COST-EFFECTIVENESS OF A ROUTINE VARICELLA VACCINATION PROGRAM FOR UNITED-STATES CHILDREN
COST-EFFECTIVENESS OF A ROUTINE VARICELLA VACCINATION PROGRAM FOR UNITED-STATES CHILDREN
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DOI：
10.1001/jama.271.5.375
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发表时间：
1994-02-02
影响因子：
120.7
通讯作者：
WASHINGTON, AE
中科院分区：
文献类型：
--
作者：
LIEU, TA;COCHI, SL;WASHINGTON, AE
目的.-评估针对健康儿童的常规水痘疫苗接种计划的经济后果。方法.-使用决策分析来比较不进行干预的常规疫苗接种计划的成本、结果和成本效益。临床结果基于疫苗功效的数学模型，该模型依赖于已发表和未发表的数据以及专家意见。医疗利用率和费用从多个来源收集，包括 Kaiser Permanente 医疗护理计划和加州医院出院数据库。 结果：健康儿童的常规水痘疫苗接种计划可以预防 94% 的潜在水痘病例，前提是入学时的疫苗接种覆盖率达到 97%。如果建议每个儿童接种一剂疫苗，每剂费用为 35 美元，每年将花费约 1.62 亿美元。从社会角度来看，包括工作损失成本和医疗成本，该计划每投资 1 美元疫苗接种即可节省 5 美元以上。然而，从医疗保健支付者的角度来看（仅医疗费用），该计划每预防一个水痘病例将花费大约 2 美元，或者每挽救一个生命年将花费 2500 美元。疾病预防的医疗成本对疫苗接种覆盖率和疫苗价格敏感，但对疫苗功效在合理范围内的假设相对不敏感。如果学龄前儿童的疫苗接种覆盖率达到 97%，那么针对 12 岁儿童的补种疫苗接种计划将产生较高的增量成本，但在覆盖率达到 50% 时将产生净节省。结论：从社会角度来看，针对健康儿童的常规水痘疫苗接种计划将带来净节省，其中包括工作损失成本和医疗费用。与其他预防计划相比，从医疗保健支付者的角度来看，它也相对具有成本效益。
Objective.-To evaluate the economic consequences of a routine varicella vaccination program that targets healthy children,Methods.-Decision analysis was used to compare the costs, outcomes, and cost-effectiveness of a routine vaccination program with no intervention. Clinical outcomes were based on a mathematical model of vaccine efficacy that relied on published and unpublished data and on expert opinion. Medical utilization rates and costs were collected from multiple sources, including the Kaiser Permanente Medical Care Program and the California Hospital Discharge Database.Results.-A routine varicella vaccination program for healthy children would prevent 94% of all potential cases of chickenpox, provided the vaccination coverage rate is 97% at school entry. lt would cost approximately $162 million annually if one dose of vaccine per child were recommended at a cost of $35 per dose. From the societal perspective, which includes work-loss costs as well as medical costs, the program would save more than $5 for every dollar invested in vaccination. However, from the health care payer's perspective (medical costs only), the program would cost approximately $2 per chickenpox case prevented, or $2500 per life-year saved. The medical cost of disease prevention was sensitive to the vaccination coverage rate and vaccine price but was relatively insensitive to assumptions about vaccine efficacy within plausible ranges. An additional program for catch-up vaccination of 12-year-olds would have high incremental costs if the vaccination coverage rate of children of preschool age were 97%, but would result in net savings at a coverage rate of 50%.Conclusions.-A routine varicella vaccination program for healthy children would result in net savings from the societal perspective, which includes work-loss costs as well as medical costs. Compared with other prevention programs, it would also be relatively cost-effective from the health care payers perspective.