Pneumococcal Vaccination Strategies in 50-Year-Olds to Decrease Racial Disparities: A US Societal Perspective Cost-Effectiveness Analysis.
Pneumococcal Vaccination Strategies in 50-Year-Olds to Decrease Racial Disparities: A US Societal Perspective Cost-Effectiveness Analysis.
复制标题
50 岁人群减少种族差异的肺炎球菌疫苗接种策略：美国社会视角的成本效益分析。
DOI：
10.1016/j.jval.2024.02.021
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Smith,KennethJ
中科院分区：
文献类型：
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作者：
Altawalbeh,ShoroqM;Wateska,AngelaR;Nowalk,MaryPatricia;Lin,ChyongchiouJ;Harrison,LeeH;Schaffner,William;Zimmerman,RichardK;Smith,KennethJ
目的本研究从社会角度评估50岁人群接种20价肺炎球菌结合疫苗（PCV 20）和15价结合疫苗后接种23价多糖疫苗（PCV 15/PPSV 23）的成本-效果，以评估扩大肺炎球菌疫苗接种至所有50岁人群以减少种族差异的影响。方法采用马尔可夫模型比较了PCV 20或PCV 15/PPSV 23在所有一般人群（50岁和65岁）中的成本效益，并与美国目前的建议进行比较，以及在美国黑人和非黑人队列中未接种疫苗。US数据告知模型参数。使用急性疾病和肺炎球菌相关的长期残疾和死亡的直接和间接成本来估计肺炎球菌疾病的社会成本。假设50岁的队列在其一生中进行了随访，每年的成本和有效性折扣为3%。确定性和概率敏感性分析评估了模型的不确定性。结果在黑人队列中，50岁和65岁的PCV 20是成本最低的策略，比没有接种疫苗和目前的推荐策略更有效，而50岁和65岁的PCV 15/PPSV 23与50岁和65岁的PCV 20相比，每增加一个质量调整生命年（QALY）的成本超过100万美元。在非黑人队列中，PCV 20在50和65时的成本为62 083美元/QALY，PCV 15/PPSV 23在50和65时的成本超过100万美元/QALY，目前的建议，再次成本更高，有效性更低。在概率敏感性分析中，PCV 20在50和65时在85.7%（黑人）和61.8%（非黑人）的模型迭代中获得100 000美元/QALY的支付意愿阈值。结论：当考虑肺炎球菌疾病的社会成本时，在美国普通人群中，50岁和65岁的PCV 20是一种潜在的经济可行的策略，特别是在黑人队列中。
Objectives This study assesses the impact of expanding pneumococcal vaccination to all 50-year-olds to decrease racial disparities by estimating from the societal perspective, the cost-effectiveness of 20-valent pneumococcal conjugate vaccine (PCV20) and 15-valent conjugate vaccine followed by 23-valent polysaccharide vaccine (PCV15/PPSV23) for 50-year-olds. Methods A Markov model compared the cost-effectiveness of PCV20 or PCV15/PPSV23 in all general population 50-and 65-years-olds compared with current US recommendations and with no vaccination in US Black and non-Black cohorts. US data informed model parameters. Pneumococcal disease societal costs were estimated using direct and indirect costs of acute illness and of pneumococcal-related long-term disability and mortality. Hypothetical 50-year-old cohorts were followed over their lifetimes with costs and effectiveness discounted 3% per year. Deterministic and probabilistic sensitivity analyses assessed model uncertainty. Results In Black cohorts, PCV20 for all at ages 50 and 65 was the least costly strategy and had greater effectiveness than no vaccination and current recommendation strategies, whereas PCV15/PPSV23 at 50 and 65 cost more than $1 million per quality-adjusted life year (QALY) gained compared with PCV20 at 50 and 65. In non-Black cohorts, PCV20 at 50 and 65 cost $62 083/QALY and PCV15/PPSV23 at 50 and 65 cost more than $1 million/QALY with current recommendations, again being more costly and less effective. In probabilistic sensitivity analyses, PCV20 at 50 and 65 was favored in 85.7%(Black) and 61.8%(non-Black) of model iterations at a $100 000/QALY gained willingness-to-pay threshold. Conclusions When considering the societal costs of pneumococcal disease, PCV20 at ages 50 and 65 years in the general US population is a potentially economically viable strategy, particularly in Black cohorts.