Measles vaccination of young infants in China: A cost-effectiveness analysis.
Measles vaccination of young infants in China: A cost-effectiveness analysis.
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DOI：
10.1016/j.vaccine.2020.04.079
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发表时间：
2020-06-15
期刊：
影响因子：
5.5
通讯作者：
Boulton ML
中科院分区：
文献类型：
--
作者：
Janusz CB;Wagner AL;Masters NB;Ding Y;Zhang Y;Hutton DW;Boulton ML
背景虽然全球在控制麻疹方面取得了进展，但在世界许多地区实现消灭麻疹仍很困难。中国已通过了消除麻疹的目标，但最近的疫情主要影响8个月以下的儿童，他们没有资格接种疫苗，也没有得到母体抗体的完全保护，这阻碍了进展。我们评估的成本效益，增加初始麻疹疫苗剂量在中国早于目前建议的8个月龄。MethodsWe进行了成本效用分析比较的成本和健康效益与增加麻疹疫苗剂量的常规时间表在4，5，6或7个月相比，目前的建议，在8个月龄的第一剂。在Microsoft Excel中开发了一个决策分析模型，其中包括与麻疹感染相关的五种非严重和两种致命健康结局。模型参数由文献和监测数据提供。未来的成本和健康福利按3%贴现。主要结果包括成本，质量调整生命年（QHMS），和增量成本效益比（ICER）在一生的时间horizon.ResultsLowering建议的年龄开始麻疹疫苗接种系列，以解决儿童的易感性<8个月提供增量的健康收益相比，在个人层面上的最低成本。ICER是最有利的（232.70美元每QALY增益）管理的初始剂量在4个月的年龄，由于减少增量计划成本时，麻疹管理转移到一个免疫接种访问已经建立在中国疫苗接种program.ConclusionWe发现潜在的有益健康收益在最低成本与增加早期麻疹剂量<8个月的年龄在中国。需要对疾病传播动力学进行进一步调查，以更全面地评估中国婴儿在较年轻时接种麻疹的权衡。
BackgroundAlthough global progress in measles control has been realized, achieving elimination has proven difficult in many regions of the world. China has adopted a goal of measles elimination but recent outbreaks predominantly affecting children <8 months who are ineligible for vaccination and incompletely protected by maternal antibodies has impeded progress. We assess the cost-effectiveness of adding an initial measles vaccine dose in China to earlier than the currently recommended 8 months of age.MethodsWe conducted a cost-utility analysis comparing the costs and health benefits associated with adding a measles vaccine dose to the routine schedule at 4, 5, 6 or 7 months compared to the current recommendation for the first dose at age 8 months. A decision analytic model was developed in Microsoft Excel, including five non-severe and two fatal health outcomes associated with measles infection. Model parameters were informed by the literature and surveillance data. Future costs and health benefits were discounted at 3%. Primary outcomes included costs, Quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) over a lifetime time horizon.ResultsLowering the recommended age for initiating the measles vaccination series to address susceptibility in children <8 months provided incremental health gains compared to minimal costs at the individual-level. The ICER was most favorable ($232.70 per QALY gain) for administering an initial dose at 4 months of age due to fewer incremental program costs when shifting measles administration to an immunization visit already established under the Chinese vaccination program.ConclusionWe found potential beneficial health gains at a minimum cost associated with adding an earlier measles dose <8 months of age in China. Further investigation about disease transmission dynamics is required to more fully assess the tradeoffs of administering measles at a younger age to infants in China.
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