Epidemiologic impact and cost-effectiveness of universal infant vaccination with a 7-valent conjugated pneumococcal vaccine in the Netherlands
Epidemiologic impact and cost-effectiveness of universal infant vaccination with a 7-valent conjugated pneumococcal vaccine in the Netherlands
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DOI：
10.1016/s0149-2918(03)80322-3
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发表时间：
2003-10-01
影响因子：
3.2
通讯作者：
Postma, MJ
中科院分区：
文献类型：
--
作者：
Bos, JM;Rümke, H;Postma, MJ
背景：肺炎链球菌是荷兰细菌性脑膜炎、菌血症、肺炎和中耳炎的主要原因之一。这些疾病导致大量的死亡率、发病率和费用。由于大多数病例发生在非常年幼的婴儿中，社会影响尤其严重。 目的：本研究的目的是评估荷兰婴儿普遍接种 7 价肺炎球菌疫苗的流行病学影响和成本效益。方法：使用 1996 年至 2001 年的流行病学数据和医疗保健资源使用数据进行决策分析。使用模型来预测肺炎球菌疫苗接种对发病率的影响。从出生到 10 岁的婴儿和儿童的肺炎球菌感染。估算了成本、效益和健康收益，并计算了成本效益。所有分析均从社会角度进行。 结果：1996年至2001年，荷兰从出生到10岁的婴儿和儿童平均每年发生339例侵袭性肺炎球菌感染。该模型预测，引入7价肺炎球菌结合疫苗每年将预防48例细菌性脑膜炎和88例肺炎球菌菌血症，以及肺炎球菌中耳炎42695例，侵袭性肺炎球菌肺炎3411例。该模型还预测，疫苗接种每年将挽救 13 条生命，并预防 31 例终身后遗症，从而使每年获得 382 个折扣质量调整生命年 (QALY) 或 329 个折扣生命年。考虑到这些健康收益，疫苗接种将在荷兰避免 9,453,600 的脑膜炎球菌和肺炎球菌感染的直接和间接医疗费用，包括紧急医疗护理、后遗症管理和工作时间损失。如果疫苗价格为每剂 40 美元，则基本情况成本效益比将为每 QALY 71,250 美元。该模型对感染发生率、疫苗有效性和疫苗价格的变化很敏感。结论：我们的分析模型预测，荷兰婴儿普遍接种肺炎球菌疫苗可以预防大量肺炎球菌感染，并大大降低相关死亡率和发病率。然而，与荷兰实施的其他干预措施相比，这种疫苗接种计划的基线成本效益比相对不利。版权所有 (C) 2003 Excerpta Medica, Inc.
Background: Streptococcus pneumoniae is one of the main causes of bacterial meningitis, bacteremia, pneumonia, and otitis media in the Netherlands. These diseases lead to substantial mortality, morbidity, and costs. The societal impact is especially severe because most cases occur in very young infants.Objective: The aim of this study was to estimate the epidemiological impact and cost-effectiveness of universal infant vaccination with a 7-valent conjugated pneumococcal vaccine in the Netherlands.Methods: Decision analysis was performed using epidemiological data and data on health care resource use from 1996 to 2001. A model was used to project the impact of pneumococcal vaccination on the incidence of pneumococcal infections in infants and children from birth to age 10 years. Costs, benefits, and health gains were estimated, and cost-effectiveness was calculated. All analyses were performed from a societal perspective.Results: On average, 339 cases per year of invasive pneumococcal infection occurred in infants and children from birth to age 10 years in the Netherlands from 1996 to 2001. The model predicted that introduction of the 7-valent conjugated pneumococcal vaccine would prevent 48 cases of bacterial meningitis and 88 cases of pneumococcal bacteremia per year, as well as 42,695 cases of pneumococcal otitis media and 3411 cases of invasive pneumococcal pneumonia. The model also predicted that vaccination would save 13 lives per year and prevent 31 cases of lifelong sequelae, rendering 382 discounted quality-adjusted life-years (QALYs) gained or 329 discounted life-years gained per year. Considering these health gains, vaccination would prevent 9,453,600 of direct and indirect medical costs of meningococcal and pneumococcal infections in the Netherlands, including acute medical care, management of sequelae, and lost time at work. With a vaccine price of 40 per dose, the base-case cost-effectiveness ratio would be 71,250 per QALY. The model was sensitive to changes in incidence of infections, vaccine effectiveness, and vaccine price.Conclusions: Our analytic model predicted that universal pneumococcal vaccination of infants in the Netherlands could prevent a large number of pneumococcal infections and considerably reduce related mortality and morbidity. However, the baseline cost-effectiveness ratio of such a vaccination program would be relatively unfavorable compared with other interventions implemented in the Netherlands. Copyright (C) 2003 Excerpta Medica, Inc.