Economic evaluation of universal newborn hepatitis B vaccination in China

Objective

To estimate the long-term cost-effectiveness of universal newborn hepatitis B vaccination in China, an area of high endemicity.

Method

A decision tree was used to describe perinatal hepatitis B virus (HBV) transmission, early infection and impact of vaccination. A Markov model based on 1-year cycles was used to simulate these impacts for the lifetime of a cohort of 10,000,000 infants born in 2002 in China. We compared both cost and health outcomes for two strategies: universal newborn vaccination comprising a timely birth dose (HepB1) with a three-dose vaccination (HepB3) compared with no vaccination. Univariate and probabilistic sensitivity analyses using Monte Carlo simulations were performed to test parameter uncertainty.

Results

Over the cohort's lifetime, 79,966 chronic infections, 37,553 cases of hepatocellular carcinoma (HCC) and 130,796 HBV related deaths would be prevented by universal infant vaccination. The prevalence of HBV infection is reduced by 76%. Over 743,000 life-years and 620,000 quality adjusted life years (QALYs) would be gained and there would be monetary benefits of more than 1 billion US dollars in medical care costs and lost productivity avoided.

Conclusion

The newborn vaccination programme for Hepatitis B in China both gains QALYs and saves medical care costs. It is important to ensure that timely and comprehensive vaccination programmes continue.     

Cost-effectiveness of universal pneumococcal vaccination for infants in Italy

This study aimed at estimating the health and economic outcomes of universal infant vaccination with seven-valent pneumococcal conjugate vaccine (PCV-7) in Italy. A Markov model simulated lifetime evolution of a birth cohort (538,138 children): universal vaccination would avert 769 invasive infections, 18 deaths and 1323 life years. At base-case analysis, universal three-dose vaccination would cost euro 26,449 (95% CI: 1975-62,075) and euro 38,286 (95% CI: 22,164-70,801) per life year-saved in the societal and the NHS perspective, respectively. In the hypothesis of a 5-year long protection period, vaccination would cost euro 32,694 and euro 43,115 per life-year saved. Considering yearly incidence of invasive pneumococcal disease reported for Veneto and Sardinia regions, PCV-7 vaccination would result highly cost-effective determining a cost of euro 10,479 and euro 16,890 per life year-save in the NHS and the societal perspective, respectively.     

Complex cytokine profiles induced by BCG vaccination in UK infants

IFNγ plays an important part in immunity to tuberculosis (TB), but although it is necessary, it is not on its own sufficient for protection against TB. To identify other cytokines that play a role in the protection against TB induced by BCG vaccination, immune responses were compared between vaccinated and unvaccinated infants from the UK where BCG is known to provide protection. Twenty-one cytokines and chemokines were tested in supernatants from diluted whole blood cultures that had been stimulated for 6 days with Mycobacterium tuberculosis PPD. For 15 out of 21 of the cytokines tested responses were much higher in BCG vaccinated infants than in unvaccinated infants. These included: pro-inflammatory cytokines; IFNγ (median 1705 pg/ml vs. 1.6 pg/ml in vaccinated and unvaccinated infants, respectively), TNFα (median 226 pg/ml vs. 18 pg/ml), as well as IL-2, IL-1α and IL-6; TH2 cytokines: IL-4, IL-5 and IL-13 (median 104 pg/ml vs. 1.6 pg/ml); the regulatory cytokine IL-10 (median response 96 pg/ml vs. 8 pg/ml); the TH17 cytokine IL-17, chemokines (IP-10, MIP-1α and IL-8) and growth factors (GM-CSF and G-CSF). The greatest increase in cytokine production in BCG vaccinees compared to unvaccinated infants was seen with IFNγ. While responses for many cytokines were correlated with the IFNγ response, others including IL-17 and IL-10 were not. The pattern of cytokine induction following BCG vaccination is complex and measurement of one of two cytokines does not reveal the whole picture of vaccine-induced protection.     

