中国婴幼儿普遍接种轮状病毒疫苗的成本效果分析

目的 对中国现阶段是否应将婴幼儿接种轮状病毒疫苗纳入免疫规划进行经济学评价,并探讨其成本效果。方法 通过构建决策树Markov模型,模拟2012年中国出生的新生儿分别在不接种轮状病毒疫苗及接种Rotarix疫苗或Rotateq疫苗3种方案下的成本和健康结局,基于各方案间的增量成本效果比(ICER)与中国2012年人均国内生产总值(GDP)的比较确定最优方案。结果 与不接种方案相比,Rotarix疫苗和Rotateq疫苗接种方案可分别减少发生238万和253万例轮状病毒腹泻,避免12.6万和13.3万个伤残调整寿命年的损失,ICER分别为3 760元和7 578元,均小于我国2012年人均GDP(38 420元);Rotateq疫苗相对于Rotarix疫苗,ICER为81 068元,介于1与3倍人均GDP之间。结论 在中国婴幼儿中开展轮状病毒疫苗普遍接种具有高的成本效果,应考虑将其纳入计划免疫;考虑到疫苗免疫费用、大规模组织实施的难度等因素,在现阶段更适宜推广接种Rotarix疫苗。     

Markov决策树模型在优化15~49岁女性戊型肝炎免疫接种策略中的应用

目的 比较15~49岁女性人群戊型肝炎（戊肝）疫苗不同免疫接种策略的成本和效用，从而为戊肝免疫接种策略的制定和优化提供科学依据。方法 应用Markov决策树模型，评价15~49岁女性人群戊肝疫苗接种策略：100%接种策略、筛查后易感人群接种策略和不接种策略，评价指标为增量成本效用比，并进行敏感性和阈值分析。结果 从社会角度看，同不接种策略相比，筛查后接种策略和100%接种策略，人均分别增加0.10个健康生命年，增量成本效用比为5 651.89元/质量调整生命年和6 385.33元/质量调整生命年。敏感性分析和阈值分析显示，当疫苗价格均<191.56元时，100%接种策略优于筛查后接种策略；当疫苗价格均>191.56元时，筛查后接种策略优于100%接种策略。接种依从率均<23%时，100%接种策略优于筛查后接种策略；依从率均>23%时，筛查后接种策略优于100%接种策略。随着易感者年感染率的增加，筛查后接种策略和100%接种策略的增量成本效用比下降，但是筛查后接种策略依然优于100%接种策略。结论 15~49岁女性人群筛查后接种戊肝疫苗是最优免疫策略，但会受到价格和接种依从性的影响。     

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。     

24中国不同抗-HAV流行区儿童接种甲型肝炎疫苗的成本效用分析

目的 探讨中国不同抗-HAV流行区儿童普遍接种（普种）甲型肝炎（甲肝）疫苗的成本效用。方法 模拟一个100万人的队列、“12+18”个月两针免疫程序,采用决策分析方法,建立马尔科夫决策树模型,以费用为投入指标,显性感染人数、住院人数、损失质量调整寿命年（QALY）、甲肝死亡人数为产出指标,结合增量费用效用分析,基于中国不同抗-HAV流行区的情况,预期未来73年的产出,并与不接种方案比较,选定最佳方案。采用灵敏性分析评估结果的稳定性。结果 在抗-HAV低、中低及中度流行区普种甲肝疫苗,其投入和各项产出指标均小于不接种,增量费用效用比（ICUR）均＜0,即接种方案在增加QALY的同时节省费用。在中高度流行区,普种甲肝疫苗的投入小于不接种,显性感染人数、住院人数、损失QALY也小于不接种疫苗,ICUR＜0,但普种后甲肝死亡人数比不接种增加20例。在高度流行区,普种的卫生服务总费用和社会总费用分别比不接种多4560814元和5840430元,但显性感染人数、住院人数、损失QALY也小于不接种,甲肝死亡人数比不接种增加51例,每增加一个QALY的卫生服务费用和社会费用分别为1507元和1929元。灵敏性分析认为结果稳定,疫苗保护年消失率和易感者年感染率是影响决策的灵敏参数。结论 中国甲肝不同流行区应根据疫苗保护期限,以抗-HAV阳性率决定是否普种疫苗。     

