新型冠状病毒疫苗接种策略经济学评价研究进展

目的:了解国内外新型冠状病毒疫苗（新冠疫苗）接种策略相关的经济学评价研究进展,为开展基于中国真实世界证据疫苗接种策略经济学评价提供参考。方法:对中英文数据库2020年1月至2021年12月的文献进行检索,纳入新冠疫苗接种策略经济学评价研究,并对相关文献进行叙述性整合。结果:共纳入16篇英文文献（含3篇综述）,发现无论品...     

新型冠状病毒感染者密切接触者的密切接触者感染风险分析

目的 研究新型冠状病毒（新冠病毒）感染者密切接触者（密接）的密接（次密接）感染率,评估新冠病毒感染者次密接的感染风险。方法 采用前瞻性研究的方法,对进入集中隔离医学观察时且采样检测核酸结果为阴性的密接（与指示病例有明确的暴露时间）及其次密接进行持续医学观察,收集新冠病毒感染者密接和次密接的动态核酸检测结果,评估密接和次密接的感染风险。结果 追踪调查了符合纳入条件的密接4 533例,14例密接转归为新冠病毒感染者,感染率为0.31%。共追踪了次密接4 201例,均未发生后续感染。结论 密接进入集中隔离医学观察时采样检测核酸结果为阴性,该次密接无感染风险。     

医务人员职业安全经济学研究进展与启示

目的 分析医务人员职业安全经济学在国内外的研究和发展现状，对我国医务人员职业安全经济学发展提出建议。方法 检索中英文数据库关于医务人员职业安全相关文献，并对检索文献进行筛选、分析和总结。结果 国外文献主要关注职业伤害的成本测算和预防措施的成本效益分析；国内文献聚焦于医务人员职业暴露因素分析及防护对策，而对经济学原理和方法视角下的医务人员职业伤害研究关注不足。结论 建议我国重视医务人员职业伤害以及因医务人员职业伤害产生的成本损失，从经济学角度积极开展研究，采用成本效益分析法为临床医疗提供最佳策略选择。     

b型流感嗜血杆菌疫苗纳入免疫规划的卫生经济学研究系统评价

目的对b型流感嗜血杆菌(Hib)疫苗纳入免疫规划(EPI)的卫生经济学研究文献进行系统评价。方法通过8个中英文文献数据库检索国内外Hib疫苗卫生经济学研究文献,对纳入文献进行信息提取,归纳Hib疫苗经济学研究的方法、设计和研究结果。结果共纳入32篇文献,其中25篇从全社会角度进行研究;26篇的研究对象为5岁或1岁儿童;均采用成本-效果分析(CEA)、成本-效益分析(CBA)和/或成本-效用分析(CUA);均使用静态模型。27篇文献(包括在中国研究的2篇文献)认为Hib疫苗纳入国家免疫规划具有经济学效益,即节约社会成本;5篇文献认为不具有经济学效益。结论本系统评价显示Hib疫苗纳入免疫规划通常具有经济学效益;建议中国针对Hib疫苗纳入国家免疫规划进行高质量的卫生经济学研究。     

新冠病毒核酸检测筛查的卫生经济学评价

目的 对新冠病毒核酸检测筛查进行成本效果分析与成本效益分析，为优化核酸筛查策略、推动精准防控提供参考。方法 选取我国具有区域代表性的8个地区，收集核酸检测筛查相关数据，构建Markov模型并测算8个地区核酸检测筛查的成本效果与成本效益。结果 8个地区人均筛查成本在21.6元～209.4元之间，核酸检测筛查效益成本比均>1,普遍具有成本效益。结论 新冠病毒核酸检测筛查具有经济学价值，但仍有优化提升空间。     

