The epidemiologic impact and cost-effectiveness of new tuberculosis vaccines on multidrug-resistant tuberculosis in India and China.
The epidemiologic impact and cost-effectiveness of new tuberculosis vaccines on multidrug-resistant tuberculosis in India and China.
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DOI：
10.1186/s12916-021-01932-7
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发表时间：
2021-02-26
期刊：
影响因子：
9.3
通讯作者：
White RG
中科院分区：
文献类型：
--
作者：
Weerasuriya CK;Harris RC;McQuaid CF;Bozzani F;Ruan Y;Li R;Li T;Rade K;Rao R;Ginsberg AM;Gomez GB;White RG
尽管开发渠道最近取得了进展，但新型结核病（TB）疫苗如何影响利福平耐药和耐多药结核病（RR/MDR-TB）尚不清楚。我们调查了假设的新型结核病疫苗对中国和印度的 RR/MDR-TB 的流行病学影响、成本效益和预算影响。我们构建了一个确定性、区室化、年龄、耐药性和治疗史分层的结核病动态传播模型。我们从 2027 年开始推出新型疫苗，具有感染后 (PSI) 或感染前和感染后 (P&PI) 功效，可提供 10 年保护，功效为 50%。我们衡量了 2027 年至 2050 年疫苗成本效益，以美元/伤残调整生命年 (DALY) 为依据，相对于人均 GDP 的 1 倍，以及两个基于医疗机会成本 (HCOC) 的阈值。我们进行了情景分析。到 2050 年，在中国和印度，P&PI 疫苗使 RR/MDR-TB 发病率分别降低了 73%（UI：66-76）和 72%（UI：65-77），PSI 疫苗则分别降低了 29%（UI：27-31）和 47%（UI：37-58）。在印度，我们发现 10 美元的 P&PI 和 PSI 疫苗在 1 倍 GDP 和 HCOC 上限阈值下具有成本效益，而 P&PI 疫苗在 HCOC 阈值下限下具有成本效益。在中国，这两种疫苗在1倍GDP门槛下都具有成本效益。 P&PI 疫苗在 HCOC 下限阈值下保持成本效益的可能性为 49%，而 PSI 疫苗在 HCOC 阈值上限下保持成本效益的概率为 21%。预计 2027 年至 2050 年间，P&PI 疫苗将在中国和印度分别避免 100 万例（UI：0.6-1.3）和 80 万例（UI：0.5-1.4）二线治疗方案。新型结核病疫苗接种可能会大大减轻未来复发/耐多药结核病的负担，同时避免二线治疗的需要。疫苗接种可能具有成本效益，具体取决于疫苗的特性和环境。在线版本包含可在 10.1186/s12916-021-01932-7 获取的补充材料。
Despite recent advances through the development pipeline, how novel tuberculosis (TB) vaccines might affect rifampicin-resistant and multidrug-resistant tuberculosis (RR/MDR-TB) is unknown. We investigated the epidemiologic impact, cost-effectiveness, and budget impact of hypothetical novel prophylactic prevention of disease TB vaccines on RR/MDR-TB in China and India. We constructed a deterministic, compartmental, age-, drug-resistance- and treatment history-stratified dynamic transmission model of tuberculosis. We introduced novel vaccines from 2027, with post- (PSI) or both pre- and post-infection (P&PI) efficacy, conferring 10 years of protection, with 50% efficacy. We measured vaccine cost-effectiveness over 2027–2050 as USD/DALY averted-against 1-times GDP/capita, and two healthcare opportunity cost-based (HCOC), thresholds. We carried out scenario analyses. By 2050, the P&PI vaccine reduced RR/MDR-TB incidence rate by 73% (UI:66–76) and 72% (UI:65–77), and the PSI vaccine by 29% (UI: 27–31) and 47% (UI: 37–58) in China and India, respectively. In India, we found both USD 10 P&PI and PSI vaccines cost-effective at the 1-times GDP and upper HCOC thresholds and P&PI vaccines cost-effective at the lower HCOC threshold. In China, both vaccines were cost-effective at the 1-times GDP threshold. P&PI vaccine remained cost-effective at the lower HCOC threshold with 49% probability and PSI vaccines at the upper HCOC threshold with 21% probability. The P&PI vaccine was predicted to avert 1.0 million (UI: 0.6–1.3) and 0.8 million (UI: 0.5–1.4) second-line therapy regimens in China and India between 2027 and 2050, respectively. Novel TB vaccination is likely to substantially reduce the future burden of RR/MDR-TB, while averting the need for second-line therapy. Vaccination may be cost-effective depending on vaccine characteristics and setting. The online version contains supplementary material available at 10.1186/s12916-021-01932-7.
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影响因子：
168.9
作者：
Dye, C;Garnett, GP;Williams, BG
通讯作者：
Williams, BG
影响因子：
168.9
作者：
Fine, PEM;Ponnighaus, JM;Peto, R
通讯作者：
Peto, R
影响因子：
8.1
作者：
Chatterjee, Susmita;Das, Palash;Laxminarayan, Ramanan
通讯作者：
Laxminarayan, Ramanan
影响因子：
56.3
作者：
Arinaminpathy, Nimalan;Batra, Deepak;Khaparde, Sunil;Vualnam, Thongsuanmung;Maheshwari, Nilesh;Sharma, Lokesh;Nair, Sreenivas A.;Dewan, Puneet
通讯作者：
Dewan, Puneet
影响因子：
2
作者：
Gomes, M. Gabriela M.;Rodrigues, Paula;Medley, Graham F.
通讯作者：
Medley, Graham F.