中国1992-2019年乙型肝炎疫苗免疫及母婴阻断策略的成本效益分析

目的 对我国1992-2019年来实施的乙型肝炎（乙肝）疫苗（HepB）免疫及母婴阻断策略进行卫生经济学评价,为我国乙肝防控策略提供参考。方法 构建决策分析马尔科夫模型,对1992-2019年中国出生的新生儿队列进行分析。模型参数主要来自于文献、年鉴、中国CDC。采用单因素敏感性分析验证模型结果的稳定性。结果 1992-2019年国家共投入直接成本和社会成本分别约374.30亿元和476.10亿元;有效保护了约5 000万人免于成为慢性HBV感染者,减少了1 250万人因HBV感染相关疾病而发生的早死;节约乙肝相关疾病治疗的直接医疗负担和社会医疗负担分别约2.89万亿元和6.92万亿元,实现直接净效益2.85万亿元和社会净效益6.87万亿元。1992-2019年我国实施HepB免疫及母婴阻断策略的直接效益成本比为77.21,社会效益成本比为145.29。结论 1992-2019年我国实施的HepB免疫及母婴阻断策略具有成本-效益收益。     

HIV疫苗接种策略经济学评价的综合分析

目的 概述全球HIV疫苗接种策略相关的经济学评价研究，为HIV疫苗接种有关决策和研究提供参考。方法 中文以“艾滋病或获得性免疫缺陷综合征”和“疫苗”和“经济学评价或成本效果分析或成本效用分析或成本效益分析”，英文以“Human immunodeficiency virus（HIV） or Acquired immunodeficiency syndrome（AIDS）”和“vaccine or vaccination”和“economic evaluation or cost-effectiveness analysis or cost-utility analysis or cost-benefit analysis or Health technology assessment（HTA）”3组检索词分别组合，在万方数据知识服务平台（万方）、中国医院知识仓库（CHKD）和PubMed数据库，检索截至2022年7月31日的HIV疫苗接种策略经济学评价相关文献，并对文献进行质量评估和综合分析。结果 共纳入17篇质量评估良好的文献，综合分析结果提示，无论是艾滋病重点人群或全人群，接种HIV疫苗是节省成本或具有成本效果的策略，可有效减少新发感染并提高人群生命质量。疫苗的有效率、覆盖率、价格和接种后风险性行为的变化等因素影响不同目标人群的接种效果。结论 目前HIV疫苗接种策略经济学评价的高质量研究数据较少，研究者可基于真实世界证据开展深入研究。     

全球肺癌筛查卫生经济学研究的系统评价

目的 了解全球肺癌筛查的卫生经济学评价研究进展,为我国相关研究和筛查工作开展提供参考。方法 系统检索PubMed、EMbase、The Cochrane Library、中国知网及万方数据知识服务平台自建库至2018年6月30日间肺癌筛查卫生经济学研究相关文献,摘录其经济学评价方法及结果等信息,并进行质量评价。成本统一货币单位后计算增量成本效果比（ICER）后计算与当年当地人均GDP比值。结果 共纳入23项研究（1项基于人群随机对照试验,20项完全基于模型评价）,整体质量较好;22项来自发达国家,11项筛查起始年龄为55岁,18项目标人群考虑了吸烟史;评价的筛查技术全部涉及低剂量螺旋CT（LDCT）,筛查频率以每年1次（17项）和终生1次（7项）居多。22项研究可获得与未筛查相比的ICER,其中17项研究报道的ICER低于3倍当年当地人均GDP。各有15项和7项研究可获得每年1次和终生1次的ICER,其中各有12项和7项支持其经济有效,且终生1次略优于每年1次;不同筛查起始年龄和吸烟包年的经济有效性优劣差异不明显。结论 发达国家多开展基于模型LDCT肺癌筛查卫生经济学评价,并结合年龄和吸烟史进行高危人群选择,初步提示该方案经济有效;可为证据有限的欠发达地区提供参考,但实施需结合当地卫生资源现状;预算有限时低频次LDCT筛查更佳,而筛查起始年龄和吸烟史等细节确定需结合人群特征进行精准评价。     

