Economic evaluation of use of diphtheria, tetanus, and acellular pertussis vaccine or diphtheria, tetanus, and whole-cell pertussis vaccine in the United States, 1997
Economic evaluation of use of diphtheria, tetanus, and acellular pertussis vaccine or diphtheria, tetanus, and whole-cell pertussis vaccine in the United States, 1997
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DOI：
10.1001/archpedi.154.8.797
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发表时间：
2000-08-01
影响因子：
--
通讯作者：
Livengood, JR
中科院分区：
文献类型：
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作者：
Ekwueme, DU;Strebel, PM;Livengood, JR
目的：比较1997年在美国使用白喉、破伤风类毒素和无细胞百日咳疫苗（DTaP）或白喉、破伤风类毒素和全细胞百日咳疫苗（DTwP）的经济成本和效益。设计：从社会和卫生保健系统的角度，对每种联合疫苗以及单独的百日咳成分进行标准的成本效益分析。设定：一个模拟队列，包括410万名从出生到15岁的儿童。结果：在没有疫苗接种规划的情况下，白喉、破伤风和百日咳疾病造成了300多万例病例和2.8万多例死亡，成本为236亿美元。从社会角度来看，由于使用DTaP和DTwP，净节省分别为2251万美元和2262.3万美元。非细胞百日咳部分和全细胞百日咳部分的净节省分别为436.2万美元和447.4万美元。从社会和卫生保健系统的角度来看，DTaP的收益成本比为27。分别为1和9.1。关键变量的敏感性分析没有导致结果的明显变化。结论：与无规划相比，接种DTaP或DTwP疫苗可节省大量费用，无论采取何种观点和进行的所有敏感性分析。与DTwP相比，DTaP的使用产生了少量的成本增加，这可能被其他因素的价值所抵消，例如由于减少了不良事件而增加了对百日咳疫苗接种的信心。
Objective: To compare the economic costs and benefits associated with using either diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) or diphtheria and tetanus toxoids and whole-cell pertussis vaccine (DTwP) in the United States in 1997.Design: Standard cost-benefit analysis, from both the societal and health care system perspectives, was performed for each combination vaccine as well as for the pertussis components singly.Setting: A simulated cohort of 4.1 million children from birth to age 15 years.Main outcome measures: Net costs (savings) and benefit-cost ratios (BCRs)Results: Without a vaccination program, diphtheria, tetanus, and pertussis disease caused more than 3 million cases and more than 28 000 deaths, at a cost of $23.6 billion. From the societal perspective, net savings because of the use of DTaP and DTwP were $22.510 million and $22.623 million, respectively. The net savings from the acellular pertussis component and the whole-cell pertussis component only were $4.362 million and $4.474 million, respectively. Benefit-cost ratios for DTaP from a societal and health care system perspective were 27. 1 and 9.1, respectively. Sensitivity analyses of key variables did not result in appreciable changes in results.Conclusions: Compared with no program, vaccination with DTaP or DTwP resulted in substantial savings, regardless of the perspective taken and for all sensitivity analyses conducted. Compared with DTwP, use of DTaP generated a small cost increase that might be offset by the value of other factors, such as increased confidence in pertussis vaccination resulting from reduced adverse events.