新生儿卡介苗接种质量监测与效果评价

目的 了解沈阳市沈河区新生儿卡介苗接种质量、卡痕大小与结核菌素纯蛋白衍化物(PPD)阳转的关系及接种不良反应的发生情况.方法 对2009-2011年在该区产院出生接种过卡介苗的1 711名新生儿采用PPD检测,测定阳转率;测定卡痕大小及所有新生儿卡介苗接种不良反应进行监测.结果 PPD阳转率达到99.36％,其中强阳性率占15.60％;卡痕的阳性(＞4 mm)有936例与PPD试验阳性结果的配对x2检验,分析看差异有统计学意义(x2=758.05,P＜0.01).发生2例卡介苗接种不良反应.结论 该地区新生儿卡介苗接种成功率达到了90％的标准;对强阳性的儿童建议追踪观察;不能用卡痕大小代替PPD试验判断卡介苗接种成功与否;提高接种人员接种技术和加强健康教育宣传,减少卡介苗接种不良反应.     

宣城市500名婴儿卡介苗接种效果评价

目的评价分析宣城市卡介苗接种效果,探讨提高卡介苗接种工作质量的相关方法。方法 2007～2009年、2011年期间随机抽取宣城市10个接种点的500名1岁以内健康婴儿,在接种卡介苗12w后,测量卡痕径值及进行BCG-PPD阳转试验。结果 500名婴儿的卡痕率为97.40%,结核菌素试验阳转率87.80%;不同性别、城乡接种点的婴儿结核菌素试验阳性率差异无统计学意义(P值均小于0.05);不同接种月龄婴儿间结核菌素试验阳性率无统计学差异(χ2=0.55,P=0.76)。卡痕径值≥4mm的婴儿结核菌素试验阳性率高于卡痕径值4mm的婴儿。结论宣城市卡介苗接种卡痕率、阳转率达到国家免疫规划要求,接种质量比较稳定。新生儿出生1个月后、3个月内接种卡介苗,对接种质量无明显影响。卡痕径值大小,对评价接种质量具有一定参考意义。     

An economic evaluation of universal pertussis vaccination in Italy.

An economic evaluation was performed of universal acellular pertussis vaccination in Italy, where until recently the overall coverage of pertussis vaccination was estimated at 50%. Over the last two years coverage seems to have increased rapidly. By means of a mathematical simulation model, the consequences of pertussis vaccination in terms of both health effects and economic costs were calculated for a single birth cohort followed for 6 years. Incremental analyses were performed for each additional 10% increase in coverage from 50-90%. The results indicate that a 50% coverage rate of pertussis vaccination in Italy was not optimal on the basis of cost-effectiveness and cost-benefit considerations. Additional increases in coverage were found to yield extra health gains at modest net costs or even potential net savings to the health care sector. For example, an increase in coverage to 90% would yield direct net savings of US$42 per extra vaccinee in comparison to a situation of 50% coverage. The total net savings for this strategy would be well over US$100 per additional vaccinee. In the sensitivity analysis, the positive relationship between incremental coverage and incremental efficiency remained unchanged.     

Case-control evaluation of a school-age BCG vaccination programme in subtropical Australia

In 1956 a programme was initiated to vaccinate all children aged 12-14 years who were attending schools in Queensland, Australia. In view of the declining incidence of tuberculosis in Australia as a whole, there was a need to evaluate the effectiveness of the programme and its procedures. We therefore carried out a case-control study of Queensland's population, excluding certain known high-risk groups. Cases were Queensland residents with notified tuberculosis and of the appropriate age; two controls per case were chosen from the electoral roll. Information on vaccination status was obtained mainly from questionnaires and school records, where available. The results show that at best BCG vaccination had a modest protective effect, approximately 30% when the patients were diagnosed, which was on average 15 years after they had been vaccinated in the school programme. In the north the climate of Queensland is tropical, while in the more heavily populated south it is subtropical. A substantial proportion of the school records reported weak positive reactions to preliminary tuberculin testing, believed to be due largely to atypical mycobacteria. A similar phenomenon has been observed in other tropical regions, and may help to explain the apparent absence of a strongly protective effect for BCG vaccination.