The economics of routine childhood hepatitis A immunization in the United States: The impact of herd immunity
The economics of routine childhood hepatitis A immunization in the United States: The impact of herd immunity
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DOI：
10.1542/peds.2006-1572
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发表时间：
2007-01-01
期刊：
影响因子：
8
通讯作者：
Bell, Beth P.
中科院分区：
文献类型：
--
作者：
Armstrong, Gregory L.;Billah, Kaafee;Bell, Beth P.
目标.由于甲型肝炎免疫现象，甲型肝炎免疫接种的益处超出了接种疫苗的人所获得的益处。本分析评估了群体免疫对美国儿童甲型肝炎常规免疫成本效益的影响。在一个经济模型中，甲型肝炎免疫接种的成本和效益是从2005年开始的10年内为所有1岁的美国儿童进行免疫接种的。甲型肝炎的未来疾病负担也用这个模型进行了估计，通过使用以前发表的甲型肝炎疫苗接种覆盖率和甲型肝炎发病率下降之间关系的分析，对群体免疫预防的比例进行了建模。如果不考虑免疫接种的影响，从2005年出生队列开始，前10个接种队列的常规免疫接种费用平均为每质量调整生命年32 000美元。预计群体免疫效应将产生大量的额外效益，将前10个队列的免疫计划成本降低到每质量调整生命年1000美元。最初几个群体的群体免疫效益最大，是免疫效益的两倍多，并将随着时间的推移而下降。在单变量敏感性分析中，估计值对疫苗接种费用最敏感，但在所有假设下，每质量调整生命年的费用仍低于20 000美元。在该计划的前10年，群体免疫效果是甲型肝炎免疫节省的两倍多。在考虑到这些影响后，按每质量调整生命年的成本计算，免疫接种接近成本中性。
OBJECTIVES. Because of the herd-immunity phenomenon, the benefits of immunization against hepatitis A extend beyond those received by those who are vaccinated. This analysis estimates the impact of herd immunity on the cost-effectiveness of routine hepatitis A immunization among US children.PATIENTS AND METHODS. In an economic model, the costs and benefits of hepatitis A immunization were estimated for immunizing all US children at age 1 year over a 10-year period starting in 2005. The future burden of disease from hepatitis A was also estimated with this model, and the fraction that would be prevented by herd immunity was modeled by using a previously published analysis of the relationship between hepatitis A vaccination coverage and declines in hepatitis A incidence.RESULTS. Without accounting for herd-immunity effects, the costs of routine immunization would average $32 000 per quality-adjusted life-year gained for the first 10 cohorts immunized starting with the 2005 birth cohort. Herd-immunity effects would be expected to produce substantial additional benefits, lowering the cost of the immunization program to $1000 per quality-adjusted life-year gained for the first 10 cohorts. Herd-immunity benefits would be greatest for the first few cohorts, more than doubling the benefits of immunization, and would decline over time. In a univariate sensitivity analysis, estimates were most sensitive to vaccination costs but remained below $20 000 per quality-adjusted life-year under all of the assumptions.CONCLUSIONS. Herd- immunity effects more than double the savings from hepatitis A immunization during the first 10 years of the program. After accounting for these effects, immunization is close to cost-neutral on a cost-per-quality-adjusted-lifeyear basis.