Is a HIV vaccine a viable option and at what price? An economic evaluation of adding HIV vaccination into existing prevention programs in Thailand
Is a HIV vaccine a viable option and at what price? An economic evaluation of adding HIV vaccination into existing prevention programs in Thailand
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DOI：
10.1186/1471-2458-11-534
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发表时间：
2011-07-05
影响因子：
4.5
通讯作者：
Tangcharoensathien, Viroj
中科院分区：
文献类型：
--
作者：
Leelahavarong, Pattara;Teerawattananon, Yot;Tangcharoensathien, Viroj
背景：本研究的目的是确定在泰国医疗保健环境中，艾滋病毒疫苗接种的最高价格是具有成本效益的。它还旨在确定疫苗接种者之间的疫苗特性和风险行为变化的相对重要性，以确定他们如何影响这种cost-effectiveness.Methods：一个半马尔可夫模型的开发，以估计成本和健康结果的艾滋病毒预防计划相结合的艾滋病毒疫苗接种相比，现有的艾滋病毒预防计划没有接种疫苗。该估计是基于生命周期（99年），并使用了政府的视角。分析重点关注一般人群和特定高危人群。通过阈值分析确定成本效益疫苗接种的最高价格，并进行单向和概率敏感性分析。该研究采用了期望值的完美信息（EVPI）分析，以确定参数的相对重要性，并优先考虑未来的study.Results：最昂贵的艾滋病毒疫苗接种，这是具有成本效益的，当给一般人群是12,000泰铢（1美元= 34泰铢在2009年）。这种疫苗接种具有70%的疫苗效力和终身保护，只要接种后风险行为不变。如果疫苗的有效性低（30%），并且接种后的风险行为增加了10%或更多，特别是在高风险人群中，则该疫苗将被认为是成本无效的。增量成本效果比对接种后风险行为的变化最为敏感，其次是疫苗效力和保护期。EVPI表明需要量化疫苗的有效性，改变接种后的风险行为，和疫苗接种programmes.Conclusions的成本：在这项研究中使用的方法区分它从其他经济评价，并可以应用于其他卫生干预措施的经济评价不可用在医疗保健系统。这项研究不仅对进行未来艾滋病毒疫苗研究的研究人员很重要，而且对将来考虑采用疫苗的政策决策者也很重要。
Background: This study aims to determine the maximum price at which HIV vaccination is cost-effective in the Thai healthcare setting. It also aims to identify the relative importance of vaccine characteristics and risk behavior changes among vaccine recipients to determine how they affect this cost-effectiveness.Methods: A semi-Markov model was developed to estimate the costs and health outcomes of HIV prevention programs combined with HIV vaccination in comparison to the existing HIV prevention programs without vaccination. The estimation was based on a lifetime horizon period (99 years) and used the government perspective. The analysis focused on both the general population and specific high-risk population groups. The maximum price of cost-effective vaccination was defined by using threshold analysis; one-way and probabilistic sensitivity analyses were performed. The study employed an expected value of perfect information (EVPI) analysis to determine the relative importance of parameters and to prioritize future studies.Results: The most expensive HIV vaccination which is cost-effective when given to the general population was 12,000 Thai baht (US$1 = 34 Thai baht in 2009). This vaccination came with 70% vaccine efficacy and lifetime protection as long as risk behavior was unchanged post-vaccination. The vaccine would be considered cost-ineffective at any price if it demonstrated low efficacy (30%) and if post-vaccination risk behavior increased by 10% or more, especially among the high-risk population groups. The incremental cost-effectiveness ratios were the most sensitive to change in post-vaccination risk behavior, followed by vaccine efficacy and duration of protection. The EVPI indicated the need to quantify vaccine efficacy, changed post-vaccination risk behavior, and the costs of vaccination programs.Conclusions: The approach used in this study differentiated it from other economic evaluations and can be applied for the economic evaluation of other health interventions not available in healthcare systems. This study is important not only for researchers conducting future HIV vaccine research but also for policy decision makers who, in the future, will consider vaccine adoption.