新型冠状病毒感染者末次核酸阴性前后的传染性分析

目的研究新型冠状病毒(新冠病毒)感染者末次核酸阴性前后密切接触者(密接)的感染率, 评估动态核酸检测结果在判断新冠病毒感染者传染性中的作用。方法采用回顾性队列研究的方法, 收集新冠病毒感染者的动态核酸检测结果。选择新冠病毒感染者在首次核酸检测阳性前有核酸阴性结果者为研究对象, 对感染者的密接以及密接的密接(次密接)进行持续隔离医学观察, 评估密接和次密接的发病风险。结果共纳入宁波市2起本土疫情的89例新冠病毒感染者, 均为确诊病例。追踪调查了5 609名密接, 密接的总感染率为0.20%。感染者末次核酸阴性前的密接无感染, 末次核酸阴性后的密接感染率为1.33%, 且均为与指示病例共同居住生活者。感染者涉及的所有次密接均未感染。结论新冠病毒感染者末次核酸阴性前无传染性, 末次核酸阴性后开始具有传染性。     

我国新型冠状病毒肺炎疫情早期围堵策略概述

2019年12月,湖北武汉市发生新型冠状病毒肺炎疫情,并迅速向全国蔓延。在疫情发生初期,我国采用围堵策略,并围绕此策略要点实施一系列核心措施,包括社会动员、加强病例隔离和密切接触者追踪管理、封锁疫区和交通管控以减少人员流动、增加人际距离、环境卫生措施以及个人防护等,以期尽快将疫情控制在武汉等有限地区。本文对围堵策略实施的背景、主要内容、以及核心措施进行了概述,分析了我国现阶段实施的围堵策略及核心措施的公共卫生意义,并基于措施效果的全面评价与疫情发展的态势评估提出下一步考虑建议。     

新冠肺炎病例密切接触者的感染情况分析

目的 分析深圳市新冠肺炎（COVID - 19）病例的密切接触者（简称密接者）感染情况,为科学防控提供参考依据。方法 选取1月19日 - 2月9日期间深圳报告的230例新冠肺炎病例的1 568名在深追踪的密接者为研究对象,采集其鼻咽拭子进行实时荧光定量PCR核酸检测,比较不同性别、不同年龄的密接者的核酸检测结果,了解密接者发病的时间分布情况。结果 共筛查了1 568名密接者的鼻咽拭子样本,总阳性数为114名,其总阳性率为7.3%;男性密接者的阳性率为5.3%低于女性密接者的阳性率9.1%;不同年龄段的密接者的阳性率分别为:≤20岁的阳性率为8.5%,21～40岁的密接者阳性率为5.3%,41～60岁密接者阳性率为7.5%,61岁及以上的密接率阳性率为12%,差异有统计学意义（χ2 = 11.1,P = 0.011）。家庭密接者的阳性率为14.2%,朋友同事密接者总人数127人,阳性数仅为1人,其阳性率为0.7%,其他类型密接均无发病;77%核酸检测阳性的密接者发病的时间集中在医学观察期的前6.0天,其平均潜伏期约为4.7天。结论 深圳1 568名COVID - 19病例的密接者中,家庭密接者感染风险最高, 61岁及以上年龄段的老年人因其抵抗力较低最为易感。女性密接者的感染风险高于男性且感染的密接者发病的速度较快,主要集中在医学观察期的前期。因此,尽早追踪管理密接者可以有效地控制病毒传播,降低疫情扩散风险,有助于制定有针对性的预防和控制战略,为实现早发现、早预防、早治疗的举措提供保障。     

青少年和成人百日咳疫苗加强免疫策略卫生经济学研究的系统评价北大核心

目的系统评价青少年和成人百日咳疫苗加强免疫的卫生经济学研究质量和结果。方法通过Pubmed、中国知网等数据库检索2000年1月-2020年1月发表的青少年和成人百日咳疫苗加强免疫卫生经济学研究文献,采用卫生经济研究统一整理评估报告标准(Consolidated health economic evaluation reporting standards,CHEERS)评分(满分24分)评价文献质量,分析卫生经济学评价结果。结果共纳入符合标准的研究文献16篇,均为国外文献,文献的CHEERS评分平均为22.56分(范围:20-24分)。针对青少年或成人百日咳加强免疫策略,8篇研究认为符合成本效果或节约成本(7篇研究人群为青少年),5篇研究认为在一定条件下(如百日咳发病率>50/10万)符合成本效果,3篇研究认为不符合成本效果。结论纳入的研究文献质量较高;经济学评价结果倾向于支持青少年百日咳加强免疫策略,而成人加强免疫策略评价结果差异较大。建议开展中国百日咳免疫策略的卫生经济学研究。     

