Cost-effectiveness of vaccination against invasive pneumococcal disease among people 50 through 64 years of age: Role of comorbid conditions and race
Cost-effectiveness of vaccination against invasive pneumococcal disease among people 50 through 64 years of age: Role of comorbid conditions and race
复制标题
DOI：
10.7326/0003-4819-138-12-200306170-00007
复制
发表时间：
2003-06-17
影响因子：
39.2
通讯作者：
Whitney, CG
中科院分区：
文献类型：
--
作者：
Sisk, JE;Whang, W;Whitney, CG
背景资料：越来越多的指南建议从50岁开始提供预防服务，政策制定者正在考虑对肺炎球菌多糖疫苗接种提出这样的建议。肺炎球菌疫苗接种对于65岁以上的人来说是节省成本的，这一发现提出了疫苗接种对其他老年人的影响的问题，特别是黑人，他们的疾病发病率超过了非黑人，以及那些有高风险条件的人。目的：评估50至64岁的黑人和非黑人接种疫苗对侵袭性肺炎球菌疾病的影响。设计：成本效益分析。数据来源：有关疫苗接种有效性和成本估算的已发表文献;来自疾病控制和预防中心的疾病发病率和病死率数据。目标人群：1995年美国年龄分布的50至64岁的假设队列。时间范围：终生。视角：社会。干预：肺炎球菌多糖疫苗接种与未接种的比较。结果测量：每名接种者的质量调整生命年中的增量医疗成本和健康影响。基础病例分析结果：接种疫苗节省了医疗费用，并改善了高风险黑人（每名接种者节省27.55美元）和非黑人（每名接种者节省5.92美元）的健康状况，这还不包括幸存者未来的费用。对于低风险的黑人和非黑人人群以及整个普通人群，接种疫苗的成本分别为2477美元、8195美元和3434美元，以获得1年的健康寿命。不包括幸存者的未来成本，在一般免疫功能正常的人群中，在全球最坏情况结果中，每质量调整生命年的成本从黑人的21 513美元到非黑人的68 871美元不等;在高危人群中，费用从黑人的11548美元到非黑人的39000美元不等。在全球最好的情况下，在一般免疫功能正常和高风险人群中，接种疫苗可以节省黑人和非黑人的成本，不包括幸存者的未来成本。在概率敏感性分析中，成本效益范围较窄，95%的概率区间范围为：在一般免疫活性人群中，黑人的成本节约为1594美元，非黑人的成本节约为12273美元。从1998年的病死率为低风险的人，每质量调整生命年的成本为黑人2477美元和8195美元的nonblack people，不包括幸存者的医疗costs.Conclusions：这些结果支持目前的建议，接种高风险的人，并考虑延长到一般人群50岁至64岁的建议提供有用的信息。缺乏证据表明，当疾病风险较高时，65岁或65岁以上的人重新接种疫苗的有效性，这就要求进一步研究以指导疫苗接种政策。
Background: Guidelines are increasingly recommending preventive services starting at 50 years of age, and policymakers are considering such a recommendation for pneumococcal polysaccharide vaccination. The finding that pneumococcal vaccination is cost-saving for people 65 years of age or older raises the question of the vaccination's implications for other older adults, especially black people, whose disease incidence exceeds that of nonblack people, and those with high-risk conditions.Objective: To assess the implications of vaccinating black and nonblack people 50 through 64 years of age against invasive pneumococcal disease.Design: Cost-effectiveness analysis.Data Sources: Published literature for vaccination effectiveness and cost estimates; data on disease incidence and case-fatality rates from the Centers for Disease Control and Prevention.Target Population: Hypothetical cohort 50 through 64 years of age with the 1995 U.S. age distribution.Time Horizon: Lifetime.Perspective: Societal.Intervention: Pneumococcal polysaccharide vaccination compared with no vaccination.Outcome Measures: Incremental medical costs and health effects, in quality-adjusted life-years per vaccinee.Results of Base-Case Analysis: vaccination saved medical costs and improved health among high-risk black people ($27.55 savings per vaccinee) and nonblack people ($5.92 savings per vaccinee), excluding survivors' future costs. For low-risk black and nonblack people and the overall general population, vaccination cost $2477, $8195, and $3434, respectively, to gain 1 year of healthy life.Results of Sensitivity Analysis: Excluding survivors' future costs, in the general immunocompetent population, cost per quality-adjusted life-year in global worst-case results ranged from $21 513 for black people to $68 871 for nonblack people; in the high-risk population, cost ranged from $11 548 for black people to $39 000 for nonblack people. In the global best case, vaccination was cost-saving for black and nonblack people in the general immunocompetent and high-risk populations, excluding survivors' future costs. The cost-effectiveness range was narrower in probabilistic sensitivity analyses, with 95% probabilistic intervals ranging from cost-saving to $1594 for black people and from cost-saving to $12 273 for nonblack people in the general immunocompetent population. Costs per quality-adjusted life-year for low-risk people with case-fatality rates from 1998 were $2477 for black people and $8195 for nonblack people, excluding survivors' medical costs.Conclusions: These results support the current recommendation to vaccinate high-risk people and provide useful information for considering extending the recommendation to the general population 50 through 64 years of age. Lack of evidence about the effectiveness of revaccination for people 65 years of age or older, when disease risks are higher, argues for further research to guide vaccination policy.