我国乳腺癌筛查卫生经济学研究的系统评价

目的 了解我国大陆地区乳腺癌筛查的卫生经济学评价进展。方法 系统检索PubMed、中国知网、万方数据知识服务平台和维普网1995年1月至2015年12月收录文献,对纳入研究基本信息、人群项目参与率及检出率、模型研究方法学、经济学评价方法及结果等信息进行摘录和比较,采用卫生经济学评价报告规范（CHEERS）评价报告质量（总分24分）。结果 共检索356篇文献,最终纳入13篇,均发表于近4年（2012-2015年）,其中11篇基于人群、3篇基于模型研究。筛查起始年龄为18～45岁,终止年龄均≥59岁;筛查技术包括临床检查、超声和钼靶单一或联合筛查。有7篇报道了研究角度,其中为政府等服务提供方5篇,社会角度2篇;仅有5篇研究进行了成本和（或）效果贴现。11篇成本-效果分析中,有9篇提供了评价指标检出1例乳腺癌的成本,为5.0～229.3（M=14.5）万元。以质量调整生命年（QALY）或伤残调整生命年（DALY）为指标的成本-效用分析仅4篇,相应增量成本效果比（ICER）为0.3万元～27.1万元（2015年我国人均GDP为4.9万元）。13篇文献平均得分14.5（9.5～21.0）分,总分24分,其中研究角度、贴现率、ICER及不确定性等维度得分较低。结论 我国大陆地区乳腺癌筛查的经济学研究尚处于起步阶段,尤其是模型研究;各研究间方法及结果可比性一般,报告质量有待加强。应从社会角度全面核算成本后对筛查项目开展以QALY或DALY为指标的成本-效用分析。     

我国结直肠癌筛查卫生经济学证据系统更新：2009－2018

目的 系统更新中国大陆结直肠癌筛查的卫生经济学评价证据。方法 基于2015年发表的系统综述（2004-2014年），扩大检索数据库范围（PubMed、EMbase、The Cochrane Library、Web of Science、中国知网、万方数据知识服务平台、维普中文科技期刊数据库和中国生物医学文献数据库），延展时间至2018年12月，重点呈现近10年证据（2009-2018年）。系统摘录研究基本特征及主要结果。成本数据采用医疗保健类居民消费价格指数均贴现至2017年，计算增量成本效果比（ICER）与对应年份全国人均GDP的比值。结果 最终纳入12篇文献（新增8篇），其中9篇基于人群（均为横断面研究），3篇基于模型。起始年龄多为40岁（7篇），筛查频率多为终生1次（11篇）。筛查技术涉及问卷评估、免疫法粪便隐血试验和结肠镜。经济学评价指标以每检出1例结直肠癌的成本最为常见，中位数（范围，筛查方案数）为52 307元（12 967~3 769 801，n=20）；每检出1例腺瘤的成本为9 220元（1 859~40 535，n=10）。3篇文献报告了与不筛查相比，每挽救1个生命年的成本，其ICER与GDP比值为0.673（-0.013~2.459，n=11），是WHO认为的非常经济有效；不同筛查技术间及不同频率间该比值的范围重叠较大，但起始年龄50岁（0.002，-0.013~0.015，n=3）比40岁（0.781，0.321~2.459，n=8）筛查方案更经济有效。结论 人群研究提示腺瘤检出成本仅为癌症检出成本的1/6，有限的ICER证据提示在我国人群开展结直肠癌筛查经济有效；尽管最优初筛技术无法定论，但初步提示筛查起始年龄50岁优于40岁。未见随机对照试验评价等高级别证据。     

