230.6377698292707.271032885385.129773632211.3976385829109.02791596254.51395798127.256978990513.62848949536.81424474763.40712237381.70356118690.85178059350.42589029670

    784063538634.870307585536391.212374713833665.212852274930827.574622456427724.858165458124786.50112077421785.387295676418903.501630444416166.240175647413331.042940779410691.63214527558508.9811105936453.68872363924765.80090361053422.80289774422225.26872464311392.0328871839800.0278896568435.6385964034239.1219190527123.32665903961.663329519530.831664759815.41583237997.70791618993.8539580951.92697904750.96348952370.48174476190

    794655243848.56749823440563.951068612937144.818719446533406.287818313329865.797166859526249.689498484222777.242446900919479.05626873516062.865127757812882.581348516810252.65739231837776.19065551435742.41771484144124.21005240192681.27494268421677.2908631056963.9710971669524.910470213288.1232287599148.598988061274.299494030637.149747015318.57487350779.28743675384.64371837692.32185918851.16092959420.58046479710

    805067046874.402470032742923.362652386738603.236099380134511.958515080730333.300328266526320.651748337122509.373451631118561.732399952914886.698338677511847.64245923648985.91682683326635.75396443064765.80502575413098.39543449811938.22359275441113.9341210044606.5697249235332.9459737049171.716230532985.858115266442.929057633221.464528816610.73226440835.36613220422.68306610211.3415330510.67076652550

    814584241977.981308000237753.004966818333751.837226293929665.213429384625740.942899883522013.607499943318152.912716543614558.820790898411586.69971235458788.00320578046489.60236734554660.83880493823030.15368780581895.53447632431089.3998703819593.2101075362325.6128829875167.934203430583.967101715341.983550857620.991775428810.49588771445.24794385722.62397192861.31198596430.65599298220

    824164137449.939964685133480.89189015529427.073763968325534.30560248921836.891659448118007.188885129414441.948794671211493.6866349558717.45686880286437.50661080824623.42358133943005.82890797261880.31793500221080.654633431588.4480701126322.99900181166.586099358783.293049679341.646524839720.823262419810.41163120995.2058156052.60290780251.30145390120.65072695060

    833514431419.341811954327615.133197439723962.058068453320492.308431023616898.415505492213552.701257159210785.97518393268180.68879378996041.12403233724338.74122350572820.7482105821764.53937095841014.1144811744552.2150101052303.1106840308156.328738614378.164369307239.082184653619.54109232689.77054616344.88527308172.44263654081.22131827040.61065913520

    843184427988.374384236524285.924947081720769.278795943317126.811458289613735.877136317810931.75648977058291.25751610526122.77478112394397.38287161532858.87293742091788.38856857981027.8210705939559.6786491275307.2074736653158.441649803879.220824901939.610412450919.80520622559.90260311274.95130155642.47565077821.23782538910.61891269450

    852712023532.423695740220124.885897739816595.430673187513309.70433733910592.58504736718034.01086286095932.8080218054260.94855817622770.17282241741732.9015724186995.9316340361542.3139177703297.675976869153.525799093976.762899546938.381449773519.19072488679.59536244344.79768122172.39884061081.19942030540.59971015270

    862356820155.310688366916620.519635488413329.825940503810608.59891119248046.15667574365941.77723747224267.39025769262774.3607680561735.5213719934997.4372828929543.1337876312298.1260032352153.757899306476.878949653238.439474826619.21973741339.60986870664.80493435332.40246717671.20123358830.60061679420

    871991516422.354071266913170.89514072110482.11315533517950.22278123055870.93374613944216.5103925192741.28221341311714.8288437547985.5448916635536.6580326107294.5714628878151.924652119375.962326059637.981163029818.99058151499.49529075754.74764537872.37382268941.18691134470.59345567230

    881566712565.09348624449999.98332102497584.54846199345600.89732577974022.56996974482615.19562001691635.9544666079940.214280528511.9741883791281.0225068242144.936804700772.468402350336.234201175218.11710058769.05855029384.52927514692.26463757341.13231878670.56615939340

    89124489906.79396984927513.8684290935548.70283994563985.08383866792590.82474106611620.7090876505931.4524700374507.2031261781278.4036719486143.586145768871.793072884435.896536442217.94826822118.97413411054.48706705532.24353352761.12176676380.56088338190

    90101367687.71114339085677.07899819624077.28372182472650.76670165631658.2062130718953.0027842542518.9379028763284.8448880091146.908190272473.454095136236.727047568118.36352378419.1817618924.5908809462.2954404731.14772023650.57386011830

