Cost-effectiveness of Rotavirus vaccination in Vietnam.
Cost-effectiveness of Rotavirus vaccination in Vietnam.
复制标题
DOI：
10.1186/1471-2458-9-29
复制
发表时间：
2009-01-21
影响因子：
4.5
通讯作者：
Salomon JA
中科院分区：
文献类型：
--
作者：
Kim SY;Goldie SJ;Salomon JA
轮状病毒是导致幼儿住院或因疾病死亡的严重腹泻的最常见原因。新的轮状病毒疫苗最近获得批准。之前的一些研究为将疫苗引入低收入国家的健康和经济后果提供了广泛的定性见解，在基于模型的分析中代表了轮状病毒感染的几个特征，例如不同程度的严重程度和临床表现的年龄依赖性。我们扩展这项工作，以反映轮状病毒的其他特征（例如，再感染的可能性和自然感染所赋予的不同程度的部分免疫力），并评估这些特征对轮状病毒疫苗接种的成本效益的影响。我们开发了一个马尔可夫模型，反映轮状病毒感染的关键特征，使用最新的数据。我们将该模型应用于2004年越南出生队列，并从社会和卫生保健系统的角度重新评估了轮状病毒疫苗接种（Rotarix®）与未接种疫苗相比的成本效益（2004美元/残疾调整生命年[DALY]）。我们进行了单变量敏感性分析，还进行了概率敏感性分析，基于Monte Carlo模拟，从分配给关键不确定参数的分布中绘制参数值。由于疫苗免疫的部分性质，轮状病毒疫苗接种不能完全保护幼儿免受轮状病毒感染，但在生命的前5年内，可有效减少约67%的轮状病毒胃肠炎严重病例（门诊就诊，住院或死亡）。根据基本情况假设（94%的覆盖率和每剂5美元），从社会角度来看，与不接种疫苗相比，接种疫苗避免的每DALY增量成本为540美元，从卫生保健系统角度来看为550美元。引入轮状病毒疫苗将是越南具有成本效益的公共卫生干预措施。然而，鉴于疫苗有效性的不确定性和当地轮状病毒流行病学的潜在变化，随着新信息的出现，可能需要进一步的临床研究和轮状病毒疫苗接种计划的重新评估。
Rotavirus is the most common cause of severe diarrhea leading to hospitalization or disease-specific death among young children. New rotavirus vaccines have recently been approved. Some previous studies have provided broad qualitative insights into the health and economic consequences of introducing the vaccines into low-income countries, representing several features of rotavirus infection, such as varying degrees of severity and age-dependency of clinical manifestation, in their model-based analyses. We extend this work to reflect additional features of rotavirus (e.g., the possibility of reinfection and varying degrees of partial immunity conferred by natural infection), and assess the influence of the features on the cost-effectiveness of rotavirus vaccination. We developed a Markov model that reflects key features of rotavirus infection, using the most recent data available. We applied the model to the 2004 Vietnamese birth cohort and re-evaluated the cost-effectiveness (2004 US dollars per disability-adjusted life year [DALY]) of rotavirus vaccination (Rotarix®) compared to no vaccination, from both societal and health care system perspectives. We conducted univariate sensitivity analyses and also performed a probabilistic sensitivity analysis, based on Monte Carlo simulations drawing parameter values from the distributions assigned to key uncertain parameters. Rotavirus vaccination would not completely protect young children against rotavirus infection due to the partial nature of vaccine immunity, but would effectively reduce severe cases of rotavirus gastroenteritis (outpatient visits, hospitalizations, or deaths) by about 67% over the first 5 years of life. Under base-case assumptions (94% coverage and $5 per dose), the incremental cost per DALY averted from vaccination compared to no vaccination would be $540 from the societal perspective and $550 from the health care system perspective. Introducing rotavirus vaccines would be a cost-effective public health intervention in Vietnam. However, given the uncertainty about vaccine efficacy and potential changes in rotavirus epidemiology in local settings, further clinical research and re-evaluation of rotavirus vaccination programs may be necessary as new information emerges.
登录
查看更多内容
影响因子：
6.4
作者：
Gentsch, JR;Woods, PA;Glass, RI
通讯作者：
Glass, RI
DOI：
10.1590/s1020-49892007000300003
发表时间：
2007-04-01
期刊：
Revista Panamericana de Salud Pública
影响因子：
--
作者：
Rheingans, Richard D.;Constenla, Dagna;Breuer, Thomas
通讯作者：
Breuer, Thomas
影响因子：
105.7
作者：
Edejer, TTT;Aikins, M;Evans, DB
通讯作者：
Evans, DB
影响因子：
5.5
作者：
Goossens, Lucas M. A.;Standaert, Baudouin;Al, Maiwenn J.
通讯作者：
Al, Maiwenn J.
影响因子：
168.9
作者：
Linhares, Alexandre C.;Velazquez, F. Raul;Bouckenooghe, Alain
通讯作者：
Bouckenooghe, Alain