Effectiveness and cost-benefit of influenza vaccination of healthy working adults - A randomized controlled trial
Effectiveness and cost-benefit of influenza vaccination of healthy working adults - A randomized controlled trial
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DOI：
10.1001/jama.284.13.1655
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发表时间：
2000-10-04
影响因子：
120.7
通讯作者：
Fukuda, K
中科院分区：
文献类型：
--
作者：
Bridges, CB;Thompson, WW;Fukuda, K
目的评价流感疫苗在预防流感类疾病(ILI)和降低社会成本效益方面的有效性和成本效益。设计在两个流感季节进行的双盲、随机、安慰剂对照试验。设置和参与者年龄在18岁到之间的健康成年人，受雇于一家美国制造公司(1997年至1998年，n=1184；在每个季节，参与者被随机分配接受三价灭活流感疫苗(1997-1998年595例，1998-1999年587例)或无菌生理盐水注射(1997-1998年589例，1998-1999年604例)。结果1997-1998年和1998-1999年分别有95%(1130/1184)和99%(1178/1191)的受试者获得了完整的随访率(95%(1130/1184)和99%(1178/1191))，其中23%(1997-1998年为275例；1998-1999年为278例)；1997-1998年，当疫苗病毒与主要流行病毒不同时，疫苗对血清学确诊的流感疾病的有效率为50%(P=.33)。在这个季节，接种疫苗并没有减少ILI、医生就诊或损失的工作日；与不接种疫苗相比，净社会成本为每人65.59美元。1998-1999年，疫苗和主要流行病毒很好地匹配。疫苗有效率为86%(P=.001)，接种疫苗后ILI、就诊次数和工作日损失分别减少了34%、42%和32%。结论65岁以下健康劳动人口接种流感疫苗可以减少ILI、损失工作日和就诊率，但在疫苗和流行病毒相似的年份，接种流感疫苗并不一定能带来整体经济效益。
Context Although the cost-effectiveness and cost-benefit of influenza vaccination are well established for persons aged 65 years or older, the benefits for healthy adults younger than 65 years are less clear.Objective To evaluate the effectiveness and cost-benefit of influenza vaccine in preventing influenzalike illness (ILI) and reducing societal costs of ILI among healthy working adults.Design Double-blind, randomized, placebo-controlled trial conducted during 2 influenza seasons.Setting and Participants Healthy adults aged 18 to 64 years and employed full-time by a US manufacturing company (for 1997-1998 season, n=1184; for 1998-1999 season, n=1191).Interventions For each season, participants were randomly assigned to receive either trivalent inactivated influenza vaccine (n =595 in 1997-1998 and n = 587 in 1998-1999) or sterile saline injection (placebo; n = 589 in 1997-1998 and n = 604 in 1998-1999). Participants in 1997-1998 were rerandomized if they participated in 1998-1999.Main Outcome Measures Influenzalike illnesses and associated physician visits and work absenteeism reported in biweekly questionnaires by all participants, and serologically confirmed influenza illness among 23% of participants in each year (n = 275 in 1997-1998; n = 278 in 1998-1999); societal cost of ILI per vaccinated vs unvaccinated person.Results For 1997-1998 and 1998-1999, respectively, 95% (1130/1184) and 99% (1178/1191) of participants had complete follow-up, and 23% in each year had serologic testing. In 1997-1998, when the vaccine virus differed from the predominant circulating viruses, vaccine efficacy against serologically confirmed influenza illness was 50% (P=.33). In this season, vaccination did not reduce ILI, physician visits, or lost workdays; the net societal cost was $65.59 per person compared with no vaccination. In 1998-1999, the vaccine and predominant circulating viruses were well matched. Vaccine efficacy was 86% (P =.001), and vaccination reduced ILI, physician visits, and lost workdays by 34%, 42%, and 32%, respectively. However, vaccination resulted in a net societal cost of $11.17 per person compared with no vaccination.Conclusion Influenza vaccination of healthy working adults younger than 65 years can reduce the rates of ILI, lost workdays, and physician visits during years when the vaccine and circulating viruses are similar, but vaccination may not provide overall economic benefits in most years.