Impact and cost-effectiveness of new tuberculosis vaccines in low- and middle-income countries
Impact and cost-effectiveness of new tuberculosis vaccines in low- and middle-income countries
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DOI：
10.1073/pnas.1404386111
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发表时间：
2014-10-28
影响因子：
11.1
通讯作者：
White, Richard G.
中科院分区：
文献类型：
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作者：
Knight, Gwenan M.;Griffiths, Ulla K.;White, Richard G.
为了帮助实现到 2050 年消除结核病 (TB) 疾病的目标，需要立即开发疫苗。我们使用年龄结构传播模型估计了潜在结核病疫苗对低收入和中等收入国家的影响和成本效益。假设新疫苗将于 2024 年上市，以预防所有个体的活动性结核病，提供 5 年至终生的保护期，有 40-80% 的功效，并针对“婴儿”或“青少年/成人”。疫苗价格按收入群体分级（每剂 1.50 美元至 10 美元），并使用每个残疾调整生命年 (DALY) 避免的增量成本与人均国民总收入相比来评估成本效益。我们的结果表明，在 2024 年至 2050 年期间，针对青少年/成人的疫苗可能比针对婴儿的疫苗产生更大的影响。在低收入国家，到 2050 年，针对青少年/成人的 10 年有效期和 60% 功效的疫苗可以预防 17（95% 范围：11-24）百万结核病病例，并且可以认为具有成本效益，每避免 DALY 为 149 美元（节省成本 387 美元）。如果针对婴儿，每避免 DALY 1,692 美元（634-4,603 美元），就可以预防 0.89 (0.42-1.58) 万个结核病例。这种针对青少年/成人的方案在低收入、中低收入和中高收入国家每剂价格分别为 4 美元、9 美元和 20 美元，具有成本效益。即使只有短期和低效疫苗可能可行，也可能需要增加对成人结核病疫苗的投资，并且应加强在成人中进行试验以发现低效疫苗。
To help reach the target of tuberculosis (TB) disease elimination by 2050, vaccine development needs to occur now. We estimated the impact and cost-effectiveness of potential TB vaccines in low- and middle-income countries using an age-structured transmission model. New vaccines were assumed to be available in 2024, to prevent active TB in all individuals, to have a 5-y to lifetime duration of protection, to have 40-80% efficacy, and to be targeted at "infants" or "adolescents/adults." Vaccine prices were tiered by income group (US $1.50-$10 per dose), and cost-effectiveness was assessed using incremental cost per disability adjusted life year (DALY) averted compared against gross national income per capita. Our results suggest that over 2024-2050, a vaccine targeted to adolescents/adults could have a greater impact than one targeted at infants. In low-income countries, a vaccine with a 10-y duration and 60% efficacy targeted at adolescents/adults could prevent 17 (95% range: 11-24) million TB cases by 2050 and could be considered cost-effective at $149 (cost saving to $387) per DALY averted. If targeted at infants, 0.89 (0.42-1.58) million TB cases could be prevented at $1,692 ($634-$4,603) per DALY averted. This profile targeted at adolescents/adults could be cost-effective at $4, $9, and $20 per dose in low-, lower-middle-, and upper-middle-income countries, respectively. Increased investments in adulttargeted TB vaccines may be warranted, even if only short duration and low efficacy vaccines are likely to be feasible, and trials among adults should be powered to detect low efficacies.