The cost and cost-effectiveness of novel tuberculosis vaccines in low- and middle-income countries: A modeling study.
The cost and cost-effectiveness of novel tuberculosis vaccines in low- and middle-income countries: A modeling study.
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DOI：
10.1371/journal.pmed.1004155
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发表时间：
2023-01
期刊：
影响因子：
15.8
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中科院分区：
文献类型：
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结核病（TB）是可以预防和治愈的，但消除它已被证明具有挑战性。能够迅速减轻疾病负担的安全有效的结核病疫苗对于实现消除结核病至关重要。我们评估了在低收入和中等收入国家（LMICs）引入新型结核病疫苗的未来成本、成本节约和成本效益，以获得一系列产品特征和交付策略。我们开发了一个流行病学和经济模型的系统，在105个中低收入国家的人口，流行病学和卫生服务数据进行校准。对于每个国家，我们评估了在几种疫苗引入情景下结核病相关结果的可能未来进程，并与“无新疫苗”的反事实进行了比较。疫苗方案考虑了2种疫苗产品特征（1种针对婴儿，1种针对青少年/成人），均假定可预防进展为活动性结核病。关键的经济投入来源于全球卫生成本联盟、世界卫生组织（WHO）患者成本调查和已发表的文献。我们估计了疫苗引入对一系列健康和经济结果的增量影响。在基本情况下，我们假设疫苗价格为4.60美元，并使用1×人均国内生产总值（GDP）的成本效益阈值（两者在敏感性分析中均有所不同）。据估计，疫苗的引进需要大量的近期资源，这些资源将被未来因避免结核病负担而节省的费用所抵消。从卫生系统的角度来看，在105个中低收入国家中，有64个国家的青少年/成人疫苗接种具有成本效益。从社会角度（包括提高生产力和避免患者成本）来看，青少年/成人疫苗接种预计在105个LMIC中的73个中具有成本效益，在105个LMIC中的58个中节省成本，包括96%的结核病负担较高的国家。在考虑健康收益的货币化价值时，我们估计，到2050年，引入青少年/成人疫苗可产生2830亿至4740亿美元的经济效益。由于数据有限，所需的假设和推断可能忽略了流行病学和费用方面重要的国家一级异质性。在大多数低收入国家，结核病疫苗接种将具有很高的影响力和成本效益。需要进一步努力，以促进新型结核病疫苗的未来开发、采用和实施。在一项建模研究中，Allison Portnoy博士及其同事探讨了新型结核病疫苗在低收入和中等收入国家的成本和成本效益。以往的研究强调了结核病（TB）的经济影响以及新型结核病疫苗对减轻特定中低收入国家（LMIC）负担的潜在经济影响。新型结核病疫苗的成本和成本效益取决于疫苗价格和交付策略，可能因国家而异，疫苗开发商、制造商和潜在购买者需要这些信息来指导投资决策。没有模型研究估计新型结核疫苗产品的成本和成本效益，并对医疗和非医疗成本、间接成本、疫苗交付成本和广泛的中低收入国家的交付策略进行国家特定的假设。我们从卫生系统和社会的角度估计了结核疫苗引进的成本、成本效益和增量净货币效益（iNMB），以便为新型结核疫苗投资和引进的全球决策提供信息。利用数学和经济模型，我们评估了引入具有广泛特征和多种健康和经济结果的新型结核病疫苗的情景，包括2028年至2047年的国家特定引入年份。我们的分析预测，一种有效的新型结核病疫苗可以在2028年至2050年期间提供巨大的潜在健康和经济效益。从社会角度来看，与人均国内生产总值（GDP）1倍的门槛相比，预计73个中低收入国家的疫苗接种具有成本效益。在考虑健康收益的货币化价值时，我们估计，到2050年，青少年/成人结核病疫苗的引入可产生2830亿至4740亿美元的健康和经济效益，结核病发病率高的中低收入国家的效益更大。在一系列关于疫苗价格和提供策略的假设下，发现引入新的结核疫苗具有影响力和成本效益，其总体健康和经济效益与近年来LMIC环境中最有影响力的健康干预措施规模相似。这些分析的结果可供全球和国家利益相关者用于为结核病疫苗政策和引进准备提供信息，以及围绕未来开发、采用和实施新型结核病疫苗的决策。
Tuberculosis (TB) is preventable and curable but eliminating it has proven challenging. Safe and effective TB vaccines that can rapidly reduce disease burden are essential for achieving TB elimination. We assessed future costs, cost-savings, and cost-effectiveness of introducing novel TB vaccines in low- and middle-income countries (LMICs) for a range of product characteristics and delivery strategies. We developed a system of epidemiological and economic models, calibrated to demographic, epidemiological, and health service data in 105 LMICs. For each country, we assessed the likely future course of TB-related outcomes under several vaccine introduction scenarios, compared to a “no-new-vaccine” counterfactual. Vaccine scenarios considered 2 vaccine product profiles (1 targeted at infants, 1 at adolescents/adults), both assumed to prevent progression to active TB. Key economic inputs were derived from the Global Health Cost Consortium, World Health Organization (WHO) patient cost surveys, and the published literature. We estimated the incremental impact of vaccine introduction for a range of health and economic outcomes. In the base-case, we assumed a vaccine price of $4.60 and used a 1× per-capita gross domestic product (GDP) cost-effectiveness threshold (both varied in sensitivity analyses). Vaccine introduction was estimated to require substantial near-term resources, offset by future cost-savings from averted TB burden. From a health system perspective, adolescent/adult vaccination was cost-effective in 64 of 105 LMICs. From a societal perspective (including productivity gains and averted patient costs), adolescent/adult