Potential cost-effectiveness of vaccination for rotavirus gastroenteritis in eight Latin American and Caribbean countries
Potential cost-effectiveness of vaccination for rotavirus gastroenteritis in eight Latin American and Caribbean countries
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DOI：
10.1590/s1020-49892007000300003
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发表时间：
2007-04-01
期刊：
影响因子：
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通讯作者：
Breuer, Thomas
中科院分区：
文献类型：
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作者：
Rheingans, Richard D.;Constenla, Dagna;Breuer, Thomas
目标.评估八个拉丁美洲和加勒比国家轮状病毒胃肠炎疫苗接种的成本、效益和成本效益：阿根廷、巴西、智利、多米尼加共和国、洪都拉斯、墨西哥、巴拿马和委内瑞拉。方法.构建了一个经济模型，从卫生保健系统的角度，使用国家行政和已公布的流行病学证据，国家特定的成本估计，疫苗的有效性数据来估计疫苗接种的成本效益。该模型适用于每个国家2003年出生队列的前五年。主要的健康结果是残疾调整生命年（DALY），主要的汇总指标是避免的每DALY的增量成本。所有预测成本及收益均采用3%贴现率。敏感性分析评价了关键变量的不确定性对成本效益估计数的影响。结果根据经济模型获得的估计，在本文分析的八个国家中，疫苗接种将防止超过65%的轮状病毒胃肠炎相关的医疗就诊，死亡和治疗费用。每疗程费用为24美元（两剂疫苗），增量成本效益比从洪都拉斯的269美元/DALY到智利的10 656美元/DALY不等。成本效益比对疫苗价格、死亡率和疫苗效力的假设很敏感。结论.在本文分析的拉丁美洲和加勒比国家，疫苗接种将有效降低轮状病毒胃肠炎的疾病负担和医疗保健费用。从卫生保健系统的角度来看，根据目前的标准，预计婴儿普遍接种疫苗具有成本效益。
Objectives. To estimate the costs, benefits and cost-effectiveness of vaccination for rotavirus gastroenteritis in eight Latin American and Caribbean countries: Argentina, Brazil, Chile, the Dominican Republic, Honduras, Mexico, Panama, and Venezuela. Methods. An economic model was constructed to estimate the cost-effectiveness of vaccination from the health care system perspective, using national administrative and published epidemiological evidence, country-specific cost estimates, and vaccine efficacy data. The model was applied to the first five years of life for the 2003 birth cohort in each country. The main health outcome was the disability- adjusted life year (DALY), and the main summary measure was the incremental cost per DALY averted. A 3% discount rate was used for all predicted costs and benefits. Sensitivity analyses evaluated the impact of uncertainty regarding key variables on cost-effectiveness estimates. Results. According to the estimates obtained with the economic model, vaccination would prevent more than 65% of the medical visits, deaths, and treatment costs associated with rotavirus gastroenteritis in the eight countries analyzed here. At a cost of US$ 24 per course (for a two- dose vaccine), the incremental cost-effectiveness ratio ranged from US$ 269/DALY in Honduras to US$ 10 656/DALY in Chile. Cost-effectiveness ratios were sensitive to assumptions about vaccine price, mortality, and vaccine efficacy. Conclusions. Vaccination would effectively reduce the disease burden and health care costs of rotavirus gastroenteritis in the Latin American and Caribbean countries analyzed here. From the health care system perspective, universal vaccination of infants is predicted to be cost-effective, based on current standards.