Pneumococcal Vaccination in Adults Aged ≥65 Years: Cost-Effectiveness and Health Impact in US Populations
Pneumococcal Vaccination in Adults Aged ≥65 Years: Cost-Effectiveness and Health Impact in US Populations
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DOI：
10.1016/j.amepre.2019.10.022
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发表时间：
2020-04-01
影响因子：
5.5
通讯作者：
Smith, Kenneth J.
中科院分区：
文献类型：
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作者：
Wateska, Angela R.;Nowalk, Mary Patricia;Smith, Kenneth J.
简介：向所有美国老年人推荐结合疫苗和多糖肺炎球菌疫苗可能对公共卫生影响不大，在经济上也不合理。对所有≥ 65岁的成年人使用两种疫苗的公共卫生影响和成本效益进行了评估，并与替代策略进行了比较（在非免疫功能低下者中省略肺炎球菌结合疫苗）和新修订的建议（基于患者-医师共同决策给予或省略结合疫苗）。策略在假设的美国65岁的人群队列中进行了检查，并根据年龄和人群特定的数据在马尔可夫状态转换模型中从医疗保健的角度进行了终身时间范围的健康状态分割。黑人群体被单独检查，考虑到更大的疾病风险和更低的疫苗摄取。模型参数来自疾病控制中心主动核心细菌监测网络、国家健康访谈调查和全国住院患者样本数据。结果包括每种策略获得的质量调整生命年的增量成本和肺炎球菌疾病的结果。结果：常规或共同决策给予两种疫苗最有效，与未接种疫苗相比，降低了肺炎球菌疾病的发病率，但成本为765，000 - 218万美元/质量调整生命年。根据不同的人群和情景，替代策略的成本为65，700 - 226，700美元/获得的质量调整生命年（黑人人群较少），病例和死亡减少0.3%-0.9%。结论：在免疫功能正常的美国老年人中，省略肺炎球菌结合疫苗的接种策略可能在经济上是合理的，特别是对黑人老年人。使用两种肺炎球菌疫苗更有效，但费用更高。(C)2019年美国预防医学杂志。爱思唯尔公司出版All rights reserved.
Introduction: Recommending both the conjugate and polysaccharide pneumococcal vaccines to all U.S. seniors may have little public health impact and be economically unreasonable. Public health impact and cost-effectiveness of using both vaccines in all adults aged >= 65 years were estimated compared with an alternative strategy (omitting pneumococcal conjugate vaccine in the nonimmunocompromised) and with the newly revised recommendation (giving or omitting conjugate vaccine based on patient-physician shared decision making).Methods: Strategies were examined in hypothetical U.S. 65-year-old population cohorts and segmented into health states based on age- and population-specific data in a Markov state-transition model with a lifetime time horizon from a healthcare perspective. Black population cohorts were examined separately given greater illness risk and lower vaccine uptake. Model parameters came from the Centers for Disease Control Active Core Bacterial Surveillance network, National Health Interview Survey, and Nationwide Inpatient Sample data. Outcomes included incremental costs per quality-adjusted life year gained and pneumococcal disease outcomes for each strategy. Data were gathered and analysis performed in 2018.Results: Giving both vaccines, either routinely or with shared decision making, was most effective, reducing pneumococcal disease incidence compared with no vaccination, but costing $765,000-$2.18 million/quality-adjusted life year gained. Depending on examined population and scenario, the alternative strategy cost $65,700-$226,700/quality-adjusted life year gained (less in black populations) and reduced cases and deaths by 0.3%-0.9%.Conclusions: A vaccination strategy that omits pneumococcal conjugate vaccine in immunocompetent U.S. seniors may be economically reasonable, particularly for black seniors. Use of both pneumococcal vaccines was more effective but substantially more expensive. (C) 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.