Burden of paediatric respiratory syncytial virus disease and potential effect of different immunisation strategies: a modelling and cost-effectiveness analysis for England.
Burden of paediatric respiratory syncytial virus disease and potential effect of different immunisation strategies: a modelling and cost-effectiveness analysis for England.
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DOI：
10.1016/s2468-2667(17)30103-2
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发表时间：
2017-08
期刊：
影响因子：
--
通讯作者：
Jit M
中科院分区：
文献类型：
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作者：
Cromer D;van Hoek AJ;Newall AT;Pollard AJ;Jit M
针对呼吸道合胞病毒（RSV）的疫苗和预防性抗体正在开发中，可能在未来5-10年内上市。当这些产品可用时，最有效的使用方法是公共卫生决策者的一个重要考虑因素。我们进行了多变量回归分析，以估计英格兰（英国）（一个代表性的高收入温带国家）5岁以下儿童的RSV负担，并使用这些结果评估不同RSV免疫策略（针对婴儿或孕妇的疫苗接种或新生儿的预防性抗体）的潜在影响。我们对这些单独或同时实施的策略进行了成本效益分析，并评估了将疫苗接种限制在一年中某些月份的影响。我们估计RSV每年每100名5岁以下儿童中有12例初级保健咨询（95%CI 11.9 - 12.1）和0.9例住院（95%CI 0.89 - 0.90），主要负担发生在6个月以下的婴儿中。最具成本效益的策略是选择性地对RSV季节开始前出生的所有儿童进行免疫接种（每种疫苗的最高价格为220英镑[95%不确定性区间（UI）208-232]，每质量调整生命年的增量成本效益比为20 000英镑）。 无季节性限制的婴儿、新生儿和孕产妇策略应支付的每名完全保护人员的最高价格分别为192英镑（95% UI 168-219）、81英镑（76-86）和54英镑（51-57）。与流感相比，呼吸道合胞病毒的初级保健咨询数量几乎增加了一倍，入院人数几乎增加了五倍。如果RSV疫苗和抗体策略的价格能够低于每个完全保护的人约200英镑，则它们可能具有成本效益。季节性疫苗接种策略可能提供最直接的好处。羊群效应可能会使全年的婴儿疫苗接种策略更具吸引力，尽管目前还不清楚这样的计划是否会引起羊群效应。英国国家健康研究所。
Vaccines and prophylactic antibodies against respiratory syncytial virus (RSV) are in development and likely to be available in the next 5–10 years. The most efficient way to use these products when they become available is an important consideration for public health decision makers. We performed a multivariate regression analysis to estimate the burden of RSV in children younger than 5 years in England (UK), a representative high-income temperate country, and used these results to assess the potential effect of different RSV immunisation strategies (targeting vaccination for infants, or pregnant women, or prophylactic antibodies for neonates). We did a cost-effectiveness analysis for these strategies, implemented either separately or concurrently, and assessed the effect of restricting vaccination to certain months of the year. We estimated that RSV is responsible for 12 primary care consultations (95% CI 11·9–12·1) and 0·9 admissions to hospital annually per 100 children younger than 5 years (95% CI 0·89–0·90), with the major burden occurring in infants younger than 6 months. The most cost-effective strategy was to selectively immunise all children born before the start of the RSV season (maximum price of £220 [95% uncertainty interval (UI) 208–232] per vaccine, for an incremental cost-effectiveness ratio of £20 000 per quality-adjusted life-year). The maximum price per fully protected person that should be paid for the infant, newborn, and maternal strategies without seasonal restrictions was £192 (95% UI 168–219), £81 (76–86), and £54 (51–57), respectively. Nearly double the number of primary care consultations, and nearly five times the number of admissions to hospital occurred with RSV compared with influenza. RSV vaccine and antibody strategies are likely to be cost-effective if they can be priced below around £200 per fully protected person. A seasonal vaccination strategy is likely to provide the most direct benefits. Herd effects might render a year-round infant vaccination strategy more appealing, although it is currently unclear whether such a programme would induce herd effects. UK National Institute for Health Research.