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。     

Modeling the evolution of SARS-CoV-2 under non-pharmaceutical interventions and testing

Background and objectivesSocial and behavioral non-pharmaceutical interventions (NPIs), such as mask-wearing, social distancing and travel restrictions, as well as diagnostic tests, have been broadly implemented in response to the COVID-19 pandemic. Epidemiological models and data analysis affirm that wide adoption of NPIs helps to control the pandemic. However, SARS-CoV-2 has extensively demonstrated its ability to evolve. Therefore, it is crucial to examine how NPIs may affect the evolution of the virus. Such evolution could have important effects on the spread and impact of the pandemic.MethodologyWe used evo-epidemiological models to examine the effect of NPIs and testing on two evolutionary trajectories for SARS-CoV-2: attenuation and test evasion.ResultsOur results show that when stronger measures are taken, selection may act to reduce disease severity. Additionally, the timely application of NPIs could significantly affect the competition between viral strains, favoring the milder strain. Furthermore, a higher testing rate can select for a test-evasive viral strain, even if that strain is less infectious than the detectable competing strain. Importantly, if a less detectable strain evolves, epidemiological metrics such as confirmed daily cases may distort our assessment of the pandemic.Conclusions and implicationsOur results highlight the important implications NPIs can have on the evolution of SARS-CoV-2.Lay SummaryWe used evo-epidemiological models to examine the effect of non-pharmaceutical interventions and testing on two evolutionary trajectories for SARS-CoV-2: attenuation and test evasion. Our results show that when stronger measures are taken, selection may act to reduce disease severity.     

Cost-Effectiveness of Food Allergy Interventions in Children: A Systematic Review of Economic Evaluations

ObjectivesTo identify published economic evaluations of interventions aimed at preventing, diagnosing, or treating food allergies in children.MethodsWe examined economic evaluations published from 2000 to 2019. Data analyzed included: food allergy type, study population/setting, intervention/comparator, and economic evaluation details. Quality assessment used reporting and economic modeling checklists. Two reviewers simultaneously undertook article screening, data extraction, and quality assessment.Results17 studies were included: 8 peanut allergy (PA) studies, 8 cow’s milk allergy (CMA) studies, and 1 egg allergy (EA) study. All PA studies reported incremental costs per quality-adjusted life-year gained for diagnostic strategies, management pathways for peanut exposure, and immunotherapies. Immunotherapies rendered inconsistent cost-effectiveness results. CMA studies reported costs per symptom-free day or probability of developing CMA tolerance. Cost-effectiveness of extensively hydrolyzed casein formula for CMA treatment was consistently demonstrated. Early introduction of cooked egg in first year of life dominated all EA prevention strategies. Quality assessment showed average noncompliance for 3.5 items/study (range 0-11) for modeling methods and 3.4 items/study (range 0-8) for reporting quality. Key quality concerns included limited justification for model choice, evidence base for model parameters, source of utility values, and representation of uncertainty.ConclusionRecent cost-effectiveness literature of interventions in PA, CMA, and EA is limited and diverse. Interventions for diagnosis and treatment of CMA and prevention of EA were generally cost-effective; however, results for PA were variable and dependent on effectiveness and utility values used. There is a need to expand economic evaluation of interventions for childhood food allergy and to improve methods and reporting.     

