Modeling of cost effectiveness of pneumococcal conjugate vaccination strategies in U.S. older adults.
Modeling of cost effectiveness of pneumococcal conjugate vaccination strategies in U.S. older adults.
复制标题
美国老年人肺炎球菌结合疫苗接种策略的成本效益建模。
DOI：
10.1016/j.amepre.2012.11.035
复制
发表时间：
2013
影响因子：
5.5
通讯作者：
Zimmerman,RichardK
中科院分区：
文献类型：
--
作者：
Smith,KennethJ;Wateska,AngelaR;Nowalk,MaryPatricia;Raymund,Mahlon;Lee,BruceY;Zimmerman,RichardK
背景13价肺炎球菌结合疫苗（PCV 13）被美国食品和药物管理局批准用于成人，但其在老年人中的作用尚不清楚。估计，在65岁或75岁的成年人中。对既往未接种疫苗、既往接种疫苗和疫苗低反应情况进行了检查。肺炎球菌疾病的发病率，间接儿童PCV 13的影响，和成本估计使用CDC的活性细菌核心监测数据和美国国家数据库。一个专家小组估计了疫苗相关的保护作用。从社会角度考虑，结果每年折扣3%。在65岁的人群中，单次接种PCV 13的成本为11，300/QALY;在65岁和80岁的人群中，PCV 13的成本为83，000/QALY。在75岁的人群中，单剂量PCV 13的成本为62，800/Q1，而PSV 23的成本高于PCV 13，但效果较PCV 13差。结果对不同的疫苗有效性和间接效果评价敏感。在低反应情况下，单剂量策略的成本-效果比增加37%-78%，而配方多剂量策略的成本-效果比增加29%-35%。
BACKGROUNDThe 13-valent pneumococcal conjugate vaccine (PCV13) is approved by the US Food and Drug Administration for adults, but its role in older adults is unclear.PURPOSETo compare PCV13 strategies to currently recommended vaccination strategies in adults aged≥ 65 years.METHODSUsing a Markov model, the cost effectiveness of PCV13 and the 23-valent pneumococcal polysaccharide vaccine (PPSV23), alone or in combination, was estimated, in adults aged either 65 years or 75 years. No prior vaccination, prior vaccination, and vaccine hyporesponsiveness scenarios were examined. Pneumococcal disease rates, indirect childhood PCV13 effects, and costs were estimated using CDC Active Bacterial Core surveillance data and US national databases. An expert panel estimated vaccine-related protection. A societal perspective was taken and outcomes were discounted 3% per year.RESULTSIn those aged 65 years, single-dose PCV13 cost 11,300perquality-adjustedlife-year(QALY)gainedcomparedtonovaccination;atages65and80years,PCV13cost 83,000/QALY. In those aged 75 years, single-dose PCV13 cost 62,800/QALYgained.PPSV23costmoreandwaslesseffectivethanPCV13.Resultsweresensitivetovaryingvaccineeffectivenessandindirecteffectestimates.Inhyporesponsivenessscenarios,cost-effectivenessratiosincreasedby37%–78%forsingle-dosestrategiesand29%–35%formultiple-dosestrategies.CONCLUSIONSSingle-dosePCV13strategiesarelikelytobeeconomicallyreasonableinolderadults.