使用乙脑减毒活疫苗成本——效益分析

目的:了解乙脑疫苗接种在防控乙脑工作中产生的社会效益和经济效益,合理分配和有效利用免疫经费资源,为制定卫生决策提供重要依据.方法:采用成本-效益分析模型,通过抽样调查乙脑病例住院和非住院治疗费用、陪护费用、康复费用、丧葬费用、家庭和社会补贴生活费及残疾人应创造的经济价值和社会效益,控制乙脑工作中需投入的经费,用目前国际通用的伤残调整寿命年指标(DALY),定量的计算因乙脑发病造成的死亡和伤残损失.计算成本效益比值和产生的净效益.结果:海南省自使用乙脑减毒活疫苗后,年均发病率较使用前下降了96.04%;因使用乙脑减毒活疫苗而减少发病、伤残和死亡损失合.成本效益比值为1:56.19.结论:使用乙脑减毒活疫苗预防乙脑的措施,可产生巨大的社会效益和经济效益.     

贵州省使用脑膜炎球菌多糖疫苗的成本效益分析

目的探讨贵州省脑膜炎球菌多糖疫苗(Meningococcal polysaccharide vaccine,MPV)推广使用和纳入免疫规划后的成本效益。方法抽样调查流行性脑脊髓膜炎(流脑)病例住院、非住院治疗费用、陪护费用以及MPV接种投入经费,计算流脑患病的直接和间接费用、流脑患病造成死亡和伤残的经济损失,以及接种MPV的成本效益比值和产生的净效益。结果贵州省MPV推广使用和纳入免疫规划后,1990-2015年全省预计减少流脑发病94 069例,减少致残13 170例,减少死亡10 710例。每例流脑病例患病后减少社会产值88.65万元。适龄儿童因接种MPV而产生的净效益为102.86亿元,成本效益比值为1∶13.54。结论接种MPV对降低贵州省流脑发病水平效果显著,可产生较好的经济效益。     

周宁县实施计划免疫控制麻疹的成本-效益分析

[目的]科学评价周宁县实施计划免疫控制麻疹的效果。[方法]应用成本一效益分析方法探讨周宁县实施计划免疫控制麻疹的效益。[结果]实施麻疹疫苗计划免疫后，年均减少麻疹1398例，减少死亡12．95例；每年因减少发病、死亡，避免医疗费、陪护误工损失费、死亡养育费等直接经济损失273500元．减少陪护误工、病例死亡避免间接经济损失316900元，总效益达590400元。麻疹疫苗计划免疫年均成本投入30400元，年均获直接净效益、间接净效益、总净效益分别为243100元、286500元、560000元；成本与直接效益、间接效益、总效益的比值分别为1：9．00、1：10．42、1：19．42。[结论]麻疹疫苗计划免疫每投入1元成本可获得9．00元效益，并为国家创造10．42元的财富。     

三明市实施计划免疫20年成本-效益研究

[目的 ]科学地评价三明市计划免疫成果。 [方法 ]应用成本—效益分析方法研究三明市实施计划免疫的成本效益。 [结果 ]实施计划免疫后 ,年均减少脊髓灰质炎、麻疹、白喉、百日咳、乙脑和流脑等 6种传染病共 2 42 70例 ,减少死亡 36 5例 ,减少残疾 70例。每年因减少发病、死亡 ,避免医疗费、死亡养育费、陪护误工损失费等直接经济损失5 94.87万元 ;减少陪护误工、病例死亡和残疾 ,避免间接经济损失 2 5 83.5 9万元 ,总效益达 3 178.46万元。计划免疫年均成本投入 15 6 .2 1万元 ,年均获得直接净效益 438.6 6万元 ,成本与直接效益比值 1∶ 3.8;年均获间接净效益 2 42 7.4万元 ,成本与间接效益比值 1∶ 16 .5 ;总净效益为 30 2 2 .2 5万元 ,成本与总效益比值 1∶ 2 0 .4。 [结论 ]计划免疫每投入1元成本可获得 3.8元的效益 ,并为国家创造 16 .5元的财富。     

