2008年胶南市部分农村合作医疗人群接种季节性流感疫苗成本效益分析

[目的]评价胶南市参加农村合作医疗人群接种季节性流感疫苗(以下简称流感疫苗)的效果和效益。[方法]2008年10月按年龄段分组选取3个社区共375名流感疫苗接种者为接种组,随机选择年龄、性别、健康状况、经济收入及受教育程度等相匹配的未接种流感疫苗的人群作为对照组,采用流行病学试验研究方法,随访12个月进行调查分析。[结果]疫苗对流感样疾病(ILI)的平均保护率为56.62%,其中60岁以上年龄组为69.23%。[结论]疫苗具有良好的保护性,特别是老年人群效果明显。且流感疫苗接种于60岁以上老年人可产生较高的经济效益,人均每年流感样疾病医疗费用节约约92元,建议农村合作医疗若按照40%的比例报销农村老年人流感疫苗接种费用,将会收到较好的经济效益和社会效益。     

2018-2019年台州市老年人接种流感疫苗的成本效益北大核心

目的评价台州市老年人2018-2019年接种流感疫苗的成本效益。方法采用前瞻性队列研究在社区招募≥60岁老年人分为流感疫苗接种组和非接种组,随访6个月,收集流感样病例经济负担和流感疫苗接种成本相关数据,计算接种流感疫苗的效益成本比。结果共纳入2073名研究对象,其中流感疫苗接种组1048名、非接种组1025名,流感样病例总经济负担中位数为552.9元,其中直接医疗费用200.0元、直接非医疗费用0.0元、间接费用为217.9元。人均流感疫苗接种成本为35.50元,其中疫苗、人力、工作经费成本分别为32.38元、2.63元、0.49元。人均接种流感疫苗效益为199.1元,效益成本比为5.6:1。结论2018-2019年台州市老年人接种流感疫苗具有良好的成本效益。     

我国消除丙型肝炎的普通人群HCV检测策略的成本效果分析

目的 分析我国消除丙型肝炎（丙肝）的普通人群HCV检测策略的成本效果,明确最佳成本效果的HCV检测年龄。方法 运用TreeAge pro 2019软件构建决策树马尔科夫模型,以1年为周期,模拟10万名20~59岁各年龄组人群HCV检测和治疗结果,以全社会角度分析策略间比较的成本效果和效益。效果指标为增量成本效果比（ICER）,效益指标为净货币效益（NMB）,以我国2022年人均国内生产总值（85 698元）为意愿支付阈值。通过单因素敏感性分析和概率敏感性分析评估结果可靠性。结果 在20~59岁人群HCV检测有成本效果,在40~49岁年龄组进行HCV检测成本效果最佳。20~59岁年龄组人群HCV检测策略与未HCV检测策略比较,增量成本为161.24元/人,增量效用为0.003 6质量调整寿命年（QALYs）/人,ICER为45 197.26元/QALY,ICER小于意愿支付阈值,具有成本效果。各年龄组人群HCV检测策略与未HCV检测策略比较,ICER为42 055.06~53 249.43元/QALY,NMB为96.52~169.86元/人,其中40~49岁年龄组的ICER最低,NMB最高。单因素敏感性分析结果显示,贴现率、丙肝抗体（抗-HCV）检测成本、人群抗-HCV阳性率和直接抗病毒药物治疗成本对经济学评价影响较大,但改变参数取值,结论不变。概率敏感性分析结果表明模型分析结果稳定。结论 医疗机构探索动员20~59岁普通人群进行HCV检测具有较好的成本效果,以40~49岁年龄组人群的HCV检测成本效果最佳。在我国普通人群中实施HCV检测的“愿检尽检”策略,能降低人群丙肝疾病负担。     

