Cost-effectiveness analysis of influenza vaccination during pregnancy in Japan.
Cost-effectiveness analysis of influenza vaccination during pregnancy in Japan.
复制标题
日本妊娠期流感疫苗接种的成本效益分析。
DOI：
10.1016/j.vaccine.2020.09.024
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发表时间：
2020
期刊：
影响因子：
5.5
通讯作者：
Kondo M.
中科院分区：
文献类型：
--
作者：
Hoshi SL;Shono A;Seposo X;Okubo I;Kondo M.
孕妇和婴儿被认为是流感的高危人群。世卫组织建议孕妇接种灭活流感疫苗。在日本，一些市政府开始提供补贴，鼓励孕妇雅阁接种疫苗，这使得将季节性产前产妇疫苗接种计划（AMVP）纳入常规疫苗接种清单成为卫生政策的当前主题，并提出了评估这种可能性的资金价值的必要性。方法我们进行了成本-效果分析，以评估在日本进行AMVP的效率。采用决策树模型，考虑到婴儿和母亲的单年疫苗有效性持续时间。该计划针对的是10月1日至3月30日期间怀孕12周或以上的20-49岁孕妇。妊娠/产后妇女或其婴儿因流感而接受治疗的估计概率因日历时间、疫苗接种状态和/或胎龄而异。从社会角度计算与当前无AMVP相比的增量成本效果比（ICER）。转移概率，效用权重，以估计质量调整生命年（QALY），疾病治疗成本计算或从文献中提取。假设每次接种疫苗的费用为3，529日元/32.1美元。结果AMVP降低了疾病治疗费用，但不能抵消预防接种费用。增量QDs为0.00009，其中84.2%来自婴儿。ICER为7，779，356日元/70，721美元/每增加一个QALY。单因素敏感性分析显示，疫苗对婴儿的有效性和每次注射的成本是影响ICER的两个主要关键变量。结论我们发现，在日本，根据WHO建议的“成本效益”标准（GDP的1-3倍），从社会角度来看，为孕妇接种流感疫苗以预防未接种疫苗的婴儿和孕妇/产后妇女患流感相关疾病是具有成本效益的。
Background Pregnant women and infants are known as high risk groups for influenza. WHO recommend pregnant women be vaccinated with inactivated influenza vaccine. In Japan, some municipalities started to give subsidy to encourage pregnant women to receive a shot on their own accord, which has made the introduction of seasonal antepartum maternal vaccination program (AMVP) into the routine vaccination list a current topic in health policy and has raised the need to evaluate the value for money of such possibility. Methods We conducted a cost-effectiveness analysis to evaluate the efficiency of conducting AMVP in Japan. A decision tree model was adopted taking into consideration the duration of single-year vaccine effectiveness for infants and for mothers. The program targeted pregnant women aged 20–49 years old at or over 12 weeks gestation during October 1 through March 30. Estimated probabilities of treatments received due to influenza for pregnant/postpartum women or their infants varied by calendar time, vaccination status, and/or gestational age. Incremental cost-effectiveness ratio (ICER) compared with current no-AMVP from societal perspective was calculated. Transition probabilities, utility weights to estimate quality-adjusted life year (QALY), and disease treatment costs were either calculated or extracted from literature. Costs per vaccination was assumed at¥ 3,529/US $32.1. Results AMVP reduces disease treatment costs, while the reduction cannot offset the vaccination cost. Incremental QALYs were at 0.00009, among them 84.2% were from infants. ICER was¥ 7,779,356/US $70,721 per QALY gained. One-way sensitivity analyses revealed that vaccine effectiveness for infant and costs per shot were the two main key variables affecting the ICER. Conclusion We found that vaccinating pregnant women with influenza vaccine to prevent unvaccinated infants and pregnant/postpartum women from influenza-associated disease in Japan can be cost-effective from societal perspective, under the WHO-suggested “cost-effective” criteria (1–3 times of GDP).