周宁县实施计划免疫控制麻疹的成本-效益分析

[目的 ]科学评价周宁县实施计划免疫控制麻疹的效果。 [方法 ]应用成本 效益分析方法探讨周宁县实施计划免疫控制麻疹的效益。 [结果 ]实施麻疹疫苗计划免疫后 ,年均减少麻疹 13 98例 ,减少死亡 12 95例 ;每年因减少发病、死亡 ,避免医疗费、陪护误工损失费、死亡养育费等直接经济损失 2 73 5 0 0元 ,减少陪护误工、病例死亡避免间接经济损失 3 1690 0元 ,总效益达 5 90 40 0元。麻疹疫苗计划免疫年均成本投入 3 0 40 0元 ,年均获直接净效益、间接净效益、总净效益分别为 2 43 10 0元、2 865 0 0元、5 60 0 0 0元 ;成本与直接效益、间接效益、总效益的比值分别为 1∶9 0 0、1∶10 42、1∶19 42。 [结论 ]麻疹疫苗计划免疫每投入 1元成本可获得 9 0 0元效益 ,并为国家创造 10 42元的财富。     

贵州省流行性乙型脑炎发病时间的圆形分布分析

目的 探讨贵州省乙脑疫苗纳入免疫规划对流行性乙型脑炎(乙脑)发病时间的影响,为乙脑防制提供理论依据.方法 运用圆形分布分析1971～2008年贵州省乙脑的发病时间,用Watson-Willianms检验比较乙脑疫苗强化免疫和纳入常规免疫前后的发病时间.结果 1971～2008年贵州省乙脑发病具有明显的季节性(Z=45 ...     

流行性乙型脑炎减毒活疫苗一针次强化免疫较长期效果评价

目的 探讨一针次流行性乙型脑炎(乙脑)减毒活疫苗强化免疫措施在乙脑自然疫源地环境1～3年较长期防控效果,为制定下一步防控措施提供依据.方法 以贵州省2004-2006年仅经历过一次乙脑减毒活疫苗强化免疫活动且自然暴露时间相同的儿童作为观察对象,动态分析其强化免疫后1～3年发病专率变化,对该人群所有乙脑确诊病例开展免疫史回顾性调查.结果 强化免疫县当年乙脑发病率较前一年均大幅度下降,下降幅度平均为62.36%.但个别县强化免疫1～2年后疫情出现反弹,病例中强化免疫目标儿童占73.28%,随机调查27例,均未接种过乙脑疫苗.免疫后1～3年观察对象发病专率分别为6.25/10万、5.77/10万、4.54/10万,差异无统计学意义(X2=0.73,P＞0.05).调查观察对象中所有实验室诊断病例52例,乙脑疫苗接种率为1.92%,低于对照组(29.41%),二者差异有统计学意义(X2=52.74,P＜0.01).结论 在贵州省乙脑自然疫源地环境中一针次乙脑减毒活疫苗强化免疫措施1～3年较长期疫情控制效果良好,提高目标儿童接种率是落实措施效果的有效手段.个别县强化免疫后1～2年疫情出现反弹与当地强化免疫活动实际接种率低有关.     

贵州省流行性乙型脑炎疫苗一针次强化免疫效果的流行病学评价

[目的]总结贵州省实施流行性乙型脑炎减毒活疫苗强化免疫的效果. [方法]对疫情信息监测管理系统的资料采用描述流行病学方法进行分析. [结果]2007年对全省8月龄～6岁2 187 181名儿童完成一针次乙脑疫苗强化免疫,报告接种率93.8%.强化免疫后乙脑发病率明显下降,发病数较2006年同期下降62.54%,死亡数下降53.66%,7岁以下儿童发病率明显降低,7～14岁儿童发病构成比相对增加;乙脑发病季节性高峰仍然存在. [结论]开展大规模的强化免疫,对降低乙脑发病水平效果显著.建议加强乙脑常规免疫的基础上,在全省范围内开展7岁以下儿童乙脑疫苗的查漏补种和7～14岁儿童的乙脑强化免疫活动,进一步降低乙脑发病率.     

贵州省1952～2007年流行性乙型脑炎流行情况分析

[目的]分析贵州省1952年以来流行性乙型脑炎(乙脑)疫情动态变化及近年流行特征,为制定下一步防控措施提供依据。[方法]分析贵州省1952年以来传染病疫情监测系统资料。[结果]20世纪70年代以来,我省乙脑疫情形势严峻。2004～2007年乙脑疫苗强化免疫县强化当年发病率即大幅度下降,2007年全省乙脑发病率降至20世纪70年代以来最低水平。发病有明显季节性,高峰在7、8月。病例高度分散,高发地区各年有所不同,高发县散在于各地区。病例以10岁以下儿童为主,6岁以下儿童发病专率最高,地区间、不同县之间高发年龄段不尽相同,2005年以来发病有逐渐大龄化趋势。病例中农村籍较多。[结论]我省乙脑疫情控制效果明显。鉴于不同地区不同年龄段人群发病情况不同,除继续加强乙脑疫苗常规免疫外,综合财力、疫苗供应量等因素,我省乙脑疫苗强化免疫可考虑针对性地分类在不同地区对不同年龄段人群开展。     

