PREVENTION OF HEPATITIS-B VIRUS TRANSMISSION BY IMMUNIZATION - AN ECONOMIC-ANALYSIS OF CURRENT RECOMMENDATIONS
PREVENTION OF HEPATITIS-B VIRUS TRANSMISSION BY IMMUNIZATION - AN ECONOMIC-ANALYSIS OF CURRENT RECOMMENDATIONS
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DOI：
10.1001/jama.274.15.1201
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发表时间：
1995-10-18
影响因子：
120.7
通讯作者：
AREVALO, JA
中科院分区：
文献类型：
--
作者：
MARGOLIS, HS;COLEMAN, PJ;AREVALO, JA
目的.-评估预防乙型肝炎病毒 (HBV) 传播的免疫策略的结果。设计和设置。-使用决策模型来确定在公共部门接受免疫服务的出生队列中以下乙型肝炎免疫策略的增量效果：(1) 预防围产期 HBV 感染，(2) 常规婴儿疫苗接种，或 (3) 常规青少年疫苗接种。主要结果措施。-在队列的一生中，感染以及医疗和工作损失成本的减少针对每种策略确定与 HBV 相关的肝脏疾病，并与未接种疫苗的结果进行比较。结果 - 预防围产期感染和常规婴儿疫苗接种可将 4.8% 的 HBV 终生感染风险降低至少 68%，而青少年疫苗接种可降低 45%。从社会角度来看，每种策略都可以节省成本，但并不能节省直接医疗费用。每年挽救生命的预防围产期 HBV 感染的估计费用为 164 美元，婴儿疫苗接种费用为 1522 美元，青少年疫苗接种费用为 3730 美元。结论：在连续出生队列中对婴儿进行常规疫苗接种以预防 HBV 传播在多种假设下都是具有成本效益的。虽然在经济上不如婴儿疫苗接种有吸引力，但青少年疫苗接种可以保护那些婴儿时未接种疫苗的儿童。
Objective.-To evaluate the outcome of immunization strategies to prevent hepatitis B virus (HBV) transmission.Design and Setting.-A decision model was used to determine the incremental effects of the following hepatitis B immunization strategies in a birth cohort receiving immunization services in the public sector: (1) prevention of perinatal HBV infection, (2) routine infant vaccination, or (3) routine adolescent vaccination.Main Outcome Measures.-Over the lifetime of the cohort, the reduction in infections and medical and work-loss costs of HBV-related liver disease were determined for each strategy and compared with the outcome without immunization.Results.-Prevention of perinatal infection and routine infant vaccination would lower the 4.8% lifetime risk of HBV infection by at least 68%, compared with a 45% reduction for adolescent vaccination. From a societal perspective, each strategy was found to be cost saving, but was not cost saving with respect to direct medical costs. The estimated cost per year of life saved was $164 to prevent perinatal HBV infection, $1522 for infant vaccination, and $3730 for adolescent vaccination.Conclusions.-Routine vaccination of infants in successive birth cohorts to prevent HBV transmission is cost-effective over a wide range of assumptions. While economically less attractive than infant vaccination, adolescent vaccination could serve to protect those children who were not vaccinated as infants.