Cost-effectiveness of pneumococcal conjugate vaccination in immunocompromised adults
Cost-effectiveness of pneumococcal conjugate vaccination in immunocompromised adults
复制标题
DOI：
10.1016/j.vaccine.2013.06.037
复制
发表时间：
2013-08-20
期刊：
影响因子：
5.5
通讯作者：
Zimmerman, Richard K.
中科院分区：
文献类型：
--
作者：
Smith, Kenneth J.;Nowalk, Mary Patricia;Zimmerman, Richard K.
目的：肺炎球菌病是免疫功能低下者，尤其是HIV感染者的一个重要问题。疾控中心最近更新了针对免疫功能低下的成年人的肺炎球菌疫苗接种建议，将13价肺炎球菌结合疫苗(PCV13)添加到之前推荐的23价肺炎球菌多糖疫苗(PPSV23)中。设计：基于马尔可夫模型的成本-效果分析。方法：该模型考虑了19-年龄段的免疫缺陷人群，并考虑了儿童PCV13的群体免疫；在单独的分析中，考虑了HIV感染亚组。PCV13的有效性由一个专家小组评估；PPSV23保护是相对于PCV13的有效性建模的。我们假设两种疫苗都预防了侵袭性肺炎球菌疾病，但只有PCV13预防了非细菌性肺炎。结果：在所有免疫受损的个体中，与未接种疫苗相比，单个PCV13的质量调整寿命年(QALY)的成本为70,937美元；目前的推荐成本为136,724美元/QALY。对于预期寿命更长(22.5岁)的艾滋病毒患者，目前的建议成本为89,391美元/QALY，而单个PCV13。结果对预期寿命和疫苗效力的变化很敏感。结论：单剂PCV13对免疫低下者的成本效益高于以往的疫苗接种建议，也可能比目前的推荐更经济合理，这取决于免疫低下者的预期寿命和疫苗效果。(C)2013爱思唯尔有限公司。保留所有权利。
Objective: Pneumococcal disease is a significant problem in immunocompromised persons, particularly in HIV-infected individuals. The CDC recently updated pneumococcal vaccination recommendations for immunocompromised adults, adding the 13-valent pneumococcal conjugate vaccine (PCV13) to the previously recommended 23-valent pneumococcal polysaccharide vaccine (PPSV23). This analysis estimates the cost-effectiveness of pneumococcal vaccination strategies in HIV-infected individuals and in the broader immunocompromised adult group.Design: Markov model-based cost-effectiveness analysis.Methods: The model considered immunocompromised persons aged 19-64 years and accounted for childhood PCV13 herd immunity; in a separate analysis, an HIV-infected subgroup was considered. PCV13 effectiveness was estimated by an expert panel; PPSV23 protection was modeled relative to PCV13 effectiveness. We assumed that both vaccines prevented invasive pneumococcal disease, but only PCV13 prevented nonbacteremic pneumonia.Results: In all immunocompromised individuals, a single PCV13 cost $70,937 per quality adjusted life year (QALY) gained compared to no vaccination; current recommendations cost $136,724/QALY. In HIV patients, with a longer life expectancy (22.5 years), current recommendations cost $89,391/QALY compared to a single PCV13. Results were sensitive to variation of life expectancy and vaccine effectiveness. The prior recommendation was not favored in any scenario.Conclusions: One dose of PCV13 is more cost-effective for immunocompromised individuals than previous vaccination recommendations and may be more economically reasonable than current recommendations, depending on life expectancy and vaccine effectiveness in the immunocompromised. (C) 2013 Elsevier Ltd. All rights reserved.