    9173105398.15384615383876.9594032112520.52974255751576.73554475906.1800349883493.4415457697270.8499438271139.690325359769.845162679834.922581339917.461290678.7306453354.36532266752.18266133371.09133066690.54566533340

    9254723929.99578355592555.01031359121598.3051144456918.5764786954500.191772114274.5551414171141.60127372370.800636861535.400318430817.70015921548.85007960774.42503980382.21251990191.1062599510.55312997550

    9340882657.73368146211662.5644574971955.5075505728520.3018214315285.5935425706147.294307388873.647153694436.823576847218.41178842369.20589421184.60294710592.30147355291.15073677650.57536838820

    9424901557.6374442794895.2039918527487.4647691004267.5692925747137.998335934268.999167967134.499583983517.24979199188.62489599594.31244799792.1562239991.07811199950.53905599970

    951684967.8269662921527.0101037825289.2757171129149.193381660674.596690830337.298345415118.64917270769.32458635384.66229317692.33114658841.16557329420.58278664710

    961023557.0534351145305.7664943355157.69846755178.849233775539.424616887719.71230844399.85615422194.9280771112.46403855551.23201927770.61600963890

    97642352.3936430318181.746327705490.873163852745.436581926322.718290963211.35914548165.67957274082.83978637041.41989318520.70994659260

    98449231.5708661417115.785433070957.892716535428.946358267714.47317913397.23658956693.61829478351.80914739170.90457369590

    9926213165.532.7516.3758.18754.093752.0468751.02343750

    10017185.542.7521.37510.68755.343752.6718751.33593750

    101100502512.56.253.1251.56250

    1026030157.53.751.8750

    1033517.58.754.3752.18750

    1042512.56.253.1250

    1050000

    106000

    10700

    1080

    VaccinationSurvivars

    Age at1234567891011121314151617181920212223242526272829303132333435363738394041424344

    31 dec. 1994dec. 1995dec. 1996dec. 1997dec. 1998dec. 1999dec. 2000dec. 2001dec. 2002dec. 2003dec. 2004dec. 2005dec. 2006dec. 2007dec. 2008dec. 2009dec. 2010dec. 2011dec. 2012dec. 2013dec. 2014dec. 2015dec. 2016dec. 2017dec. 2018dec. 2019dec. 2020dec. 2021dec. 2022dec. 2023dec. 2024dec. 2025dec. 2026dec. 2027dec. 2028dec. 2029dec. 2030dec. 2031dec. 2032dec. 2033dec. 2034dec. 2035dec. 2036dec. 2037dec. 2038

    65105154.872408924103426.707173395101485.94783102799573.333675587297415.901817941195145.654352273792619.637042819489818.58434700586875.969070645483779.720251529879320.249459926774181.46196103770407.405730759366985.201279984163688.066050933859989.48408374255495.780953442750818.045799408645703.339600645340859.573436731835912.355185512231161.679872322526649.41188892121975.70061917617624.735603859514026.721111865610638.65234776277856.23557988635642.35612272933668.26807979012294.71153282561318.8145494835718.1331134592394.1830903951203.2991529203101.649576460150.824788230125.41239411512.70619705756.35309852883.17654926441.58827463220.794137316101743032.69919427

    66103018.814060386101085.86672644899180.947623501397032.16922652694771.012719726592256.74056475389466.662778694786535.577073754283451.45978341179009.461811784273890.80878917270131.539830338266722.744047336663438.527447645459754.43703335355278.340850041850618.933705778945524.267629446840699.480007639335771.64563803431039.584124192326544.995827426821889.596801320917555.679465423813971.762489128110596.96864448297825.45376823365620.2485953163653.89530087122285.72053739491313.6472526714715.3193691391392.6386268257202.5025988747101.251299437350.625649718725.312824859312.65641242976.32820621483.16410310741.58205155370.7910257769001631449.16232217

    6799542.719107427997667.032665987895551.202999167293324.703618274790848.944057560988103.159433946885216.74450482179.630243728277805.3298803972764.686926558469062.710546211265705.866007475662471.702021567958843.758438354554435.879532046849847.48338817744830.461811144540079.205646258635226.473202182230566.529966828526140.440773366721555.991662526217288.124748091413758.827924517510435.46712266277706.19110596635534.59403394063598.20865391962250.88535408641293.6268074328704.4176508667386.6546763315199.416388186799.708194093449.854097046724.927048523312.46352426176.23176213083.11588106541.55794053270.77897026640001505125.7083171