中国流感疫苗预防接种技术指南（2022-2023）

流感是由流感病毒引起的一种急性呼吸道传染病,严重危害人群健康。流感病毒其抗原性易变,传播迅速,每年可引起季节性流行,在学校、托幼机构和养老院等人群聚集的场所易发生暴发疫情。每年季节性流感流行在全球可导致300万~500万重症病例,29万~65万呼吸道疾病相关死亡。孕妇、婴幼儿、老年人和慢性基础疾病患者等高危人群,患流感后出现严重疾病和死亡的风险较高。尤其是全球新型冠状病毒肺炎（新冠肺炎）疫情严重流行态势仍在持续,今年我国南方部分省份出现夏季流感流行高峰,今冬明春可能会出现新冠肺炎与流感等呼吸道传染病叠加流行的情况。接种流感疫苗是预防流感、减少流感相关重症和死亡的有效手段,可以减少流感相关疾病带来的健康危害及对医疗资源的挤兑。我国现已批准上市的流感疫苗有三价灭活流感疫苗（IIV3）、四价灭活流感疫苗（IIV4）和三价减毒活流感疫苗（LAIV3）,IIV3包括裂解疫苗和亚单位疫苗,IIV4为裂解疫苗,LAIV3为减毒疫苗。流感疫苗在我国属于非免疫规划类疫苗,居民自愿接种。2018年以来,中国疾病预防控制中心每年印发当年度的《中国流感疫苗预防接种技术指南》。一年来,新的研究证据在国内外发表,为更好地指导我国流感预防控制和疫苗接种工作,国家免疫规划技术工作组流感疫苗工作组综合国内外最新研究进展,在2021年版指南的基础上进行了更新和修订,形成了《中国流感疫苗预防接种技术指南（2022-2023）》。本指南更新的内容主要包括：第一,增加了新的研究证据,尤其是我国的研究结果,包括流感疾病负担、疫苗效果、疫苗安全性监测、疫苗预防接种成本效果等;第二,更新了一年来国家出台的有关流感防控政策和措施;第三,更新了2022-2023年度国内批准上市及批签发的流感疫苗种类;第四,更新了本年度三价和四价流感疫苗组分;第五,更新了2022-2023年度的流感疫苗接种建议。本指南建议：原则上,接种单位应为≥6月龄所有愿意接种流感疫苗且无接种禁忌的人提供接种服务。≥18岁的人群可在一次接受免疫服务时,在两侧肢体分别接种灭活流感疫苗和新型冠状病毒疫苗（新冠疫苗）;<18岁的人群,建议流感疫苗与新冠疫苗接种间隔仍>14 d。对可接种不同类型或不同厂家疫苗产品的人群,可由受种者自愿选择接种任何一种流感疫苗,无优先推荐。结合今年新冠肺炎疫情形势,为尽可能降低流感的危害和对新冠肺炎疫情防控的影响,优先推荐以下重点和高风险人群及时接种：①医务人员,包括临床救治人员、公共卫生人员、卫生检疫人员等;②大型活动参加人员和保障人员;③养老机构、长期护理机构、福利院等人群聚集场所脆弱人群及员工;④重点场所人群,如托幼机构、中小学校的教师和学生,监所机构的在押人员及工作人员等;⑤其他流感高风险人群,包括≥60岁居家老年人、6月龄至5岁儿童、慢性病患者、6月龄以下婴儿的家庭成员和看护人员以及孕妇。对于IIV,6月龄至8岁儿童首次接种流感疫苗的应接种2剂次,间隔≥4周;2021-2022年度或以前接种过1剂次或以上流感疫苗的儿童,建议接种1剂次;≥9岁儿童和成年人仅需接种1剂次。对于LAIV,无论是否接种过流感疫苗,仅接种1剂次。建议各地在疫苗供应到位后尽早开展接种工作,尽量在当地流感流行季前完成接种。同一流行季,已按照接种程序完成全程接种的人员,无需再次接种。孕妇在孕期的任一阶段均可接种灭活流感疫苗。接种单位在整个流行季节都可以提供接种服务。本指南适用于疾控机构、医疗机构、妇幼保健机构和接种单位等从事流感防治相关的专业人员。根据国内外研究进展,本指南今后亦将定期更新、完善。     

