Modeling the impact of the 7-valent pneumococcal conjugate vaccine in Chinese infants: an economic analysis of a compulsory vaccination
Modeling the impact of the 7-valent pneumococcal conjugate vaccine in Chinese infants: an economic analysis of a compulsory vaccination
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DOI：
10.1186/1472-6963-14-56
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发表时间：
2014-02-07
影响因子：
2.8
通讯作者：
Wu, Bin
中科院分区：
文献类型：
--
作者：
Che, Datian;Zhou, Hua;Wu, Bin
背景资料：本研究的目的是从中国社会的角度比较将肺炎球菌结合七价疫苗（PCV-7）加入常规强制儿童免疫计划的预期健康效益、成本和成本效益。方法：一个决策树模型，其中的数据和假设经过调整，适合中国，旨在预测PCV-7疫苗接种（与未接种疫苗相比）在5年期间以及一生中的健康结果。接种疫苗的出生队列包括中国的1600万名儿童。在基础病例分析中使用2 + 1剂量方案，每剂疫苗136.51美元。采用单因素敏感性分析检验模型的稳健性。评价了净间接效应（群体免疫力）的影响。结果以节省的疾病负担、成本、质量调整生命年（QHLS）和增量成本效益比的形式呈现。在中国出生队列中，PCV-7疫苗接种计划将使肺炎球菌相关感染的数量减少至少32%，并将在生命的前5年内预防2，682例死亡，节省1美元，1.9亿美元的总成本，并获得额外的9,895个季度（折扣3%）。每个质量调整生命年的增量成本估计为530，354美元。如果考虑到群体免疫力，每个质量调整生命年的成本估计为95，319美元。模型的稳健性主要受PCV-7每剂成本、有效性、群体免疫和肺炎球菌疾病发生率的影响。有和没有群体免疫力，在中国的盈亏平衡成本分别为29.05美元和25.87美元，respectively：强制性的常规婴儿接种PCV-7预计将大大降低肺炎球菌疾病的发病率，死亡率和相关费用在中国。然而，在世界卫生组织目前推荐的中国支付意愿门槛下，PCV-7的普遍疫苗接种计划并不具有成本效益。
Background: The purpose of this study was to compare, from a Chinese societal perspective, the projected health benefits, costs, and cost-effectiveness of adding pneumococcal conjugate heptavalent vaccine (PCV-7) to the routine compulsory child immunization schedule.Methods: A decision-tree model, with data and assumptions adapted for relevance to China, was developed to project the health outcomes of PCV-7 vaccination (compared with no vaccination) over a 5-year period as well as a lifetime. The vaccinated birth cohort included 16,000,000 children in China. A 2 + 1 dose schedule at US$136.51 per vaccine dose was used in the base-case analysis. One-way sensitivity analysis was used to test the robustness of the model. The impact of a net indirect effect (herd immunity) was evaluated. Outcomes are presented in terms of the saved disease burden, costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio.Results: In a Chinese birth cohort, a PCV-7 vaccination program would reduce the number of pneumococcus-related infections by at least 32% and would prevent 2,682 deaths in the first 5 years of life, saving $1,190 million in total costs and gaining an additional 9,895 QALYs (discounted by 3%). The incremental cost per QALY was estimated to be $530,354. When herd immunity was taken into account, the cost per QALY was estimated to be $95,319. The robustness of the model was influenced mainly by the PCV-7 cost per dose, effectiveness herd immunity and incidence of pneumococcal diseases. With and without herd immunity, the break-even costs in China were $29.05 and $25.87, respectively.Conclusions: Compulsory routine infant vaccination with PCV-7 is projected to substantially reduce pneumococcal disease morbidity, mortality, and related costs in China. However, a universal vaccination program with PCV-7 is not cost-effective at the willingness-to-pay threshold that is currently recommended for China by the World Health Organization.