    6899372.714463583597220.085429816494954.846833972392435.98664157689642.376004490886707.22423256683616.989458660279166.180586857374037.374488735870270.648853032166855.091572263863564.360583146659872.962611964955387.987893160950719.338607976245614.567035307740780.209233059235842.600285214131101.152517283126597.64900509721933.015788349617590.501935015513999.476100291910617.98820223427840.97590318845631.39660791183661.14296441262290.25436555381316.2529303155716.7382368639393.417442973202.9042717695101.452135884850.726067942425.363033971212.68151698566.34075849283.17037924641.58518962320.792594811600001430156.5227636

    6998612.693702867896315.157785652493760.35933406690926.86553696987949.793370170784816.927336974180302.24754385575099.840987889971279.061304118267814.489384300164476.535064293560732.164027730856182.828093781351447.181788563746269.154663287441365.421856248836356.956207592331547.466731730626979.336108662122247.763504100717842.93280710314200.37428806510770.36066048517953.49710312745712.20944441063713.68185811552323.12044913321335.1416963277727.0237226822399.0631436239205.8160307666102.908015383351.454007691725.727003845812.86350192296.43175096153.21587548071.60793774040.8039688702000001349870.47759859

    7095644.612626809593107.746244354290294.11599150687337.897492173784226.959549074879745.75478908774579.400792599470785.099025406867344.536510440164029.71413818960311.291508012755793.482368937351090.653985242545948.510470541841078.760420672536105.003325403131328.843502562526792.369921137622093.587007445817719.281687306614101.96601621710695.72230530677898.37954853425672.6239624753687.94612703992307.02127709331325.8891946441721.985464768396.2976450866204.3897303399102.1948651751.09743258525.548716292512.77435814626.38717907313.19358953661.59679476830.79839738410000001242573.43396136

    7192841.536058011890036.091216603287088.456593548683986.534952877779518.5808370174368.876596313370585.285458617867154.435031044363848.969804443860141.043610647455635.987431878350946.434284444845818.806113379540962.802489526836003.085413403131240.407828249526716.739893485222031.220796422617669.263351193114062.158709774910665.53021046437876.08384772745656.61116822033677.53572033122300.50897215371322.1464486029719.9474300281395.1789683161203.8127749977101.906387498850.953193749425.476596874712.73829843746.36914921873.18457460931.59228730470.796143652300000001143677.08864306

    7287927.401823594585048.935235238882019.785633786577656.907909046172628.186831711468934.94606783365584.311616829262356.130762359358734.898794080154335.174365706549755.266652645144747.526453938640005.060007277635161.305010285530509.982566268126092.081539366621516.113557411317256.142101839813733.374398888810416.16174059747691.93482382575524.35515808143591.55204794332246.72126624681291.2336266126703.1144938807385.9393737805199.047472304199.523736152149.76186807624.88093403812.4404670196.22023350953.11011675481.55505837740.7775291887000000001026251.86127449

    7386476.362187017483396.502966087378960.849415337373848.117170144370093.246005080766688.044181322463405.535573075559723.361108817655249.592766485450592.608795998145500.59225443540678.313814262935753.042216839831023.44166144426531.190822676121878.212885881717546.54944935613964.49632684310591.45757929267821.38405855465617.32572582063651.99505412362284.53182434781312.9640765774714.9473597648392.4344309711202.3972852646101.198642632350.599321316225.299660658112.6498303296.32491516453.16245758231.58122879110.7906143956000000000954101.103666691

    7482855.263273133678448.849849919573369.693294178769639.550075238366256.77180852162997.127985942559338.671135214154893.719219043550266.731802792645207.513946243240416.296754658135522.749805105330823.613541722326360.298178528821737.29099231617433.528656165813874.548245830410523.23590755567771.00497788725581.14342052053628.471832142269.81670331491304.5070154445710.3422425067389.9066832341201.0936043451100.546802172650.273401086325.136700543112.56835027166.28417513583.14208756791.57104378390.7855218920000000000862022.049033955

    7559020.237163997755199.301308679552393.250252171149848.507998603647396.377513411544645.069094556641300.788179211837819.547886057134013.107221833630408.30417395426726.510539202523190.987091341519832.889935331516354.644276900813116.591196370210438.8951292727917.44380524785846.72773310614199.12561014362729.97983531531707.7585596846981.4814643581534.4453775385293.3569370596151.298262814275.649131407137.824565703618.91228285189.45614142594.72807071292.36403535651.18201767820.591008839100000000000586217.333800138