中国流感疫苗预防接种技术指南（2019-2020）

流行性感冒（流感）是由流感病毒引起的一种急性呼吸道传染病，严重危害人群健康。流感病毒其抗原性易变，传播迅速，每年可引起季节性流行，在学校、托幼机构和养老院等人群聚集的场所可发生暴发疫情。每年流感季节性流行在全球可导致300万~500万重症病例，29万~65万呼吸道疾病相关死亡。孕妇、婴幼儿、老年人和慢性基础疾病患者等高危人群，患流感后出现严重疾病和死亡的风险较高。接种流感疫苗是预防流感病毒感染及其严重并发症的最有效手段。我国现已批准上市的流感疫苗有三价灭活流感疫苗（IIV3）和四价灭活流感疫苗（IIV4），IIV3包括裂解疫苗和亚单位疫苗，IIV4为裂解疫苗。除个别地区外，流感疫苗在我国大多数地区属于第二类疫苗，实行自愿、自费接种。2018年，中国疾病预防控制中心印发了《中国流感疫苗预防接种技术指南（2018-2019）》（2018年版指南）。一年来，新的研究证据在国内外发表，新的疫苗产品在我国上市。为更好的指导我国流感预防控制和疫苗应用工作，国家免疫规划技术工作组流感疫苗工作组综合国内外最新研究进展，在2018年版指南的基础上进行了更新和修订，形成了《中国流感疫苗预防接种技术指南（2019-2020）》。本指南更新的内容主要包括以下几个方面：第一，增加了新的研究证据，尤其是我国的研究结果，包括流感疾病负担、疫苗效果、接种疫苗可避免的疾病负担、疫苗安全性监测、疫苗预防接种成本效果等；第二，增加了一年来国家卫生健康委员会流感防控有关政策和措施；第三，更新了我国2019-2020年度国内批准上市及批签发的流感疫苗种类；第四，更新了本年度IIV3和IIV4疫苗组份。本指南建议：原则上，接种服务单位应为≥ 6月龄所有愿意接种流感疫苗且无禁忌证的人提供接种服务。对可接种不同类型、厂家疫苗产品的人群，可由受种者自愿选择接种任一种流感疫苗，无优先推荐。为降低高危人群罹患流感及感染后发生严重临床结局的风险，指南推荐6月龄至59月龄儿童、≥ 60岁老年人、慢性病患者、医务人员、<6月龄婴儿的家庭成员和看护人员以及孕妇或准备在流感季节怀孕的女性为优先接种对象。首次接种流感疫苗的6月龄至8岁儿童应接种2剂次，间隔≥ 4周；2018-2019年度或以前接种过≥ 1剂次流感疫苗的儿童，建议接种1剂次。≥ 9岁儿童和成年人仅需接种1剂次。建议各地疾控机构在疫苗供应到位后尽快安排接种工作，最好在10月底前完成免疫接种；对10月底前未接种的对象，整个流行季节都可以提供接种服务。孕妇在孕期的任一阶段均可接种流感疫苗。本指南适用于从事流感防控相关的各级CDC工作人员，预防接种点的接种人员，各级医疗机构儿科、内科、感染科等医务人员，以及各级妇幼保健机构的专业人员。根据国内外研究进展，本指南今后亦将定期更新、完善。     

中国流感疫苗预防接种技术指南(2018-2019)

接种流感疫苗是预防流感病毒感染及其并发症的最有效手段。目前,我国国内批准上市的灭活流感疫苗为三价（ⅡV3）和四价（ⅡV4）疫苗,包括裂解疫苗和亚单位疫苗。流感疫苗在我国大多数地区属于第二类疫苗,实行自愿、自费接种。为指导我国流感预防控制和疫苗应用工作,中国CDC国家免疫规划技术工作组流感疫苗工作组综合国内外最新研究进展,对2014年版指南进行了更新和修订,形成了《中国流感疫苗预防接种技术指南（2018－2019）》。本指南主要更新了以下内容：流感的流行病学和疾病负担,流感疫苗的种类、2018－2019年度流感疫苗抗原组份、ⅡV3和ⅡV4疫苗的免疫反应、免疫持久性、免疫原性、效力、效果、安全性、成本效果和成本效益等;并基于现有的科学证据,提出了2018－2019年度流感疫苗预防接种的建议。本指南建议：原则上,接种服务单位应为≥6月龄所有愿意接种流感疫苗且无禁忌证的人提供接种服务。对可接种不同类型、厂家疫苗产品的人群,可由受种者自愿选择接种任一种流感疫苗,无优先推荐。为降低高危人群罹患流感及感染后发生严重临床结局的风险,指南推荐6月龄至5岁儿童、≥60岁老年人、慢性病患者、医务人员、<6月龄婴儿的家庭成员和看护人员以及孕妇或准备在流感季节怀孕的女性为优先接种对象;首次接种流感疫苗的6月龄至8岁儿童应接种2剂次,间隔≥4周;2017－2018年度或以前接种过≥1剂次流感疫苗的儿童,建议接种1剂次;≥9岁儿童和成年人仅需接种1剂次。建议各地防疫部门在疫苗供应到位后尽快安排接种工作,最好在10月底前完成免疫接种;对10月底前未接种的对象,整个流行季节都可以提供接种服务;孕妇在孕期的任一阶段均可接种流感疫苗。本指南适用于从事流感防控相关的各级CDC工作人员,预防接种点的接种人员,各级医疗机构儿科、内科、感染科等医务人员,以及各级妇幼保健机构的专业人员。     

开封市社会医疗保险参保人员流行性感冒疫苗接种效果

目的了解社会医疗保险参保人员接种流行性感冒(流感)疫苗后的人群预防效果。方法选择开封市7 000名符合要求的参加医疗保险人员作为对象,用随机抽样方法,抽取2 626人,进行问卷调查。采用历史性队列研究方法,对接种组和对照组进行回顾性调查。结果流感疫苗接种后与接种前相比,年人均感冒发病次数降低1.92次,降低了64.43%(P﹤0.01);接种流感疫苗比未种人群年人均发病次数降低0.95次,降低了47.26%(P﹤0.01);差异均有统计学意义接种过流感疫苗者明显比未接种流感疫苗者所花费的药物治疗费用要低;接种疫苗后,出现发热等一般反应的占7.17%,轻度过敏反应的占1.81%。结论接种流感疫苗是目前预防流感安全有效的措施,对该市参保的人员具有较高的成本效益。     

