Effectiveness and Cost-Effectiveness of Vaccination Against Pandemic Influenza (H1N1) 2009
Effectiveness and Cost-Effectiveness of Vaccination Against Pandemic Influenza (H1N1) 2009
复制标题
DOI：
10.7326/0000605-200912150-00157
复制
发表时间：
2009-12-15
影响因子：
39.2
通讯作者：
Owens, Douglas K.
中科院分区：
文献类型：
--
作者：
Khazeni, Nayer;Hutton, David W.;Owens, Douglas K.
背景：2009年H1N1大流行病毒疫苗接种的时间和范围的决定是复杂的。目的：评估2009年10月或11月不同情景下大流行性流感(H1N1)疫苗接种的有效性和成本效益。设计：分区流行病模型和疾病进展的马尔可夫模型。数据来源：文献和专家意见。目标人群：美国一个拥有830万人口的大城市的居民。时间视野：生命周期。视角：社会。干预：在2009年10月中旬或11月中旬接种疫苗。结果措施：感染和避免死亡，成本，基础病例分析结果：假设每一次初次感染导致1.5例继发感染，在10月或11月为40%的人口接种疫苗将节省成本。与不接种相比，10月份接种疫苗将避免2051例死亡，增加69679个QALY，节省4.69亿美元；11月份接种将避免1468例死亡，增加49422个QALY，节省3.02亿美元。敏感性分析结果：如果潜伏期更长，传染性较低，或增加非药物干预措施的实施，推迟疫情高峰期，接种疫苗甚至更节省成本。接种疫苗挽救的生命较少，如果疫情在10月中旬之前达到高峰，则成本效益较低。限制：该模型假设病例-患者和接触者的同质混合；异质混合将导致较快的初始传播，然后是较慢的传播。模型中没有包含的额外成本和节省将使接种疫苗更节省成本。结论：及早接种2009年甲型H1N1流感疫苗可以防止更多的死亡，而且更节省成本。完全覆盖人口并不是充分降低病毒繁殖率以帮助缩短大流行的必要条件。
Background: Decisions on the timing and extent of vaccination against pandemic (H1N1) 2009 virus are complex.Objective: To estimate the effectiveness and cost-effectiveness of pandemic influenza (H1N1) vaccination under different scenarios in October or November 2009.Design: Compartmental epidemic model in conjunction with a Markov model of disease progression.Data Sources: Literature and expert opinion.Target Population: Residents of a major U. S. metropolitan city with a population of 8.3 million.Time Horizon: Lifetime.Perspective: Societal.Interventions: Vaccination in mid-October or mid-November 2009.Outcome Measures: Infections and deaths averted, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness.Results of Base-Case Analysis: Assuming each primary infection causes 1.5 secondary infections, vaccinating 40% of the population in October or November would be cost-saving. Vaccination in October would avert 2051 deaths, gain 69 679 QALYs, and save $469 million compared with no vaccination; vaccination in November would avert 1468 deaths, gain 49 422 QALYs, and save $302 million.Results of Sensitivity Analysis: Vaccination is even more cost-saving if longer incubation periods, lower rates of infectiousness, or increased implementation of nonpharmaceutical interventions delay time to the peak of the pandemic. Vaccination saves fewer lives and is less cost-effective if the epidemic peaks earlier than mid-October.Limitations: The model assumed homogenous mixing of case-patients and contacts; heterogeneous mixing would result in faster initial spread, followed by slower spread. Additional costs and savings not included in the model would make vaccination more cost-saving.Conclusion: Earlier vaccination against pandemic (H1N1) 2009 prevents more deaths and is more cost-saving. Complete population coverage is not necessary to reduce the viral reproductive rate sufficiently to help shorten the pandemic.