Is immunising all patients with chronic lung disease in the community against influenza cost effective? Evidence from a general practice based clinical prospective cohort study in Utrecht, the Netherlands
Is immunising all patients with chronic lung disease in the community against influenza cost effective? Evidence from a general practice based clinical prospective cohort study in Utrecht, the Netherlands
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DOI：
10.1136/jech.52.2.120
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发表时间：
1998-02-01
影响因子：
6.3
通讯作者：
de Melker, RA
中科院分区：
文献类型：
--
作者：
Hak, E;van Essen, GA;de Melker, RA
研究目的——关于对社区中所有慢性肺病患者进行流感免疫的潜在益处的信息很少。流感疫苗接种计划的临床有效性和经济效益是在 1995/96 年甲型流感流行期间随访的慢性肺病成年患者的全科医生队列中建立的。设计-1995 年 10 月至 1996 年 3 月的前瞻性队列研究。背景-该研究在乌得勒支全科医生网络中进行，有 6 个大型团体诊所，覆盖荷兰总人口约 50 000 名患者。患者-计算机化医疗记录根据荷兰全科医生指南，对 1696 名年龄超过 18 岁、有接种指征的慢性肺病患者进行了审查。 主要结果——任何并发症（包括全因死亡、下呼吸道感染和急性心脏病）的总体发病率为 15%。肺部疾病的恶化最为常见（13%）。死亡、肺炎和急性心脏病主要限于65岁以上的患者。在多变量逻辑回归分析中控制基线预后后，无法确定 18-64 岁患者 (n=1066) 的免疫计划是否有效。在大于或等于 65 岁的接种者 (n=630) 中，任何并发症的发生率降低了 50% (95% CI 17, 70%)。预计每位老年疫苗接种者的经济效益为 50 英镑。结论 - 这项研究表明，在荷兰，对患有慢性肺病的老年患者进行流感疫苗接种是有效且节省成本的，因此应高度重视这些患者。需要更多（最好是实验性的）研究来确定社区中 65 岁以下的成年肺病患者是否也能从疫苗接种中受益。
Study objective-There is little information on the potential benefit of immunising all patients with chronic lung disease in the community against influenza. The clinical effectiveness and economic benefit was established of the influenza vaccination programme in a general practice based cohort of adult patients with chronic lung disease followed up during the 1995/96 influenza A epidemic.Design-A prospective cohort study from October 1995 to March 1996.Setting-The study was undertaken in the Utrecht General Practices Network with six large group practices, covering a total population of approximately 50 000 patients in the Netherlands.Patients-Computerised medical records of 1696 patients with chronic lung disease aged over 18 years with an indication for vaccination according to the Dutch GP guidelines were reviewed.Main results-The overall attack rate of any complication, including all cause death, low respiratory tract infection, and acute cardiac disease was 15%. Exacerbations of lung disease were most frequent (13%). Death, pneumonia, and acute cardiac disease were mainly limited to patients greater than or equal to 65 years. No effectiveness of the immunisation programme could be established in patients 18-64 years (n=1066), after controlling for baseline prognosis in multivariable logistic regression analysis. In vaccinees greater than or equal to 65 years (n=630), the occurrence of any complication was reduced by 50% (95% CI 17, 70%). The economic benefit was estimated at pound 50 per elderly vaccinee.Conclusions-This study suggests that in the Netherlands immunisation of elderly patients with chronic lung disease against influenza is effective and cost-saving, hence these patients should be given high priority. More, preferably experimental, studies are needed to establish whether adult lung patients under 65 years in the community will also benefit from vaccination.