椒江区老年人群流感疫苗免费接种意愿及影响因素分析

目的了解台州市椒江区老年人群流感疫苗免费接种意愿及影响因素。方法采用街头截访方式对椒江区户籍、60岁及以上老年人进行问卷调查,收集基本情况、流感疫苗接种相关知识和接种意愿等资料,采用多因素Logistic回归模型分析老年人群流感疫苗免费接种意愿的影响因素。结果发放问卷430份,获得有效问卷393份,问卷有效率为91.40%。2017年老年人群流感疫苗免费接种率为23.66%。愿意免费接种流感疫苗205人,占52.16%;不愿意免费接种流感疫苗188人,占47.84%。多因素Logistic回归分析结果显示,2017年免费接种过流感疫苗(OR=12.519,95%CI:5.620～27.889)、同意接种过流感疫苗就不会得流感(OR=3.387,95%CI:2.118～5.417)、知晓预防流感最好每年接种一次流感疫苗(OR=3.430,95%CI:1.789～6.576)是老年人群愿意免费接种流感疫苗的促进因素。结论免费接种过流感疫苗、认同流感疫苗预防效果、认识到每年需接种流感疫苗的老年人更愿意免费接种流感疫苗。     

基于倾向得分匹配的老年人接种流感疫苗对流感就诊的保护效果研究

目的 评估老年人接种流感疫苗对流感就诊的保护效果,并探讨倾向得分匹配法（PSM）在疫苗保护效果研究中的应用价值。方法 以成都市为研究现场,选取2017年9-12月间接种流感疫苗的60岁及以上老年人作为接种组,采用PSM法选取观察对象作为对照组。匹配后比较两组人群疫苗接种后一年内的流感就诊情况,评价疫苗保护效果。结果 流感疫苗接种组与未接种组各有1442例匹配成功。两组的一般人口学特征、生活方式及健康意识、基本健康状况等特征在匹配前有显著差异,匹配后两组协变量达到均衡。匹配后接种组和对照组流感就诊率分别为0.69%、2.84%,疫苗接种可减少之后一年内75.70%的流感就诊。结论 PSM可有效降低观察性研究组间的混杂偏倚,在疫苗接种效果评价中具有长远的应用价值。流感疫苗接种对降低≥60岁老年人流感就诊具有良好效果,今后有必要采取措施提高流感疫苗接种率。     

