Evaluating the next generation of RSV intervention strategies: a mathematical modelling study and cost-effectiveness analysis.
Evaluating the next generation of RSV intervention strategies: a mathematical modelling study and cost-effectiveness analysis.
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评估下一代RSV干预策略：数学建模研究和成本效益分析。
DOI：
10.1186/s12916-020-01802-8
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发表时间：
2020-11-18
期刊：
影响因子：
9.3
通讯作者：
Atkins KE
中科院分区：
文献类型：
--
作者：
Hodgson D;Pebody R;Panovska-Griffiths J;Baguelin M;Atkins KE
随着一系列有前景的新RSV抗病毒药物的出现，包括长效单克隆抗体和新疫苗，其中一种或多种可能会取代目前的单克隆帕利珠单抗项目。然而，选择最佳的干预方案将需要平衡方案的成本与累积的健康效益。为了比较下一代RSV抗病毒药物，我们将新的传播模型与经济分析相结合。我们通过使用贝叶斯方法将模型校准到7年的历史流行病学数据来估计关键流行病学参数。我们确定了一套综合干预方案的成本效益和负担得起的最高购买价格。我们的传播模型表明，母亲对婴儿的保护是季节性的，38-62%的婴儿出生时具有抗RSV的保护。我们的经济分析发现，要以长效单克隆抗体取代目前的单克隆抗体帕利珠单抗计划，每剂的购买价格必须低于4350英镑左右，但对于接种疫苗的高危婴儿则降至200英镑或所有婴儿90英镑。季节性孕产妇疫苗的价格必须低于85英镑，才具有成本效益和负担得起。虽然为学龄前儿童和学龄儿童接种疫苗的成本效益可能低于为老年人接种疫苗的成本效益，但为老年人接种疫苗的费用可能也负担不起。相反，如果价格低于80英镑，季节性地为2个月大的婴儿接种疫苗将具有成本效益且负担得起。在季节性RSV流行病学的背景下，赋予新生儿的母体保护也是季节性的，这一假设以前未纳入RSV的传播模型。对于像英格兰这样具有季节性RSV动态的国家，季节性方案而不是全年干预方案始终是最佳方案。
With a suite of promising new RSV prophylactics on the horizon, including long-acting monoclonal antibodies and new vaccines, it is likely that one or more of these will replace the current monoclonal Palivizumab programme. However, choosing the optimal intervention programme will require balancing the costs of the programmes with the health benefits accrued. To compare the next generation of RSV prophylactics, we integrated a novel transmission model with an economic analysis. We estimated key epidemiological parameters by calibrating the model to 7 years of historical epidemiological data using a Bayesian approach. We determined the cost-effective and affordable maximum purchase price for a comprehensive suite of intervention programmes. Our transmission model suggests that maternal protection of infants is seasonal, with 38–62% of infants born with protection against RSV. Our economic analysis found that to cost-effectively and affordably replace the current monoclonal antibody Palivizumab programme with long-acting monoclonal antibodies, the purchase price per dose would have to be less than around £4350 but dropping to £200 for vaccinated heightened risk infants or £90 for all infants. A seasonal maternal vaccine would have to be priced less than £85 to be cost-effective and affordable. While vaccinating pre-school and school-age children is likely not cost-effective relative to elderly vaccination programmes, vaccinating the elderly is not likely to be affordable. Conversely, vaccinating infants at 2 months seasonally would be cost-effective and affordable if priced less than £80. In a setting with seasonal RSV epidemiology, maternal protection conferred to newborns is also seasonal, an assumption not previously incorporated in transmission models of RSV. For a country with seasonal RSV dynamics like England, seasonal programmes rather than year-round intervention programmes are always optimal.
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DOI：
10.1016/s2468-2667(17)30103-2
发表时间：
2017-08
期刊：
The Lancet. Public health
影响因子：
--
作者：
Cromer D;van Hoek AJ;Newall AT;Pollard AJ;Jit M
通讯作者：
Jit M
影响因子：
6.4
作者：
HALL, CB;WALSH, EE;SCHNABEL, KC
通讯作者：
SCHNABEL, KC
影响因子：
5.1
作者：
GLEZEN, WP;PAREDES, A;FRANK, AL
通讯作者：
FRANK, AL
影响因子：
5
作者：
Atkins, Katherine E.;Fitzpatrick, Meagan C.;Townsend, Jeffrey P.
通讯作者：
Townsend, Jeffrey P.
DOI：
10.1164/rccm.201002-0221oc
发表时间：
2010-11-15
影响因子：
24.7
作者：
DeVincenzo, John P.;Wilkinson, Tom;Lambkin-Williams, Robert
通讯作者：
Lambkin-Williams, Robert