计划免疫控制效益评价中存在的问题及探讨

计划免疫的经济效益是指由于实施计划免疫减少发病、死亡、残疾而节约的病家费用和社会负担 ,分直接效益和间接效益两个方面。直接效益包括因接种减少发病、死亡、致残而节约的费用 ,家长避免因误工减少的收入 ,因减少死亡而避免消耗于平均死亡年龄以前的抚养费 ,以及因避免致残而节约的治疗费、平均致残年龄以前的养育费 ;间接效益包括因少误工所能创造的劳动价值和因减少死亡、致残 ,正常存活一生所能创造的价值[1] 。效益评价中常用两个基本指标 :一是成本效益比值 ,即获益与成本之比 ,它是指每花 1元钱所收到的经济效益 ;二是净效益 ,即…     

Cost-effectiveness of Japanese encephalitis (JE) immunization in Bali, Indonesia

Two hypothetical birth cohorts in Bali, each consisting of 100,000 newborns, one immunized with live, attenuated JE vaccine and the other un-immunized, were modeled for JE risk over 11 years. Cumulative JE incidence before JE vaccine introduction was used to represent JE risk in the unvaccinated cohort. Data on vaccine efficacy, vaccination and treatment costs were taken from published papers and surveys. The potential immunization program averted 54 cases, 5 deaths and saved 1,224 disability adjusted life years (DALYs) at a net cost of USD 700 per JE case averted and USD 31 per DALY saved and thus was highly cost-effective.     

Cost-effectiveness of routine immunization to control Japanese encephalitis in Shanghai,China

OBJECTIVE: To assess the cost-effectiveness of inactivated and live attenuated Japanese encephalitis (JE) vaccines given to infants and children in Shanghai. METHODS: A decision-analytical model was constructed in order to compare costs and outcomes for three hypothetical cohorts of 100,000 children followed from birth in 1997 to the age of 30 years who received either no JE vaccine, inactivated JE vaccine (P3), or live attenuated JE vaccine (SA 14-14-2). Cumulative incidences of JE from birth to 30 years of age in the pre-immunization era, i.e. before 1968, were used to estimate expected rates of JE in the absence of vaccination. The economic consequences were measured as cost per case, per death, and per disability-adjusted life year (DALY) averted for the two JE immunization programmes. FINDINGS: In comparison with no JE immunization, a programme using the P3 vaccine would prevent 420 JE cases and 105 JE deaths and would save 6456 DALYs per 100,000 persons; the use of the SA 14-14-2 vaccine would prevent 427 cases and 107 deaths and would save 6556 DALYs per 100,000 persons. Both kinds of immunization were cost saving but the SA 14-14-2 vaccine strategy resulted in a saving that was 47% greater (512,456 US dollars) than that obtained with the P3 vaccine strategy (348,246 US dollars). CONCLUSION: Both JE immunization strategies resulted in cost savings in comparison with no JE immunization. This provides a strong economic rationale for vaccinating against JE in Shanghai and suggests that vaccination against JE might be economically justifiable in other parts of China and in certain other developing countries of Asia where the disease is endemic.     

Japanese encephalitis vaccination in the Philippines: A cost-effectiveness analysis comparing alternative delivery strategies

IntroductionJapanese encephalitis (JE) is a mosquito-borne viral infection of the brain that can cause permanent brain damage and death. In the Philippines, efforts are underway to deliver a live attenuated JE vaccine (CD-JEV) to children under five years of age (YOA), who are disproportionately infected. Multiple vaccination strategies are being considered.MethodsWe conducted a cost-effectiveness analysis comparing three vaccination strategies to the current state of no vaccination from the societal and government perspectives: (1) national routine vaccination only, (2) sub-national campaign followed by national routine, and (3) national campaign followed by national routine. We developed a Markov model to estimate impact of vaccination or no vaccination over the child’s lifetime horizon, assuming an annual incidence of 10.6 cases per 100,000.Costs of illness ($859/case), vaccine ($0.50/dose), routine vaccination ($0.95/dose), and campaign vaccination ($0.98/dose) were based on hospital financial records, expert opinion and literature. The societal perspective included transportation and opportunity costs of caregiver time, in addition to costs incurred by the health system.ResultsJE vaccination via national campaign followed by national routine delivery was the most cost-effective strategy modeled with a cost per disability adjusted life year (DALY) averted of $233 and $29 from the government and societal perspectives, respectively. Results were similar for other delivery strategies with cost/DALY ranging from $233 to $265 from the government perspective and $29–$57 from the societal perspective. JE vaccination was projected to prevent 27,856–37,277 cases, 5571–7455 deaths, and 173,233–230,704 DALYs among children under five over 20 consecutive birth cohorts. Total incremental costs of vaccination versus no vaccination over 20 birth cohorts were $6.6–$9.8 million from the societal perspective ($230 K–$440 K annually) and $45.9–$53.9 million ($2.2 M–$2.7 M annually) from the governmental perspective.ConclusionVaccination with CD-JEV in the Philippines is projected to be cost-effective, reducing long-term costs associated with JE illness and improving health outcomes compared to no vaccination.     