中国流感疫苗预防接种技术指南（2021-2022）

流感是由流感病毒引起的一种急性呼吸道传染病,严重危害人群健康。流感病毒其抗原性易变,传播迅速,每年可引起季节性流行,在学校、托幼机构和养老院等人群聚集的场所可发生暴发疫情。每年流感季节性流行在全球可导致300万~500万重症病例,29万~65万呼吸道疾病相关死亡。孕妇、婴幼儿、老年人和慢性基础疾病患者等高危人群,罹患流感后出现严重疾病和死亡的风险较高。尤其是2021年全球新型冠状病毒肺炎（新冠）疫情严重流行态势仍将持续,今冬明春可能会出现新冠疫情与流感等呼吸道传染病叠加流行的风险。而接种流感疫苗是预防流感的最有效手段,可以减少流感相关疾病带来的危害及对医疗资源的占用。我国现已批准上市的流感疫苗有三价灭活流感疫苗（IIV3）、四价灭活流感疫苗（IIV4）和三价减毒活流感疫苗（LAIV3）,IIV3包括裂解疫苗和亚单位疫苗,IIV4为裂解疫苗,LAIV为减毒疫苗。流感疫苗在我国大多数地区属于非免疫规划类疫苗,实行自愿、自费接种。2018-2020年,中国CDC均印发了当年度的《中国流感疫苗预防接种技术指南》。一年来,新的研究证据在国内外发表,为更好地指导我国流感预防控制和疫苗应用工作,国家免疫规划技术工作组流感疫苗工作组综合国内外最新研究进展,在2020年版指南的基础上进行了更新和修订,形成了《中国流感疫苗预防接种技术指南（2021-2022）》。本指南更新的内容主要包括：第一,增加了新的研究证据,尤其是我国的研究结果,包括流感疾病负担、疫苗效果、疫苗安全性监测、疫苗预防接种成本效果等;第二,更新了一年来国家卫生健康委员会流感防控有关政策和措施;第三,更新了我国2021-2022年度国内批准上市及批签发的流感疫苗种类;第四,更新了本年度三价和四价流感疫苗组分;第五,更新了2021-2022年度的流感疫苗接种建议。本指南建议：原则上,接种服务单位应为≥6月龄所有愿意接种流感疫苗且无禁忌证的人提供接种服务。流感疫苗与新冠疫苗的接种间隔应>14 d。对可接种不同类型、厂家疫苗产品的人群,可由受种者自愿选择接种任一种流感疫苗,无优先推荐。结合今年新冠疫情形势,为尽可能降低流感的危害和对新冠疫情防控的影响,推荐按照优先顺序对重点和高风险人群进行接种：①医务人员,包括临床救治人员、公共卫生人员、卫生检疫人员等;②大型活动参加人员和保障人员;③养老机构、长期护理机构、福利院等人群聚集场所脆弱人群及员工;④重点场所人群,如托幼机构、中小学校的教师和学生,监所机构的在押人员及工作人员等;⑤其他流感高风险人群,包括≥60岁的居家老年人、6月龄~5岁儿童、慢性病患者、<6月龄婴儿的家庭成员和看护人员以及孕妇或准备在流感季节妊娠的女性。首次接种或既往接种<2剂次流感疫苗的6月龄~8岁儿童应接种2剂次,间隔≥4周,对IIV或LAIV均建议上述原则;2020-2021年度或以前接种过≥2剂次流感疫苗的儿童,建议接种1剂次;≥9岁儿童和成年人仅需接种1剂次。建议各地在疫苗供应到位后尽快安排接种工作,最好在10月底前完成免疫接种;对10月底前未接种的对象,接种单位在整个流行季节都可以提供接种服务。孕妇在孕期的任一阶段均可接种IIV。本指南适用于从事流感防控相关的各级疾病预防控制机构工作人员,预防接种点的接种人员,各级医疗机构儿科、内科、感染科等医务人员,以及各级妇幼保健机构的专业人员。根据国内外研究进展,本指南今后亦将定期更新、完善。     

Cost-effectiveness of dual influenza and pneumococcal vaccination among the elderly in Shenzhen,China

ObjectiveTo assess the cost-effectiveness of dual influenza and pneumococcal vaccination for the elderly in Shenzhen, China.MethodsA Markov state-transition model with a weekly cycle was developed to compare the outcomes of dual influenza and pneumococcal vaccination for the prevention of influenza and pneumococcal infections compared with no vaccination among 70–74 years old people in Shenzhen over 5 years. The model allowed seasonal variation of influenza activity. We calculated the incremental cost-effectiveness ratio (ICER) with costs and quality-adjusted life years (QALYs) discounted at 5% annually from the societal perspective. The impact of parameter uncertainty on the results was examined using one-way and probabilistic sensitivity analyses (PSA).ResultsIn the base case, dual vaccination prevented 5042 influenza infections, 26 IPD cases, 3 disabilities, 34 deaths, and cost US$7.1 per person while resulting in a net gain of 0.0026 QALYs compared with no vaccination. Using once the Chinese gross domestic product per capita in 2019 (US$10,289) as the willingness-to-pay threshold, dual vaccination was cost-effective with an ICER of US$2699 per QALY gained. One-way sensitivity analyses showed that the ICER was relatively sensitive to changes in influenza attack rates and influenza vaccine effectiveness. Based on the results of PSA with 1000 Monte Carlo simulations, receiving both vaccines was cost-effective in 100% of the repetitions.ConclusionThe current study provides evidence that dual influenza and pneumococcal vaccination is a cost-effective disease prevention strategy for the elderly in Shenzhen, China.     

