Economic Evaluation of Immunisation Programme of 23-Valent Pneumococcal Polysaccharide Vaccine and the Inclusion of 13-Valent Pneumococcal Conjugate Vaccine in the List for Single-Dose Subsidy to the Elderly in Japan.
Economic Evaluation of Immunisation Programme of 23-Valent Pneumococcal Polysaccharide Vaccine and the Inclusion of 13-Valent Pneumococcal Conjugate Vaccine in the List for Single-Dose Subsidy to the Elderly in Japan.
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DOI：
10.1371/journal.pone.0139140
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Okubo I
中科院分区：
文献类型：
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作者：
Hoshi SL;Kondo M;Okubo I
目前在日本，23价肺炎球菌多糖疫苗（PPSV-23）和13价肺炎球菌结合疫苗（PCV-13）可用于老年人预防S。肺炎相关疾病。PPSV-23于1988年获得批准，而PCV-13的延长使用于2014年6月被批准用于65岁及以上的成年人。尽管有这两种疫苗，但最近启动的老年人国家免疫接种计划只补贴PPSV-23。目前的免疫方案框架为期五年。有资格获得第一年PPSV-23补贴注射的老年人口为65岁、70岁、75岁、80岁、85岁、90岁、95岁和≥100岁的老年人。而从第二年到第五年，65岁、70岁、75岁、80岁、85岁、90岁、95岁和100岁的人将获得相同的补贴注射。我们进行了经济学评价，以（1）评价PPSV-23单剂免疫接种计划替代策略的有效性，（2）调查PCV-13纳入单剂肺炎球菌疫苗免疫接种计划列表的有效性。本研究中创建了三种替代策略，即：（1）当前PPSV-23策略，（2）65 - 80岁（作为“65-80 PPSV-23策略”），和（3）65岁及以上（作为“≥65 PPSV-23策略”）。我们构建了一个描述S.肺炎相关疾病的病程途径。转移概率，效用权重估计质量调整生命年（QALY）和疾病治疗费用的计算或引用文献。PPSV-23和PCV-13的疫苗成本分别为8，116日元（74美元; 1美元= 110日元）和10，776日元（98美元）。该模型运行15年，免疫后一年为一个周期。贴现率为3%。与当前的PPSV-23策略相比，65-80 PPSV-23策略的成本更低，但收益更少，而≥65 PPSV-23策略的增量成本-效果比（ICER）为5，025，000日元（45，682美元）/QALY收益。将PCV-13纳入单剂量补贴清单，无论PCV-13扩散水平如何，ICER为每QALY 377，000日元（3，427美元）。这些ICER被认为是具有成本效益的，因为它们低于WHO建议的GDP三倍标准（每获得一个QALY 11，000，000日元或113，636美元），这是用于判断免疫规划成本效益的基准。结果表明，将目前的PPSV-23策略转换为≥65 PPSV-23策略或将PCV-13纳入日本老年人单次剂量补贴清单具有经济价值。
Currently in Japan, both 23-valent pneumococcal polysaccharide vaccine (PPSV–23) and 13-valent pneumococcal conjugate vaccine (PCV–13) are available for the elderly for the prevention of S. pneumoniae-related diseases. PPSV–23 was approved in 1988, while the extended use of PCV–13 was approved for adults aged 65 and older in June 2014. Despite these two vaccines being available, the recently launched national immunisation programme for the elderly only subsidised PPSV–23. The framework of the current immunisation programme lasts for five years. The elderly population eligible for the subsidised PPSV–23 shot for the 1st year are those aged 65, 70, 75, 80, 85, 90, 95 and ≥100. While from the 2nd year to the 5th year, those who will age 65, 70, 75, 80, 85, 90, 95 and 100 will receive the same subsidised shot. We performed economic evaluations to (1) evaluate the efficiency of alternative strategies of PPSV–23 single-dose immunisation programme, and (2) investigate the efficiency of PCV–13 inclusion in the list for single-dose pneumococcal vaccine immunisation programme. Three alternative strategies were created in this study, namely: (1) current PPSV–23 strategy, (2) 65 to 80 (as “65–80 PPSV–23 strategy”), and (3) 65 and older (as “≥65 PPSV–23 strategy”). We constructed a Markov model depicting the S. pneumoniae-related disease course pathways. The transition probabilities, utility weights to estimate quality adjusted life year (QALY) and disease treatment costs were either calculated or cited from literature. Cost of per shot of vaccine was ¥8,116 (US$74; US$1 = ¥110) for PPSV–23 and ¥10,776 (US$98) for PCV–13. The model runs for 15 years with one year cycle after immunisation. Discounting was at 3%. Compared to current PPSV–23 strategy, 65–80 PPSV–23 strategy cost less but gained less, while the incremental cost-effectiveness ratios (ICERs) of ≥65 PPSV–23 strategy was ¥5,025,000 (US$45,682) per QALY gained. PCV–13 inclusion into the list for single-dose subsidy has an ICER of ¥377,000 (US$3,427) per QALY gained regardless of the PCV–13 diffusion level. These ICERs were found to be cost-effective since they are lower than the suggested criterion by WHO of three times GDP (¥11,000,000 or US$113,636 per QALY gained), which is the benchmark used in judging the cost-effectiveness of an immunisation programmne. The results suggest that switching current PPSV–23 strategy to ≥65 PPSV–23 strategy or including PCV–13 into the list for single-dose subsidy to the elderly in Japan has value for money.