Projected cost-effectiveness of pneumococcal conjugate vaccination of healthy infants and young children
Projected cost-effectiveness of pneumococcal conjugate vaccination of healthy infants and young children
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DOI：
10.1001/jama.283.11.1460
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发表时间：
2000-03-15
影响因子：
120.7
通讯作者：
Shinefield, HR
中科院分区：
文献类型：
--
作者：
Lieu, TA;Ray, GT;Shinefield, HR
目的评价肺炎球菌结合疫苗对美国健康婴幼儿的健康和经济影响。设计基于北加州Kaiser Permanente随机试验和其他已发表和未发表的资料的成本-效果分析。设定和患者美国380万名婴儿的假设出生队列，干预健康婴儿常规接种的假设比较，需要4剂肺炎球菌结合疫苗(2、4、6和12-15个月)，结果健康婴幼儿接种疫苗可预防脑膜炎、菌血症、肺炎、中耳炎等疾病12000余例，肺炎5.3万例，肺炎1100例，肺炎肺炎116例，肺炎死亡116例。在计入疫苗成本之前，疫苗接种计划将为避免肺炎球菌疾病节省3.42亿美元的医疗成本和4.15亿美元的工作损失和其他成本。如果每剂疫苗的成本低于46美元，健康婴儿的疫苗接种将为社会带来净节省，如果疫苗成本低于18美元宠物剂量，将为医疗保健支付者带来净节省。按生产商标价每剂58美元计算，婴儿接种疫苗每挽救一个生命年将花费社会80,000美元，或每预防一次中耳炎发作花费160美元(其他估计成本为每预防肺炎病例3,200美元，菌血症15,000美元，脑膜炎28万美元)。为2-4.9岁的儿童接种1剂疫苗的额外计划的成本-效果因儿童的年龄、肺炎球菌疾病的相对风险和疫苗成本而异。结论美国健康婴儿的肺炎球菌结合疫苗接种具有潜在的成本效益，要实现成本节约，其成本需要低于制造商的标价。除了有形的成本外，疫苗的评估还应基于预防肺炎球菌病的死亡率和发病率这一不太明显的价值。
Context Pneumococcal conjugate vaccine for infants has recently been found effective against meningitis, bacteremia, pneumonia, and otitis media.Objective Tc,evaluate the projected health and economic impact: of pneumococcal conjugate vaccination of healthy US infants and young children.Design Cost-effectiveness analysis based on data from the Northern California Kaiser Permanente randomized trial and other published and unpublished sources.Setting and Patients A hypothetical US birth cohort of 3.8 million infants,Interventions Hypothetical comparisons of routine vaccination of healthy infants, requiring 4 doses of pneumococcal conjugate vaccine (at 2, 4, 6, and 12-15 months), and catch-up vaccination of children aged 2 to 4.9 years requiring 1 dose, with children receiving no intervention.Main Outcome Measures Cost per life-year saved and cost per-episode of meningitis, bacteremia, pneumonia, and otitis media prevented.Results Vaccination of healthy infants would prevent more than 12 000 cases of meningitis and bacteremia, 53 000 cases of pneumonia, 1 million episodes of otitis media, and 116 deaths due to pneumococcal infection. Before accounting for vaccine costs, the vaccination program would save $342 million in medical and $415 million in work-loss and other costs from averted pneumococcal disease. Vaccination of healthy infants would result in net savings for society if the vaccine cost less than $46 per dose, and net savings for the health care payer if the vaccine cost less than $18 pet dose. At the manufacturer's list price of $58 per dose, infant vaccination would cost society $80 000 per life-year saved or $160 per otitis media episode prevented (other estimated costs would be $3200 per pneumonia case prevented, $15 000 for bacteremia, and $280 000 for meningitis). The cost-effectiveness of an additional program to administer 1 dose of vaccine to children aged 2 to 4.9 years would vary depending on the children's ages, relative risks of pneumococcal disease, and vaccine costConclusions Pneumococcal conjugate vaccination of healthy US infants has the potential to be cost-effective, To achieve cost savings, its cost would need to be lower than the manufacturer's list price. In addition to tangible costs, the vaccine should be appraised based on the less tangible value of preventing mortality and morbidity from pneumococcal disease.