基于社区慢性乙型肝炎抗病毒治疗策略成本效果分析

目的 我国消除乙型肝炎（乙肝）将会承受巨量的公共卫生资源,基于社区慢性乙肝（chronic hepatitis B,CHB）抗病毒治疗策略的经济学问题凸显,本研究对该策略的成本效果和可支付性做出评价。方法 以WHO有关规划和我国重大传染病社区综合防治方案为策略依据,按照我国CHB防治指南确定抗病毒药物治疗和监测内容,遵循成本效果分析理论和方法构建决策分析马尔科夫模型,参数主要采用全国调查或Meta分析结果,利用TreeAge Pro 2015软件实现模型构建和运行。以我国20~59岁社区人群为研究对象,分别从全社会和支付者角度计算成本,效果用质量调整生命年（QALYs）,策略间比较采用增量成本效果比（ICER）或成本效果比（CER）。通过敏感性分析明确模型中各参数的不确定性,绘制成本效果可支付曲线评价策略的可支付性。结果 我国20~59岁社区人群CHB抗病毒治疗策略的ICER为37 598.6元/QALYs,低年龄组人群ICER较小,即每多获得一个QALYs需要增加投入但具有成本效果价值,抗病毒治疗应优先在低年龄人群中实施。乙肝疫苗接种策略的ICER为-64 000.0元/QALYs,即该策略每多获得一个QALYs可节省成本,最具成本效果价值。人群CHB抗病毒治疗与乙肝疫苗接种策略对比,CER变动在731.8元和1 813.3元/QALYs之间,各年龄人群乙肝疫苗接种的CER均低于抗病毒治疗策略,表明乙肝疫苗接种策略的经济学价值高于抗病毒治疗策略。恩替卡韦成本降低可提高抗病毒治疗策略的成本效果价值,当成本降至一半时,抗病毒治疗成为节省费用的策略。概率敏感性分析表明,抗病毒治疗策略的经济学评价结果可靠,该策略的成本效果价值受公众支付意愿的影响不能忽视。可支付分析发现,按照10万人计算,总预算小于0.3亿元,抗病毒治疗策略无法实现;总预算增加到1.27亿元时,该策略实现的概率为42.6%;只有当总预算达到2.69亿元,该策略才可以完全实现。结论 我国20~59岁社区人群CHB抗病毒治疗策略虽然符合成本效果价值,但作为公共卫生措施将耗资较多。对该人群易感者接种乙肝疫苗,再实施CHB抗病毒治疗,成本效果价值更高,印证了消除乙肝目标的合理性。     

Cost-effectiveness of introducing an MF59-adjuvanted trivalent influenza vaccine for older adults in Argentina

IntroductionInfluenza surveillance in Argentina reported influenza-like illness at a rate of 3500/100,000, a hospitalization rate of 15.5/100,000, and a death rate of 0.32/100,000 annually in adults aged over 65 years. The high burden of disease may be due to a combination of immunosenescence and the suboptimal clinical effectiveness of conventional, non-adjuvanted influenza vaccines in this age group. There is a clinical need for more effective influenza vaccines in this population. This study evaluated the cost-effectiveness of an MF59®-adjuvanted trivalent influenza vaccine (aTIV) in adults aged over 65 years in Argentina compared with the non-adjuvanted trivalent influenza vaccine (TIV) used under the current national vaccination policy.MethodsA decision tree cost-effectiveness model was developed to estimate the cost-effectiveness of switching from TIV to aTIV in Argentinian older adults. The model compared cost and health benefits of vaccination in one influenza season from the payer perspective. The main predictions included survival, quality-adjusted survival, and costs. Model inputs were sourced from Argentina or internationally where local data was considered inaccurate. Vaccine efficacy assumptions were extracted from recently published, peer-reviewed scientific literature.ResultsSwitching from TIV to aTIV would result in 170 deaths averted and 1310 incremental quality-adjusted life years (QALYs) gained. The incremental cost-effectiveness ratio per QALY was US $2660.59 from the payer perspective. In all sensitivity analyses, aTIV remained highly cost-effective. The probabilistic sensitivity analyses showed a 95% CI per QALY of US $113.74–7721.67.ConclusionIntroducing an adjuvanted influenza vaccine in Argentina is potentially beneficial and cost-effective relative to the currently-used TIV through the reduction of disease burden and utilization of healthcare resources.     

Cost-effectiveness of seasonal inactivated influenza vaccination among pregnant women

ObjectiveTo evaluate the cost-effectiveness of seasonal inactivated influenza vaccination among pregnant women using data from three recent influenza seasons in the United States.Design, setting, and participantsWe developed a decision-analytic model following a cohort of 5.2 million pregnant women and their infants aged <6 months to evaluate the cost-effectiveness of vaccinating women against seasonal influenza during pregnancy from a societal perspective. The main outcome measures were quality-adjusted life-year (QALY) gained and cost-effectiveness ratios. Data sources included surveillance data, epidemiological studies, and published vaccine cost data. Sensitivity analyses were also performed. All costs and outcomes were discounted at 3% annually.Main outcome measuresTotal costs (direct and indirect), effects (QALY gains, averted case numbers), and incremental cost-effectiveness of seasonal inactivated influenza vaccination among pregnant women (cost per QALY gained).ResultsUsing a recent benchmark of 52.2% vaccination coverage among pregnant women, we studied a hypothetical cohort of 2,753,015 vaccinated pregnant women. With an estimated vaccine effectiveness of 73% among pregnant women and 63% among infants <6 months, QALY gains for each season were 305 (2010–2011), 123 (2011–2012), and 610 (2012–2013). Compared with no vaccination, seasonal influenza vaccination during pregnancy was cost-saving when using data from the 2010–2011 and 2012–2013 influenza seasons. The cost-effectiveness ratio was greater than $100,000/QALY with the 2011–2012 influenza season data, when CDC reported a low attack rate compared to other recent seasons.ConclusionsInfluenza vaccination for pregnant women can reduce morbidity from influenza in both pregnant women and their infants aged <6 months. Seasonal influenza vaccination during pregnancy is cost-saving during moderate to severe influenza seasons.     

