Cost-effectiveness of hepatitis B vaccination in adults with diagnosed diabetes.
Cost-effectiveness of hepatitis B vaccination in adults with diagnosed diabetes.
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DOI：
10.2337/dc12-0759
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发表时间：
2013-01
期刊：
影响因子：
16.2
通讯作者：
Murphy TV
中科院分区：
文献类型：
--
作者：
Hoerger TJ;Schillie S;Wittenborn JS;Bradley CL;Zhou F;Byrd K;Murphy TV
为了检查美国未接种疫苗的确诊糖尿病成人的乙型肝炎疫苗接种计划的成本效益，我们使用成本效益模拟模型来估计为 20-59 岁患有诊断糖尿病、之前未接种过乙型肝炎病毒 (HBV) 疫苗或感染过乙型肝炎病毒 (HBV) 的成年人接种疫苗的成本效益。该模型估计了急性和慢性 HBV 感染、并发症、质量调整生命年 (QALY) 和增量成本效益比。数据来源包括监测数据、流行病学研究和疫苗价格。该干预措施的接种率为 10%，将为 528,047 人接种疫苗，预防 4,271 例急性乙型肝炎感染和 256 例慢性乙型肝炎感染。净医疗保健成本将增加 9140 万美元，并且将获得 1,218 个 QALY，每获得一个 QALY，成本效益比将达到 75,094 美元。结果对年龄、贴现率、糖尿病患者的乙型肝炎发病率以及乙型肝炎感染率最为敏感。成本效益比随着疫苗接种年龄的增加而上升；另一种为 60 岁或以上患有糖尿病的成年人接种疫苗的替代干预措施的成本效益比为每 QALY 270 万美元。 20-59 岁患有糖尿病的成人接种乙型肝炎疫苗具有一定的成本效益。为患有糖尿病的老年人接种疫苗并不划算。该研究没有考虑肝炎爆发调查成本，并且有关老年糖尿病患者肝炎进展的信息有限。部分基于这些结果，免疫实践咨询委员会最近建议 20-59 岁确诊糖尿病的人接种乙型肝炎疫苗。
To examine the cost-effectiveness of a hepatitis B vaccination program for unvaccinated adults with diagnosed diabetes in the U.S. We used a cost-effectiveness simulation model to estimate the cost-effectiveness of vaccinating adults 20–59 years of age with diagnosed diabetes not previously vaccinated for or infected by hepatitis B virus (HBV). The model estimated acute and chronic HBV infections, complications, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Data sources included surveillance data, epidemiological studies, and vaccine prices. With a 10% uptake rate, the intervention will vaccinate 528,047 people and prevent 4,271 acute and 256 chronic hepatitis B infections. Net health care costs will increase by $91.4 million, and 1,218 QALYs will be gained, producing a cost-effectiveness ratio of $75,094 per QALY gained. Results are most sensitive to age, the discount rate, the hepatitis B incidence ratio for people with diabetes, and hepatitis B infection rates. Cost-effectiveness ratios rise with age at vaccination; an alternative intervention that vaccinates adults with diabetes 60 years of age or older had a cost-effectiveness ratio of $2.7 million per QALY. Hepatitis B vaccination for adults with diabetes 20–59 years of age is modestly cost-effective. Vaccinating older adults with diabetes is not cost-effective. The study did not consider hepatitis outbreak investigation costs, and limited information exists on hepatitis progression among older adults with diabetes. Partly based on these results, the Advisory Committee on Immunization Practices recently recommended hepatitis B vaccination for people 20–59 years of age with diagnosed diabetes.
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