    7639339.157688804637339.571056067635526.191714513733778.794661248931818.155895804329435.48049534926954.366084066224241.478149766421672.299340272419048.248577527416528.44602463714135.096945963311656.11684048679348.3243625017439.90387392515642.84056011544167.0207213162992.75838171821945.68364764451217.1364274269699.5115535156380.9045100568209.0783924395107.83176932953.915884664526.957942332313.47897116616.73948558313.36974279151.68487139580.84243569790.4212178489000000000000375731.808225976

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    7840637.228885898138638.885692470936396.570611325833671.433350988630834.249939100627731.582138294224792.512468397221790.67079799518908.086203274716170.160893984513334.276052742510694.22513398238511.04475173086455.25390487164766.95672975133423.63301321562225.80840806971392.3704900406800.2219164672435.7442496793239.17991211123.356568844261.678284422130.83914221115.41957110557.70978555283.85489277641.92744638820.96372319410.48186159700000000000000342096.326820482

    7946554.55344152443853.124751145140569.923698639837151.682163265433413.521522288629873.040371051226256.055705953722782.766498947719483.780427987416066.760775055512885.705697306210255.14391864767778.07657660455743.8103950314125.21027668432681.92521904541677.6976481696964.2048843132525.0377741553288.1931058627148.635027039474.317513519737.158756759918.57937837999.289689194.6448445952.32242229751.16121114870.5806055744000000000000000363226.904300182

    8050672.779319514146879.274202891942929.682681818738610.369022660734519.431637891130339.868616139726326.351148528522514.247568297518565.751705485414889.921862630111850.20791454298987.86261208856637.19085200384766.83699982283099.06635236521938.64329026121114.1753291782606.7010698324333.0180688933171.753413484485.876706742242.938353371121.469176685510.73458834285.36729417142.68364708571.34182354280.67091177140000000000000000365924.216170043

    8145844.514497042941982.344147847237758.563713565833758.073731049429671.121285311825746.069233541822017.991531154118156.527886656714561.720194130711589.00721480128789.75334511286490.89477792944661.76701549113030.75714584151895.91197384741089.616825419593.3282459025325.6777291078167.967647689583.983823844741.991911922420.995955961210.49797798065.24898899032.62449449511.31224724760.656123623800000000000000000308298.919665508

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    8431845.74668740127991.963433524624290.343777309820773.764915851717130.757030595613739.041525472210934.27488239538293.1676063826124.18530932824398.39591435942859.53154745561788.80056683331028.0578538598559.8075845445307.2782462842158.478150642679.239075321339.619537660719.80976883039.90488441524.95244220762.47622110381.23811055190.619055275900000000000000000000172381.454127606

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    Differencesin Survivars

    Age at1234567891011121314151617181920212223242526272829303132333435363738394041424344

    31 dec. 1994dec. 1995dec. 1996dec. 1997dec. 1998dec. 1999dec. 2000dec. 2001dec. 2002dec. 2003dec. 2004dec. 2005dec. 2006dec. 2007dec. 2008dec. 2009dec. 2010dec. 2011dec. 2012dec. 2013dec. 2014dec. 2015dec. 2016dec. 2017dec. 2018dec. 2019dec. 2020dec. 2021dec. 2022dec. 2023dec. 2024dec. 2025dec. 2026dec. 2027dec. 2028dec. 2029dec. 2030dec. 2031dec. 2032dec. 2033dec. 2034dec. 2035dec. 2036dec. 2037dec. 2038

    652.87240892365.48861315097.84031090129.945238714111.781279823913.361636277913.006898851912.613537246712.200295514411.765478487511.139219441710.417561589.8875576939.40696557928.94393737278.42453259987.79346618727.13655551536.41827947465.73805248855.04329736484.37614345183.74246991213.08612432832.47510312731.96982139591.49402307571.1032785790.79237576090.51514768790.32225434860.18520572960.10084993920.0553565070.02855000950.01427500480.00713750240.00356875120.00178437560.00089218780.00044609390.00022304690.00011152350

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    Gain in QALY

    survivants

    Age at1234567891011121314151617181920212223242526272829303132333435363738394041424344

    31 dec. 1994dec. 1995dec. 1996dec. 1997dec. 1998dec. 1999dec. 2000dec. 2001dec. 2002dec. 2003dec. 2004dec. 2005dec. 2006dec. 2007dec. 2008dec. 2009dec. 2010dec. 2011dec. 2012dec. 2013dec. 2014dec. 2015dec. 2016dec. 2017dec. 2018dec. 2019dec. 2020dec. 2021dec. 2022dec. 2023dec. 2024dec. 2025dec. 2026dec. 2027dec. 2028dec. 2029dec. 2030dec. 2031dec. 2032dec. 2033dec. 2034dec. 2035dec. 2036dec. 2037dec. 2038

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