Cost-Effectiveness of Pediatric Influenza Vaccination in The Netherlands

ObjectiveThis study evaluates the cost-effectiveness of extending the Dutch influenza vaccination program for elderly and medical high-risk groups to include pediatric influenza vaccination, taking indirect protection into account.MethodsAn age-structured dynamic transmission model was used that was calibrated to influenza-associated GP visits over 4 seasons (2010-2011 to 2013-2014). The clinical and economic impact of different pediatric vaccination strategies were compared over 20 years, varying the targeted age range, the vaccine type for children or elderly and high-risk groups. Outcome measures include averted symptomatic infections and deaths, societal costs and quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Costs and QALYs were discounted at 4% and 1.5% annually.ResultsAt an assumed coverage of 50%, adding pediatric vaccination for 2- to 17-year-olds with quadrivalent live-attenuated vaccine to the current vaccination program for elderly and medical high-groups with quadrivalent inactivated vaccine was estimated to avert, on average, 401 820 symptomatic cases and 72 deaths per year. Approximately half of averted symptomatic cases and 99% of averted deaths were prevented in other age groups than 2- to 17-year-olds due to herd immunity. The cumulative discounted 20-year economic impact was 35 068 QALYs gained and €1687 million saved, that is, the intervention was cost-saving. This vaccination strategy had the highest probability of being the most cost-effective strategy considered, dominating pediatric strategies targeting 2- to 6-year-olds or 2- to 12-year-olds or strategies with trivalent inactivated vaccine.ConclusionModeling indicates that introducing pediatric influenza vaccination in The Netherlands is cost-saving, reducing the influenza-related disease burden substantially.     

Evaluating the effectiveness and cost-effectiveness of free influenza vaccination policy for older adults in Yinzhou,China: Study protocol of a real-world analyses

BackgroundInfluenza causes excessive morbidity and mortality among older adults. While influenza vaccine provides protection against its infection, the vaccination coverage in China among older adults has been very low. Previous evidence on the cost-effectiveness of government-sponsored free influenza vaccination programs in China was primarily based on literature data, which might not always reflect real-world patient populations. The Yinzhou Health Information System (YHIS) is a regional database that captures electronic health records, insurance claims data, etc. for all residents in Yinzhou district, Zhejiang province, China. We will use YHIS to study the effectiveness, influenza-related direct medical cost and cost-effectiveness analysis (CEA) of the free influenza vaccination program for older adults. In this paper, we describe the study design and innovations in detail.MethodsWe will establish a retrospective cohort of permanent older residents aged 65 and over, using YHIS between 2016 and 2021. We will estimate the vaccine coverage rate, influenza incidence rate and influenza-related direct medical cost from 2016 to 2021. Regression discontinuity will be used to estimate vaccine effectiveness for the 2020/2021 season. We will build a decision tree model to compare the cost-effectiveness of three influenza vaccination options (free trivalent influenza vaccine, free quadrivalent influenza vaccine, and no policy) from both societal and health system perspectives. Parameter inputs will be gathered from both YHIS and published literature. We will calculate the incremental cost-effectiveness ratio with cost and quality-adjusted life years (QALYs) discounted at 5 % annually.DiscussionOur CEA solidifies multiple sources including regional real-world data and literature for a rigorous evaluation of the government-sponsored free influenza vaccination program. The results will provide real-world evidence from real-world data on the cost-effectiveness of a real-world policy. Our findings are expected to support evidence-based policy making and to promote health for older adults.     

The Net Benefit of Personalized Medicine: A Systematic Literature Review and Regression Analysis