HIV自检模式在男男性行为者中的成本效果分析

目的 分析珠海市MSM中HIV自我检测（HIVST）模式和现场HIV快速检测（HIV-RDT）模式的成本效果和支付意愿,为政府合理配置卫生资源提供参考依据。方法 以卫生服务提供者的视角,收集珠海市在2019年1-9月MSM参与两种HIV检测模式的成本投入和效果产出,采用TreeAge Pro 2019软件构建10 000名MSM队列决策树模型,测算成本效果比（CER）和增量成本效果比（ICER）,以敏感性分析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 珠海市男同社会组织通过互联网+社交媒体动员参与HIVST和现场HIV-RDT的MSM人次数为2 303 vs.816,发现HIV筛查阳性者人数为33 vs.35,筛查阳性率为1.7% vs.4.3%。每筛查1例的成本为60.45元vs.240.43元,每发现1例筛查阳性的成本为4 218元vs.5 606元。决策树模型运行结果显示,每检测1例MSM的平均费用为44.67元vs.148.42元,ICER为负值。当发现1例HIV筛查阳性支付意愿低于6 528元时,HIVST更具成本效果的选择;当投入高于该阈值时,现场HIV-RDT是更具成本效果的选择。结论 珠海市现行的HIVST模式是具有经济学价值的公共卫生项目,决策者应加大社会组织扶持力度,推广HIVST在MSM中的应用。     

应用EVITA模型对甘肃省水痘疫苗接种的经济学评价

目的:对甘肃省水痘疫苗接种进行成本效益分析,为今后制定水痘防控策略提供参考依据。方法:设定三种免疫策略,即未予以免疫接种、策略Ⅰ常规免疫(1岁时接种1剂次水痘疫苗)、策略Ⅱ常规免疫+加强免疫(1岁和12岁各接种1剂次水痘疫苗)、策略Ⅲ常规免疫+强化免疫(2-15岁强化免疫1剂次及1岁接种1剂次水痘),利用EVITA模型评价成本效益,推算15年的水痘发病情况、经济负担、BCR值和NPV值。结果:未予以免疫接种:15年累计发病5 301 764例;策略Ⅰ:BCR=0.744,NPV=-0.98;策略Ⅱ:BCR=0.595,NPV=-6.19;策略Ⅲ:BCR=1.518,NPV=0.49。以策略Ⅲ的BCR值最高,BCR>1且NPV>0,说明该策略可接受,成本效益最好。结论:常规免疫+强化免疫的免疫接种策略是水痘预防控制的最佳方案。     

A retrospective nationwide register-based study to evaluate the non-specific effects of first MMR vaccination among children in Finland

BackgroundAccording to earlier studies, live vaccines like measles-mumps-rubella (MMR) vaccine could reduce also other infections than only the infections they are targeted against. This non-specific effect has been seen especially in studies in low-income countries and results from high-income countries have not been unambiguous. In 2011 Finland changed the recommended schedule for the first MMR vaccination from 18 months to 12 months of age. This change created a natural experiment for evaluating the potential non-specific effects.MethodsThis is a retrospective nationwide register-based cohort study of Finnish children born between 2008 and 2012. Children were divided into two cohorts by age at MMR vaccination: children administered early MMR vaccination (11 through 12 months of age) and late MMR vaccination (18 through 19 months of age). Morbidity was evaluated during the main follow-up period (from 13 to 17 months of age) and before any MMR vaccination (3 to 10 months) and after all were vaccinated with MMR (20 to 35 months) as control follow-up periods. We analyzed all infections and did additional analyzes for urinary tract infections (UTI) and bronchitis. Injuries were analyzed as a control outcome.ResultsEarly MMR vaccinated children (N = 79 949) had fewer infections compared to late MMR vaccinated (N = 60 965) during the main follow-up period. The incidence rate ratio (IRR) was 0.84 (95 % confidence interval (95 % CI) 0.81–0.87). However, similar differences were also observed during the control follow-up periods. MMR vaccinated children had less UTI in the main follow-up period (IRR 0.73, 0.60–0.89) but not in the control follow-up periods. When stratified by sex, the difference was observed among girls but not in boys.ConclusionNo clear evidence was found for non-specific effects in infectious diseases morbidity. However, there could be a nonspecific effect on UTI. Confirmation is needed from other studies, especially from high-income countries.     