A cost–effectiveness analysis of Japanese encephalitis vaccine in Cambodia

This study aimed to evaluate the cost and effectiveness of introducing a live, attenuated vaccine (SA 14-14-2) against Japanese encephalitis (JE) into the immunization program. The study demonstrated that SA 14-14-2 immunization is cost–effective in controlling JE in Cambodia compared to no vaccination. Averting one disability-adjusted life year, from a societal perspective, through the introduction of SA 14-14-2 through routine immunization, or a combination of routine immunization plus a campaign targeting children 1–5 or 1–10 years of age, costs US$22, US$34 and US$53, respectively. Sensitivity analyses confirmed that there was a high probability of SA 14-14-2 immunization being cost–effective under conditions of uncertainty.     

贵州省脑膜炎球菌多糖疫苗不同免疫策略的成本-效果比较分析

目的 比较分析贵州省脑膜炎球菌多糖疫苗（meningococcal polysaccharide vaccine，MPV）推广使用和纳入免疫规划策略的成本-效果。方法 根据贵州省MPV接种、流脑发病情况，采用成本-效果分析法，计算贵州省不同阶段推广使用MPV和将MPV纳入免疫规划策略的成本-效果比值（cost-effectiveness ratio，CER）。结果 1999—2015年，贵州省共接种6 285.73万剂次MPV，共减少流脑发病94 069例，减少致残13 170例，减少死亡10 710例；推广使用MPV、将MPV纳入免疫规划免疫策略总投入成本8.20亿元，26年间，接种MPV每减少1例流脑病例投入的成本为6 952元，其中，1990—2005年推广使用MPV 、2006—2015年纳入免疫规划策略每减少1例流脑病例投入的成本分别为4 915.64、614.59元。结论 接种MPV对降低贵州省流脑发病水平具有良好的成本-效果，2006—2015年将MPV纳入免疫规划策略的成本-效果明显优于1990—2005年推广使用MPV策略。     

Economic analysis of the 1992-1993 mass immunization campaign against serogroup C meningococcal disease in Quebec

The objective of the study was to evaluate the cost-effectiveness and utility of the mass immunization campaign performed in the province of Quebec in 1992-1993, following an outbreak of serogroup C meningococcal disease (CMD). Effectiveness data were extracted from a population-based cohort study, and cost estimates were obtained from surveys. Costs of the campaign to the health system were $ 26 million (1993 Canadian dollars). Between 48 and 74 CMD cases, and between 7 and 11 deaths were prevented in the following 5 years. Net societal costs were between $ 18 and 21 million (using a 3% discount rate), net costs per death averted were between $ 1.7 and 3.0 million, between $ 58,000 and 105,000 per life-year gained, and between $ 49,000 and 87,000 per quality-adjusted life-year gained. These economic indices are less favorable than those for current routine immunization programs in Canada, but within the range of those for other common health interventions.     

贵州省2004～2008年流行性乙型脑炎流行特征分析

[目的]分析贵州省流行性乙型脑炎的流行特征,探讨防制策略。[方法]对《疾病监测信息报告管理系统》贵州省乙脑疫情资料进行描述流行病学分析,数据采用SPSS11.5软件进行统计分析。[结果]2004～2008年贵州省共报告4676例乙脑病例,死亡234例。2007、2008年乙脑发病率和死亡率明显下降。乙脑在贵州省高度散在发病。发病时间以7、8月为高峰。0～14岁占发病总数的94.56%～97.78%,2004～2006年与2007~2008年0~14岁(或≥15岁)发病构成差异有统计学意义(χ2=10.293,P=0.001)。散居儿童和学生占发病总数的89.07%～94.47%。[结论]贵州省乙脑发病率高,病例呈高度散在分布,发病有明显的季节性和周期性,0～14岁儿童是易感人群。乙脑疫苗强化免疫有效地降低贵州省乙脑发病率和死亡率。     

