Cost-Effectiveness of Stockpiling 23-Valent Pneumococcal Polysaccharide Vaccine to Prevent Secondary Pneumococcal Infections Among a High-Risk Population in the United States During an Influenza Pandemic
Cost-Effectiveness of Stockpiling 23-Valent Pneumococcal Polysaccharide Vaccine to Prevent Secondary Pneumococcal Infections Among a High-Risk Population in the United States During an Influenza Pandemic
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DOI：
10.1016/j.clinthera.2010.07.019
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发表时间：
2010-08-01
影响因子：
3.2
通讯作者：
Dasbach, Erik J.
中科院分区：
文献类型：
--
作者：
Dhankhar, Praveen;Grabenstein, John D.;Dasbach, Erik J.
背景：继发性细菌感染（尤其是肺炎球菌感染）是流感大流行期间死亡的主要原因。在未来大流行期间预防成人肺炎球菌感染的一种策略是储备23价肺炎球菌多糖疫苗（PPSV 23）。储存肺炎球菌疫苗可以确保在最需要的时候--也就是在流感大流行开始的时候--可以获得。目的：本文的目的是预测在美国流感大流行期间储存PPSV 23预防18至64岁的高危成人继发肺炎球菌感染的健康和经济影响。方法：开发了一个成本效益模型，以评估在流感大流行期间，储存PPSV 23与不储存该疫苗对预防2000万18至64岁的高风险美国成年人继发性肺炎球菌感染的健康和经济影响。该模型用于预测肺炎球菌病例、住院、死亡和避免的工作损失天数。根据继发性肺炎球菌感染估计了三种健康结局（死亡、住院和门诊治疗）。为了评估不同策略的总体有效性，使用质量调整生命年（QALY）作为这3种健康结局的衡量标准。根据大流行的严重程度和大流行前流感疫苗的预期可用性，列出了3种情景的结果：基本情景、较严重情景和较不严重情景。在基本情况下，为2000万高危成人接种PPSV 23疫苗避免了2858例死亡，878例住院，41,881例肺炎球菌肺炎病例，232例，在大流行期间损失了891天的工作。在更严重的情况下，疫苗接种避免了21，921例死亡，10，280例住院治疗，70，345例肺炎球菌病例，以及类似的112万个工作日损失。在不太严重的情况下，肺炎球菌疫苗接种避免了715例死亡，219例住院，10，470例肺炎球菌病例和58，235天的工作损失。在基本情况和不太严重的情况下，储存PPSV 23与不储存的增量成本效益比分别为每质量调整生命年39，946美元和198，653美元。对于更严重的情况，储存PPSV 23可以节省成本。概率敏感性分析发现，由于下一次大流行的时间和影响存在很大的不确定性，因此增量成本效益比值的范围很广。此外，PPSV 23的保质期和库存管理大大影响了成本效益ratio.Conclusions：对于严重的大流行或大流行中，大流行前流感疫苗是不可用的，PPSV 23的库存可以是一个具有成本效益的战略，以减少与继发性肺炎球菌感染的高风险美国人口的健康和经济负担。然而，对于有大流行前流感疫苗可用的轻度严重大流行来说，储存PSV 23可能不具有成本效益。(Clin Then 2010;32：1501-1516）（C）2010 Excerpta Medica Inc.
Background: Secondary bacterial infections (especially pneumococcal infections) were a major cause of death during prior influenza pandemics. One strategy to prevent pneumococcal infections in adults during a future pandemic is to stockpile 23-valent pneumococcal polysaccharide vaccine (PPSV23). Stockpiling a pneumococcal vaccine can ensure that it is available when needed most-that is, at the onset of a pandemic.Objective: The purpose of this article was to project the health and economic impact of stockpiling PPSV23 to prevent secondary pneumococcal infections among high-risk adults aged 18 to 64 years during an influenza pandemic within the United States.Methods: A cost-effectiveness model was developed to evaluate the health and economic effects of stockpiling PPSV23 versus not stockpiling this vaccine for preventing secondary pneumococcal infections among 20 million high-risk US adults aged 18 to 64 years during an influenza pandemic. The model was used to project the number of pneumococcal cases, hospitalizations, deaths, and days of work loss averted. Three health outcomes (deaths, hospitalizations, and outpatient care) were estimated from secondary pneumococcal infections. To assess the overall effectiveness of the different strategies, the quality-adjusted life-year (QALY) was used as a measure of these 3 health outcomes. The results are presented for 3 scenarios based on the pandemic severity and anticipated prepandemic influenza vaccine availability: base case, more-severe case, and less-severe case.Results: In the base-case scenario, vaccinating 20 million high-risk adults with PPSV23 avoided 2858 deaths, 878 hospitalizations, 41,881 pneumococcal pneumonia cases, and 232,891days of work loss during a pandemic. Under the more-severe case scenario, vaccination avoided 21,921 deaths, 10,280 hospitalizations, 70,345 pneumococcal cases, and similar to 1.12 million days of work loss. Under the less-severe case scenario, pneumococcal vaccination avoided 715 deaths, 219 hospitalizations, 10,470 pneumococcal cases, and 58,235 days of work loss. The incremental cost-effectiveness ratio for stockpiling PPSV23 versus no stockpiling for the base-case and less-severe case scenarios was $39,946 and $198,653 per QALY, respectively. For the more-severe case scenario, stockpiling PPSV23 was cost saving. Probabilistic sensitivity analyses found that the range of incremental cost-effectiveness ratio values was broad due to the large uncertainty regarding the timing and impact of the next pandemic. In addition, the shelf life of PPSV23 and stockpile management substantially influenced the cost-effectiveness ratio.Conclusions: For severe pandemics or pandemics in which prepandemic influenza vaccine is unavailable, stockpiling of PPSV23 can be a cost-effective strategy for reducing the health and economic burden associated with secondary pneumococcal infections in a high-risk US population. However, for a mildly severe pandemic in which prepandemic influenza vaccine is available, stockpiling of PPSV23 may not be cost-effective. (Clin Then 2010;32:1501-1516) (C) 2010 Excerpta Medica Inc.