甲型肝炎减毒活疫苗(LA-1株)在1岁幼儿0、6个月免疫程序中的效果观察

为了了解1岁幼儿0、6个月免疫程序接种甲肝减毒活疫苗的免疫效果，我们观察了95例1岁健康儿童的免疫效果。本次研究采用ELISA免疫竞争抑制法检测1岁的幼儿初免1针2个月后和按0、6个月程度免疫接种2针2个月后血清抗－HAV－IgG抗体。结果：两者抗体阳性率分别为：78．95％（75／95）和97．89％（93／95）；GMT分别为1：5．76和1：12．48。经统计学处理，阳性率和GMT两者都存在非常显著性差异。按0、6个月免疫程序接种的血清免疫效果明显优于初免1针的效果。0、6个月免疫程序接种甲肝减毒活疫苗值得大力推广。     

Travel medicine consultation: An opportunity to improve coverage for routine vaccinations

BackgroundTravelers may be responsible for the spread of vaccine-preventable diseases upon return. Travel physicians and family physicians may play a role in checking and updating vaccinations before traveling. Our aim was to evaluate the vaccine coverage for mandatory and recommended vaccination in travelers attending a travel medicine clinic (TMC).MethodsVaccine coverage was measured using the current French immunization schedule as reference for correct immunization, in travelers providing a vaccination certificate during the TMC visit (university hospital of Saint-Étienne), between August 1, 2013 and July 31, 2014.ResultsIn total, 2336 travelers came to the TMC during the study period. Among the 2019 study participants, only 1216 (60.3%) provided a vaccination certificate. Travelers who provided a vaccination certificate were significantly younger than travelers who did not (mean age: 34.8 ± 17.8 vs. 46 ± 18.4 years, P < 0.005) and were less likely to be Hajj pilgrims. Vaccine coverage against Tetanus, Diphtheria, and Poliomyelitis (Td/IPV vaccine) was 91.8%, 78.6% against Measles, Mumps, and Rubella (MMR), and 59.4% against Viral Hepatitis B (HBV). BCG vaccine coverage was 71.9%. Older travelers were less likely to be correctly vaccinated, except against HBV as vaccinated travelers were significantly older than unvaccinated travelers.ConclusionObtaining information about immunization in travelers is difficult. Coverage for routine vaccines should be improved in this population. Travel medicine consultations could be the opportunity to vaccinate against MMR, HBV, and Td/IPV.     

Safety of guidelines recommending live attenuated influenza vaccine for routine use in children and adolescents with asthma

