Cost-effectiveness of adjuvanted versus nonadjuvanted influenza vaccine in adult hemodialysis patients.
Cost-effectiveness of adjuvanted versus nonadjuvanted influenza vaccine in adult hemodialysis patients.
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成人血液透析患者中佐剂流感疫苗与非佐剂流感疫苗的成本效益。
DOI：
10.1053/j.ajkd.2010.12.016
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Wagner,MichaelM
中科院分区：
文献类型：
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作者：
Lee,BruceY;Stalter,RandyM;Bacon,KristinaM;Tai,JulieHY;Bailey,RachelR;Zimmer,ShantaM;Wagner,MichaelM
背景：目前有超过34万人正在接受终末期肾病的长期血液透析（HD）治疗，因此他们特别容易感染流感，容易发生更严重的流感结局，并且不太可能从标准流感疫苗中获得血清保护。流感疫苗佐剂，即添加到疫苗中以增强引起的免疫反应的化学或生物化合物，可能有助于克服这一问题。研究设计：经济随机决策分析模拟模型。环境和参与者：美国成年HD人群。模型、视角和时间框架：该模型模拟了使用佐剂或非佐剂疫苗的决定，假设了社会视角，并代表了单个流感季节或1年。干预：不同佐剂成本和效果的佐剂流感疫苗。敏感性分析探讨了不同的流感临床发病率、流感住院率和流感相关死亡率的影响。结果：以质量调整生命年为衡量有效性的有佐剂流感疫苗（与无佐剂流感疫苗）的增量成本-效果比。结果：当佐剂效果（克服HD患者和健康成人流感疫苗应答的差异）≥60%时，佐剂成本为1美元（在标准疫苗成本之上）时，佐剂疫苗将具有成本效益（增量成本-效果比< 50,000美元/质量调整生命年）；当佐剂效果为100%时，佐剂成本为1美元（在经济上占主导地位）（提供成本节约和健康效益）。如果辅助治疗的效果是100%，那么2美元的辅助治疗是划算的。局限性：所有模型都是对现实生活的简化，不能捕捉到所有可能的因素和结果。结论：根据佐剂的效力，佐剂成本≤2美元的佐剂流感疫苗在标准流感季节可能是一种具有成本效益的策略。
BACKGROUND: Currently more than 340,000 individuals are receiving long-term hemodialysis (HD) therapy for end-stage renal disease and therefore are particularly vulnerable to influenza, prone to more severe influenza outcomes, and less likely to achieve seroprotection from standard influenza vaccines. Influenza vaccine adjuvants, chemical or biologic compounds added to a vaccine to boost the elicited immunologic response, may help overcome this problem. STUDY DESIGN: Economic stochastic decision analytic simulation model. SETTING & PARTICIPANTS: US adult HD population. MODEL, PERSPECTIVE, & TIMEFRAME: The model simulated the decision to use either an adjuvanted or nonadjuvanted vaccine, assumed the societal perspective, and represented a single influenza season, or 1 year. INTERVENTION: Adjuvanted influenza vaccine at different adjuvant costs and efficacies. Sensitivity analyses explored the impact of varying influenza clinical attack rate, influenza hospitalization rate, and influenza-related mortality. OUTCOMES: Incremental cost-effectiveness ratio of adjuvanted influenza vaccine (vs nonadjuvanted) with effectiveness measured in quality-adjusted life-years. RESULTS: Adjuvanted influenza vaccine would be cost-effective (incremental cost-effectiveness ratio <$50,000/quality-adjusted life-year) at a $1 adjuvant cost (on top of the standard vaccine cost) when adjuvant efficacy (in overcoming the difference between influenza vaccine response in HD patients and healthy adults) ≥60% and economically dominant (provides both cost savings and health benefits) when the $1 adjuvant's efficacy is 100%. A $2 adjuvant would be cost-effective if adjuvant efficacy was 100%. LIMITATIONS: All models are simplifications of real life and cannot capture all possible factors and outcomes. CONCLUSIONS: Adjuvanted influenza vaccine with adjuvant cost ≤$2 could be a cost-effective strategy in a standard influenza season depending on the potency of the adjuvant.