Projected cost-effectiveness of new vaccines for adolescents in the United States
Projected cost-effectiveness of new vaccines for adolescents in the United States
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DOI：
10.1542/peds.2007-1115h
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发表时间：
2008-01-01
期刊：
影响因子：
8
通讯作者：
Miller, Ted
中科院分区：
文献类型：
--
作者：
Ortega-Sanchez, Ismael R.;Lee, Grace M.;Miller, Ted
背景。鉴于新的和预期的青少年疫苗，指导免疫政策制定的经济评估正变得越来越重要。然而，限制这些评估效用的重要考虑因素，如所使用方法的多样性，往往被忽视，应该更好地理解。我们的目的是检查青少年疫苗的经济研究，比较特定疫苗研究的成本效益结果，跨青少年疫苗研究，以及青少年新疫苗与推荐给幼儿的疫苗之间的成本效益结果。对有关青少年免疫接种的经济研究进行了系统回顾。通过搜索Medline、Embase和EconLit数据库来确定研究。对每项研究进行模型设计、基线设置、敏感性分析和输入变量（即流行病学、临床、成本和生活质量影响）的适当性审查。为了进行比较，选择了在针对低龄儿童的疫苗的关键研究中报告的成本-效果结果。为健康青少年接种的疫苗一直被认为比它们所节省的保健费用或社会费用更昂贵，而且总体而言，比为年幼儿童接种的疫苗成本效益更低。在新疫苗中，百日咳和人乳头瘤病毒疫苗比脑膜炎球菌疫苗更具成本效益。在研究中纳入群体免疫益处可显著提高新疫苗的成本效益估算。测量或假设的差异限制了进一步的比较。尽管使用新的青少年疫苗不太可能节省成本，但疫苗接种计划将带来相当大的健康效益。
BACKGROUND. Economic assessments that guide policy making on immunizations are becoming increasingly important in light of new and anticipated vaccines for adolescents. However, important considerations that limit the utility of these assessments, such as the diversity of approaches used, are often overlooked and should be better understood.OBJECTIVE. Our goal was to examine economic studies of adolescent vaccines and compare cost-effectiveness outcomes among studies on a particular vaccine, across adolescent vaccines, and between new adolescent vaccines versus vaccines that are recommended for young children.METHODS. A systematic review of economic studies on immunizations for adolescents was conducted. Studies were identified by searching the Medline, Embase, and EconLit databases. Each study was reviewed for appropriateness of model design, baseline setup, sensitivity analyses, and input variables (ie, epidemiologic, clinical, cost, and quality-of-life impact). For comparison, the cost-effectiveness outcomes reported in key studies on vaccines for younger children were selected.RESULTS. Vaccines for healthy adolescents were consistently found to be more costly than the health care or societal cost savings they produced and, in general, were less cost-effective than vaccines for younger children. Among the new vaccines, pertussis and human papillomavirus vaccines were more cost-effective than meningococcal vaccines. Including herd-immunity benefits in studies significantly improved the cost-effectiveness estimates for new vaccines. Differences in measurements or assumptions limited further comparisons.CONCLUSION. Although using the new adolescent vaccines is unlikely to be cost-saving, vaccination programs will result in sizable health benefits.