ObjectiveEvaluate whether a guideline recommending Live Attenuated Influenza Vaccine (LAIV) for children 2 years and older with asthma increased risks for lower respiratory events (LREs), within 21 or 42 days of vaccination, as compared to standard guidelines to administer Inactivated Influenza Vaccine (IIV) in children with asthma.MethodsThis was a pre/post guideline retrospective cohort study of children ages 2–17 years with asthma and receiving one or more influenza vaccines in two large medical groups from 2007 to 2016. Both groups recommended IIV in the pre-period; in 2010, one group implemented a guideline recommending LAIV for all children, including those with asthma. Main outcomes were medically attended LREs within 21 and 42 days after influenza immunization. Analysis used a generalized estimating equation regression to estimate the ratio of rate ratios (RORs) comparing pre/post events between LAIV guideline and control group.ResultsThe cohort included 7851 influenza vaccinations in 4771 children with asthma. Among patients in the LAIV guideline group, the proportion receiving LAIV increased from 23% to 68% post-guideline implementation, versus an increase from 7 to 11% in the control group. Age and baseline asthma severity adjusted ROR showed no increase in LREs, primarily asthma exacerbations, following implementation of the LAIV guideline: overall aROR (95% Confidence Interval): 0.74 (0.43–1.29) for LRE within 21 days of vaccination, 0.77 (0.53–1.14) for LRE within 42 days of vaccination. For the subset of children ages 2–4 years aROR: 0.92 (0.34–2.53) for LRE within 21 days of vaccination and 0.94 (0.49–1.82) for LRE within 42 days of vaccination; for children 5–18 years aROR (95% CI): 0.58 (0.26–1.30) for LRE within 21 days of vaccination and 0.67 (0.37–1.23) for LRE within 42 days.ConclusionIn a large cohort of children with asthma, a guideline recommending LAIV rather than IIV did not increase LREs following vaccination.     

Program cost analysis of influenza vaccination of health care workers in Albania

BackgroundSince 2012, WHO has recommended influenza vaccination for health care workers (HCWs), which has different costs than routine infant immunization; however, few cost estimates exist from low- and middle-income countries. Albania, a middle-income country, has self-procured influenza vaccine for some HCWs since 2014, supplemented by vaccine donations since 2016 through the Partnership for Influenza Vaccine Introduction (PIVI). We conducted a cost analysis of HCW influenza vaccination in Albania to inform scale-up and sustainability decisions.MethodsWe used the WHO’s Seasonal Influenza Immunization Costing Tool (SIICT) micro-costing approach to estimate incremental costs from the government perspective of facility-based vaccination of HCWs in Albania with trivalent inactivated influenza vaccine for the 2018–19 season based on 2016–17 season data from administrative records, key informant consultations, and a convenience sample of site visits. Scenario analyses varied coverage, vaccine presentation, and vaccine prices.ResultsIn the baseline scenario, 13,377 HCWs (70% of eligible HCWs) would be vaccinated at an incremental financial cost of US$61,296 and economic cost of US$161,639. Vaccine and vaccination supplies represented the largest share of financial (89%) and economic costs (44%). Per vaccinated HCW financial cost was US$4.58 and economic cost was US$12.08 including vaccine and vaccination supplies (US$0.49 and US$6.76 respectively without vaccine and vaccination supplies). Scenarios with higher coverage, pre-filled syringes, and higher vaccine prices increased total economic and financial costs, although the economic cost per HCW vaccinated decreased with higher coverage as some costs were spread over more HCWs. Across all scenarios, economic costs were <0.07% of Albania’s estimated government health expenditure, and <5.07% of Albania’s estimated immunization program economic costs.ConclusionsCost estimates can help inform decisions about scaling up influenza vaccination for HCWs and other risk groups.     

Cost-Effectiveness Analysis of a Television Campaign to Promote Seasonal Influenza Vaccination Among the Elderly