2008年贵州省流行性乙型脑炎减毒活疫苗强化免疫效果评价

目的 分析贵州省2008年流行性乙型脑炎(乙脑)减毒活疫苗强化免疫活动疫情防控效果,为制定下一步防控措施提供依据.方法 综合分析强化免疫活动接种成果、调杏数据和活动前后的疫情资料.结果 贵州省报告实际接种1 503 052人,撤告接种率96.72%,用人口资料估箅伞省接种率91.82%.2008年全省乙脑发病率0.85/10万,较2007年下降44.08%,各地区、各类县强化免疫目标人群发病率均大幅度下降,下降幅度高于非目标人群.2008年全省各年龄组发病率均较2007年有所下降,仍以8月龄至6岁组发病率最高.安顺市、黔西南州、铜仁地区、毕节地区该组人群发病牢高于全省平均水平,且安顺市的发病率较2007年上升111.59%;安顺市、黔西南州7～10岁组发病率高于全省平均水平,且较2007年分别上升117.83%和66.32%.结论 此次乙脑疫苗强化免疫效果显著,达到了预期目标.低龄儿童尤其是8月龄至6岁学龄前儿童仍是贵州省乙脑防控工作的重点,应加强安顺市、黔西南州等重点地区的乙脑防控工作.     

Comparison of the immunogenicity and safety of measles vaccine administered alone or with live, attenuated Japanese encephalitis SA 14-14-2 vaccine in Philippine infants

Japanese encephalitis (JE) virus is a major cause of disease, disability, and death in Asia. An effective, live, attenuated JE vaccine (LJEV) is available; however, its use in routine immunization schedules is hampered by lack of data on concomitant administration with measles vaccine (MV). This study evaluated the immunogenicity and reactogenicity of LJEV and MV when administered at the same or separate study visits in infants younger than 1 year of age. Three groups of healthy infants were randomized to receive LJEV at age of 8 months and MV at 9 months (Group 1; n=100); MV and LJEV together at 9 months (Group 2; n=236); or MV and LJEV at 9 and 10 months, respectively (Group 3; n=235). Blood was obtained 4 weeks after each vaccine administration to determine antibody levels for measles and JE. Reactogenicity was assessed by parental diaries and clinic visits. Four weeks after immunization, measles seroprotection rates (defined as > or =340 mIU/ml) were high and comparable in all three groups and specifically, rates in the combined MV-LJEV (Group 2) were not statistically inferior to those in Group 3 receiving MV separately (96% versus 100%, respectively). Likewise, the LJEV seroprotection rates were high and similar between the three groups. The reactogenicity profiles of the three vaccine schedules were also analogous. LJEV and MV administered together are well tolerated and immunogenic in infants younger than 1 year. These results should facilitate incorporation of LJEV into routine immunization schedules with MV.     

Economic evaluation of delivering Haemophilus influenzae type b vaccine in routine immunization services in Kenya

OBJECTIVE: Haemophilus influenzae type b (Hib) vaccine was introduced into routine immunization services in Kenya in 2001. We aimed to estimate the cost-effectiveness of Hib vaccine delivery. METHODS: A model was developed to follow the Kenyan 2004 birth cohort until death, with and without Hib vaccine. Incidence of invasive Hib disease was estimated at Kilifi District Hospital and in the surrounding demographic surveillance system in coastal Kenya. National Hib disease incidence was estimated by adjusting incidence observed by passive hospital surveillance using assumptions about access to care. Case fatality rates were also assumed dependent on access to care. A price of US$ 3.65 per dose of pentavalent diphtheria-tetanus-pertussis-hep B-Hib vaccine was used. Multivariate Monte Carlo simulations were performed in order to assess the impact on the cost-effectiveness ratios of uncertainty in parameter values. FINDINGS: The introduction of Hib vaccine reduced the estimated incidence of Hib meningitis per 100,000 children aged < 5 years from 71 to 8; of Hib non-meningitic invasive disease from 61 to 7; and of non-bacteraemic Hib pneumonia from 296 to 34. The costs per discounted disability adjusted life year (DALY) and per discounted death averted were US$ 38 (95% confidence interval, CI: 26-63) and US$ 1197 (95% CI: 814-2021) respectively. Most of the uncertainty in the results was due to uncertain access to care parameters. The break-even pentavalent vaccine price--where incremental Hib vaccination costs equal treatment costs averted from Hib disease--was US$ 1.82 per dose. CONCLUSION: Hib vaccine is a highly cost-effective intervention in Kenya. It would be cost-saving if the vaccine price was below half of its present level.