Potential impact of vaccination against Neisseria meningitidis on Neisseria gonorrhoeae in the United States: results from a decision-analysis model.
Potential impact of vaccination against Neisseria meningitidis on Neisseria gonorrhoeae in the United States: results from a decision-analysis model.
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DOI：
10.4161/hv.36221
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发表时间：
2014
影响因子：
4.8
通讯作者：
Huels J
中科院分区：
文献类型：
--
作者：
Régnier SA;Huels J
针对B群脑膜炎奈瑟菌的4CMenB疫苗中的成分已被证明可能与淋病奈瑟菌发生交叉反应。我们模拟了美国4CMenB疫苗接种计划对淋病结果的理论影响。决策分析模型使用已发布的医疗保健利用率和成本数据进行填充。假定青少年接种两剂疫苗，从15岁开始保护性免疫，对淋病的基本有效率为20%。20%的疗效水平是一个假设，因为还没有临床数据量化4CMenB治疗淋病奈瑟菌的疗效。关键的结果指标是淋病和艾滋病毒感染的减少，质量调整后寿命年(QALY)损失的减少，以及假设每增加一个QALY的支付意愿门槛为75,000美元的经济合理价格。在美国，青少年接种4CMenB疫苗将预防83,167例淋病感染(95%可信区间[CRI]，44,600-134,600)，并使每个接种疫苗的出生队列中艾滋病毒感染人数减少55例(95%可信区间，2-129例)。不包括疫苗接种成本，淋病的直接医疗成本将减少2,870万美元(95%CRI，680万至7,000万美元)，收入和生产力损失将减少4,000万美元(95%CRI，820万至9170万美元)。大约83%的生产力损失是通过避免感染艾滋病毒而减少的。以每QALY增加75,000美元的成本，并增加疫苗对脑膜炎双球菌疾病的效果，从社会角度来看，在脑膜炎双球菌疫苗价格的基础上增加26.10美元(95%CRI，9.10-57.20美元)的价格是合理的。按此价格计算，每避免一次感染的净成本为1,677美元(95%CRI，404-2,564美元)。即使4CMenB疫苗和淋病的交叉免疫率只有20%，淋病感染和相关成本的减少也将是相当可观的。
Components in 4CMenB vaccine against Neisseria meningitidis serogroup B have shown to potentially cross-react with Neisseria gonorrhoeae. We modeled the theoretical impact of a US 4CMenB vaccination program on gonorrhea outcomes. A decision-analysis model was populated using published healthcare utilization and cost data. A two-dose adolescent vaccination campaign was assumed, with protective immunity starting at age 15 years and a base-case efficacy against gonorrhea of 20%. The 20%-efficacy level is an assumption since no clinical data have yet quantified the efficacy of 4CMenB against Neisseria gonorrhoea. Key outcome measures were reductions in gonorrhea and HIV infections, reduction in quality-adjusted life-years (QALYs) lost, and the economically justifiable price assuming a willingness-to-pay threshold of $75,000 per QALY gained. Adolescent vaccination with 4CMenB would prevent 83,167 (95% credible interval [CrI], 44,600–134,600) gonorrhea infections and decrease the number of HIV infections by 55 (95% CrI, 2–129) per vaccinated birth cohort in the USA. Excluding vaccination costs, direct medical costs for gonorrhea would reduce by $28.7 million (95% CrI, $6.8–$70.0 million), and income and productivity losses would reduce by $40.0 million (95% CrI, $8.2–$91.7 million). Approximately 83% of the reduction in lost productivity is generated by avoiding HIV infections. At a cost of $75,000 per QALY gained, and incremental to the vaccine's effect on meningococcal disease, a price of $26.10 (95% CrI, $9.10–$57.20) per dose, incremental to the price of the meningococcal vaccine, would be justified from the societal perspective. At this price, the net cost per infection averted would be $1,677 (95% CrI, $404–$2,564). Even if the cross-immunity of 4CMenB vaccine and gonorrhea is only 20%, the reduction in gonorrhea infections and associated costs would be substantial.