vaccination was projected to be cost-effective in 73 of 105 LMICs and cost-saving in 58 of 105 LMICs, including 96% of countries with higher TB burden. When considering the monetized value of health gains, we estimated that introduction of an adolescent/adult vaccine could produce $283 to 474 billion in economic benefits by 2050. Limited data availability required assumptions and extrapolations that may omit important country-level heterogeneity in epidemiology and costs. TB vaccination would be highly impactful and cost-effective in most LMICs. Further efforts are needed for future development, adoption, and implementation of novel TB vaccines. In a modelling study, Dr. Allison Portnoy and colleagues explore the cost and cost-effectiveness of novel tuberculosis vaccines in low- and middle-income countries. Previous studies have highlighted the economic impact of tuberculosis (TB) and the potential economic impact that novel TB vaccines could have on reducing this burden in specific low- and middle-income countries (LMICs). The cost and cost-effectiveness of novel TB vaccines, which depend on vaccine price and delivery strategy that may vary by country, are needed by vaccine developers, manufacturers, and potential purchasers to guide investment decisions. No modeling studies have estimated the cost and cost-effectiveness of novel TB vaccine products with country-specific assumptions for medical and non-medical costs, indirect costs, vaccine delivery costs, and delivery strategies across a wide range of LMICs. We estimated the costs, cost-effectiveness, and incremental net monetary benefit (iNMB) of TB vaccine introduction from both the health system and societal perspective, in order to inform global-level decision-making for novel TB vaccine investment and introduction. Using mathematical and economic models, we assessed scenarios for the introduction of novel TB vaccines with a wide range of characteristics and a diverse set of health and economic outcomes, including country-specific introduction years from 2028 to 2047. Our analysis projected that an effective new TB vaccine could offer large potential health and economic benefits over 2028 to 2050. From a societal perspective, vaccination was projected to be cost-effective in 73 LMICs compared to a 1× per-capita gross domestic product (GDP) threshold. When considering the monetized value of health gains, we estimated that introduction of an adolescent/adult TB vaccine could produce $283 to 474 billion in health and economic benefits by 2050, with greater benefits in LMICs with elevated TB incidence. Introduction of a new TB vaccine was found to be impactful and cost-effective for a range of assumptions on vaccine price and delivery strategies, with aggregate health and economic benefits of similar scale to the most influential health interventions in LMIC settings in recent years. The results of these analyses can be used by global and country stakeholders to inform TB vaccine policy and introduction preparedness, as well as decision-making around future development, adoption, and implementation of novel TB vaccines.
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DOI：
10.1016/s2214-109x(21)00299-0
发表时间：
2021-10
期刊：
The Lancet. Global health
影响因子：
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作者：
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影响因子：
34.3
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影响因子：
5.5
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影响因子：
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DOI：
10.1073/pnas.1404386111
发表时间：
2014-10-28
影响因子：
11.1
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