BackgroundThe U.S. policy goals regarding influenza vaccination coverage rate among the elderly include the increase in the coverage rate and the elimination of disparities across racial/ethnic groups.ObjectiveTo examine the potential effectiveness of a television (TV) campaign to increase seasonal influenza vaccination among the elderly.MethodsWe estimated the incremental cost-effectiveness ratio (ICER, defined as incremental cost per additionally vaccinated Medicare individual) of a hypothetical nationwide TV campaign for influenza vaccination compared with no campaign. We measured the effectiveness of the nationwide TV campaign (advertised once a week at prime time for 30 seconds) during a 17-week influenza vaccination season among four racial/ethnic elderly groups (N=39 million): non-Hispanic white (W), non-Hispanic African American (AA), English-speaking Hispanic (EH), and Spanish-speaking Hispanic (SH).ResultsThe hypothetical campaign cost was $5,960,000 (in 2012 US dollars). The estimated campaign effectiveness ranged from −1.1% (the SH group) to 1.42% (the W group), leading to an increased disparity in influenza vaccination among non-Hispanic white and non-Hispanic African American (W-AA) groups (0.6 percentage points), W-EH groups (0.1 percentage points), and W-SH groups (1.5 percentage points). The estimated ICER was $23.54 (95% confidence interval $14.21–$39.37) per additionally vaccinated Medicare elderly in a probabilistic analysis. Race/ethnicity-specific ICERs were lowest among the EH group ($22.27), followed by the W group ($22.47) and the AA group ($30.55). The nationwide TV campaign was concluded to be reasonably cost-effective compared with a benchmark intervention (with ICER $44.39 per vaccinated individual) of a school-located vaccination program. Break-even analyses estimated the maximum acceptable campaign cost to be $14,870,000, which was comparable to the benchmark ICER.ConclusionsThe results could justify public expenditures on the implementation of a future nationwide TV campaign, which should include multilingual campaigns, for promoting seasonal influenza vaccination.     

Assessing the effectiveness of zoster vaccine live: A retrospective cohort study using primary care data in the United Kingdom

BackgroundHerpes zoster (shingles) is a common viral disease increasing in risk and severity with age. Post-herpetic neuralgia (PHN), a complication of shingles, causes severe pain impacting quality of life (QoL). Zoster Vaccine Live (ZVL), a licensed vaccine for the prevention of shingles in the United Kingdom (UK), is part of the national immunisation programme (NIP) for adults aged 70–79. Public Health England (PHE) reports show shingles vaccine coverage varies, but is typically 50–60% across eligible cohorts.Materials/methodsThis retrospective, matched cohort study was conducted using The Health Improvement Network (THIN) UK primary care database. Individuals aged 70–79 were classified based on their vaccination status between September 2013 and May 2016. Risk and incidence rates for shingles were calculated for both groups over the duration of the study (mean 1.2 years). Vaccine effectiveness (VE) was calculated using the equation 1-relative risk (RR) for shingles and PHN.ResultsWithin the total cohort (n = 295,135), 70,867 (24%) were vaccinated and 224,268 (76%) were unvaccinated. 2435 (0.83%) patients developed shingles: 241 (0.34%) among the vaccinated and 2194 (0.98%) among the unvaccinated. The VE for preventing shingles was 65.3% (95% CI: 60.3–69.6%). The incidence rate in the vaccinated group was 2.95 (95% CI: 2.59–3.34) vs 8.02 (95% CI: 7.68–8.36) per 1000 person years in the unvaccinated group. Risk of PHN was 0.02% and 0.06% in the respective vaccinated and unvaccinated groups. The VE for preventing PHN was 72% (95% CI: 50.0–83.9%). PHN incidence rates were 0.16 (95% CI: 0.08–0.27) and 0.53 (95% CI: 0.44–0.62) per 1000 person years in the vaccinated and unvaccinated groups, respectively.ConclusionsZVL reduced the risk of shingles among an elderly population. Given the negative impact of shingles and PHN on QoL, the benefits of vaccination are clear. Improving uptake in the UK is needed in this population.     

北京市东城区(北)脊髓灰质炎防控系统评价

目的 了解北京市东城区(北)脊髓灰质炎防控体系运转情况.方法 对口服脊灰减毒活疫苗(OPV)接种数据及急性弛缓性麻痹(AFP)病例监测数据进行分析.结果 东城区(北)维持了OPV高接种率、高接种质量;AFP病例监测系统敏感性指标不达标.结论 东城区(北)建立了对脊髓灰质炎的免疫屏障,但AFP病例监测系统有待加强.