ObjectivesAmidst conflicting expectations about the benefits of personalized medicine (PM) and the potentially high implementation costs, we reviewed the available evidence on the cost-effectiveness of PM relative to non-PM.MethodsWe conducted a systematic literature review of economic evaluations of PM and extracted data, including incremental quality-adjusted life-years (ΔQALYs) and incremental costs (Δcosts). ΔQALYs and Δcosts were combined with estimates of national cost-effectiveness thresholds to calculate incremental net monetary benefit (ΔNMB). Regression analyses were performed with these variables as dependent variables and PM intervention characteristics as independent variables. Random intercepts were used to cluster studies according to country.ResultsOf 4774 studies reviewed, 128 were selected, providing cost-effectiveness data for 279 PM interventions. Most studies were set in the United States (48%) and the United Kingdom (16%) and adopted a healthcare perspective (82%). Cancer treatments (60%) and pharmaceutical interventions (72%) occurred frequently. Prognostic tests (19%) and tests to identify (non)responders (37%) were least and most common, respectively. Industry sponsorship occurred in 32%. Median ΔQALYs, Δcosts, and ΔNMB per individual were 0.03, Int$575, and Int$18, respectively. We found large heterogeneity in cost-effectiveness. Regression analysis showed that gene therapies were associated with higher ΔQALYs than other interventions. PM interventions for neoplasms brought higher ΔNMB than PM interventions for other conditions. Nonetheless, average ΔNMB in the ‘neoplasm' group was found to be negative.ConclusionsPM brings improvements in health but often at a high cost, resulting in 0 to negative ΔNMB on average. Pricing policies may be needed to reduce the costs of interventions with negative ΔNMB.     

Cost-effectiveness of routine annual influenza vaccination by age and risk status

BackgroundThe epidemiology of circulating seasonal influenza strains changed following the 2009 pandemic influenza A(H1N1). A universal influenza vaccination recommendation has been implemented and new vaccine types have become available post-2009. The objective of this study was to evaluate the cost-effectiveness of routine annual influenza vaccination in the context of this new evidence.MethodsA state transition simulation model was constructed to estimate the health and economic outcomes of influenza vaccination compared to no vaccination for hypothetical US cohorts stratified by age and risk status. Model input parameters were derived from multiple sources, including post-2009 vaccine effectiveness data from the US Flu Vaccine Effectiveness Network. The analysis used societal and healthcare sector perspectives and a one-year time horizon, except permanent outcomes were also included. The primary outcome was the incremental cost-effectiveness ratio (ICER) in dollars per quality-adjusted life years (QALYs) gained.ResultsCompared to no vaccination, vaccination yielded ICERs lower than $95,000/QALY for all age and risk groups, except for non-high-risk adults 18–49 years ($194,000/QALY). Vaccination was cost-saving for adults ≥50 years at higher risk for influenza-related complications. Results were most sensitive to changes in the probability of influenza illness. Performing the analysis from the healthcare sector perspective, excluding vaccination time costs, delivering vaccinations in lower-cost settings, and including productivity losses improved the cost-effectiveness of vaccination. Sensitivity analysis revealed that vaccination remains below $100,000/QALY for older persons ≥65 years at vaccine effectiveness estimates as low as 4 %.ConclusionsCost-effectiveness of influenza vaccination varied by age and risk status and was less than $95,000/QALY for all subgroups, except for non-high-risk working-age adults. Results were sensitive to the probability of influenza illness and vaccination was more favorable under certain scenarios. Vaccination for higher risk subgroups resulted in ICERs below $100,000/QALY even at low levels of vaccine effectiveness or circulating virus.     

Potential cost-effectiveness of adjuvanted herpes zoster subunit vaccine for older adults in Hong Kong

BackgroundAdjuvanted herpes zoster (HZ) subunit vaccine is recommended for adults aged ≥50 years. This study aimed to investigate cost-effectiveness of HZ subunit vaccine for older adults at different age in Hong Kong.MethodsA life-long Markov model was designed to simulate outcomes of four alternatives: Vaccination at model entry (age 50 years); deferring vaccination to 60 years; deferring vaccination to 70 years; and no vaccination. Outcome measures included direct cost, indirect cost, HZ and post-herpetic neuralgia incidences, quality-adjusted life years (QALYs) loss, and incremental cost per QALY saved (ICER). Model clinical inputs were derived from literature. HZ treatment costs were collected from a cohort of HZ patients (n = 218). One-way and probabilistic sensitivity analyses were performed.ResultsIn base-case analysis, vaccination at 50 years showed highest QALYs saved and increment cost (0.00258; USD166), followed by deferring to 60 years (0.00215 QALYs saved; USD102) and deferring to 70 years (0.00134 QALYs; USD62) when comparing to no vaccination. ICERs of vaccination arms versus no vaccine (46,267–64,341 USD/QALY) were between 1–3 × gross domestic product (GPD) per capita in Hong Kong (USD43,530–USD130,590). One-way sensitivity analyses found vaccine cost to be the common and most influential parameter for ICER of each vaccination strategy to become <1 × GDP per capita. In probabilistic sensitivity analysis, vaccination at 50 years, deferring to 60 years and 70 years were accepted as cost-effective in 90% of time at willingness-to-pay (WTP) of 78,400 USD/QALY, 57,680 USD/QALY and 53,760 USD/QALY, respectively.ConclusionsCost-effectiveness of each strategy is highly subject to the vaccine cost and WTP threshold per QALY saved.