Economic evaluation of hepatitis B vaccination in low-income countries: using cost-effectiveness affordability curves
Economic evaluation of hepatitis B vaccination in low-income countries: using cost-effectiveness affordability curves
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DOI：
10.2471/blt.06.038893
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发表时间：
2007-11-01
期刊：
影响因子：
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通讯作者：
Goldie, Sue J
中科院分区：
文献类型：
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作者：
Kim, Sun-Young;Salomon, Joshua A;Goldie, Sue J
目的：我们试图描述一种方法，明确考虑了医疗保健计划的成本效益和负担能力。为了说明，我们应用该方法的方案，以接种婴儿对肝炎B在Gambia.Methods我们综合选定的数据，并开发了一个基于计算机的模型，从社会和付款人的角度来评估的成本效益的常规婴儿接种疫苗对肝炎B在冈比亚相比，没有接种疫苗。主要的结局指标是每避免残疾调整生命年（DALY）的成本，以2002年美元表示。我们使用蒙特卡罗方法进行不确定性分析，以检查从付款人的角度来看，该方案的负担能力，我们得出了一个负担能力曲线和成本效益的负担能力曲线的program.Findings在冈比亚，接种婴儿肝炎B是非常具有成本效益的。与不提供干预措施相比，从社会角度看，接种疫苗方案每避免一个残疾调整生命年将花费28美元，从支付者角度看，每避免一个残疾调整生命年将花费47美元。该方案也有可能是负担得起的，起始预算相对较低，每年160 000美元。将成果计量的两个方面结合起来，在年度方案预算为182，000美元的情况下，为婴儿接种疫苗既具有成本效益又负担得起的概率为40（从付款人的角度估计的方案总费用），鉴于成本效益阈值为美元，结论面对疫苗方案的健康和经济后果以及为该方案提供资金所需资源的可得性和规模的不确定性，成本效益负担能力曲线可向决策者提供关于方案既具有成本效益又负担得起的可能性的信息：这些是资源贫乏环境中不同但同样相关的考虑因素。
Objective We sought to describe a method that explicitly considers both a health-care programme's cost-effectiveness and its affordability. For illustration, we apply the method to the programme to vaccinate infants against hepatitis B in the Gambia.Methods We synthesized selected data and developed a computer-based model from the societal and payer perspectives to evaluate the cost-effectiveness of routine infant vaccination against hepatitis B in the Gambia compared with no vaccination. The primary outcome measure was cost per averted disability-adjusted life year (DALY), which was expressed in 2002 US dollars. We used Monte Carlo methods for uncertainty analysis to examine the affordability of the programme from the payer's perspective, and we derived an affordability curve and cost-effectiveness affordability curves for the programme.Findings In the Gambia, vaccinating infants against hepatitis B is highly cost-effective. Compared with offering no intervention, the vaccination programme would cost US$ 28 per DALY averted from the societal perspective or US$ 47 per DALY averted from the payer's perspective. The programme also has the potential to be affordable, starting at a relatively low budget of US$ 160 000 per year. Combining the two dimensions of the outcome measure, the probability that vaccinating infants would be both cost-effective and affordable is 40% at an annual programme budget of US$ 182 000 (the estimated total programme cost from the payer's perspective), given a threshold cost-effectiveness value of US$ 47 per DALY averted.Conclusion In the face of uncertainties about both the health and economic consequences of a vaccine programme, as well as the availability and magnitude of resources needed to fund the programme, cost-effectiveness affordability curves can provide information to decision-makers about the probability that a programme will be both cost-effective and affordable: these are distinct but equally relevant considerations in resource-poor settings.