Impact of implementation timing on the effectiveness of stay-at-home requirement under the COVID-19 pandemic: Lessons from the Italian Case

When a new infectious outbreak emerges, governments must initially rely on non-pharmaceutical interventions (NPIs) to mitigate the impact of the pathogen. Although a strict stay-at-home requirement (i.e., lockdown) presents high effectiveness in reducing patients hospitalized in intensive care units (ICUs), it comes with unintended physical, psychological, and economic damages for the citizens. Using how Italy managed the COVID-19 outbreak from February to September 2020 on a national basis, this study aims at understanding the impact of implementation timing on the effectiveness of NPIs. Our findings may be helpful to avoid the implementation of stay-at-home requirements when it is not strictly necessary. A compartmental SEICRD model was developed to create the baseline scenario without NPIs. Generalized Poisson regressions were applied to study the change in effectiveness over-time of NPIs on Avoided ICUs for each one of the Italian regions. Our study suggests that although the stay-at-home requirement is the most effective measure in reducing ICU hospitalizations in regions encountering the outbreak early, its effectiveness decreases in regions encountering the outbreak later, where a set of other NPIs are more effective. We developed a reference of daily new cases when lockdown should be implemented or avoided, accordingly. Our findings could be useful to support policymakers in contrasting the pandemic and in limiting the societal and economic impact of stringent NPIs.     

Assessing the cost-effectiveness of COVID-19 vaccines in a low incidence and low mortality setting: the case of Thailand at start of the pandemic

Objective

This study aimed to assess the cost-effectiveness of COVID-19 vaccines, preferred COVID-19 vaccine profiles, and the preferred vaccination strategies in Thailand.

Methods

An age-structured transmission dynamic model was developed based on key local data to evaluate economic consequences, including cost and health outcome in terms of life-years (LYs) saved. We considered COVID-19 vaccines with different profiles and different vaccination strategies such as vaccinating elderly age groups (over 65s) or high-incidence groups, i.e. adults between 20 and 39 years old who have contributed to more than 60% of total COVID-19 cases in the country thus far. Analyses employed a societal perspective in a 1-year time horizon using a cost-effectiveness threshold of 160,000 THB per LY saved. Deterministic and probabilistic sensitivity analyses were performed to identify and characterize uncertainty in the model.

Results

COVID-19 vaccines that block infection combined with social distancing were cost-saving regardless of the target population compared to social distancing alone (with no vaccination). For vaccines that block infection, the preferred (cost-effective) strategy was to vaccinate the high incidence group. Meanwhile, COVID-19 vaccines that reduces severity (including hospitalization and mortality) were cost-effective when the elderly were vaccinated, while vaccinating the high-incidence group was not cost-effective with this vaccine type. Regardless of vaccine type, higher vaccination coverage, higher efficacy, and longer protection duration were always preferred. More so, vaccination with social distancing measures was always preferred to strategies without social distancing. Quarantine-related costs were a major cost component affecting the cost-effectiveness of COVID-19 vaccines.

Conclusion

COVID-19 vaccines are good value for money even in a relatively low-incidence and low-mortality setting such as Thailand, if the appropriate groups are vaccinated. The preferred vaccination strategies depend on the type of vaccine efficacy. Social distancing measures should accompany a vaccination strategy.

     

The cost-utility of integrated cervical cancer prevention strategies in the Ontario setting – Can we do better?

IntroductionA universal, publicly funded, school-based human papillomavirus (HPV) vaccination program in grade eight girls was initiated in Ontario in 2007. We present a cost-utility analysis of integrated cervical cancer prevention programs from the healthcare payer perspective.MethodsOur analysis was based on linked HPV transmission and disease history models. We obtained data from the literature, provincial surveys and Ontario population-based linked health administrative datasets. We modeled combinations of vaccination and screening strategies. We considered vaccination based on the Ontario experience, as well as conservative and optimistic scenarios, varying coverage, vaccine effectiveness and duration of protection. We considered 900 screening scenarios (screening start age: 21–70 years, screening interval: 3–20 years; 1-year time steps). The current schedule screens every 3 years starting at age 21 years. We examined (1) first vaccinated cohort (low herd-immunity), and (2) steady state, i.e. all cohorts were vaccinated (high herd-immunity).ResultsAdding vaccination to the current screening schedule was cost-effective (<C$10,000/quality-adjusted life year (QALY)) across all scenarios. Delaying screening start and/or extending screening intervals increased both expected QALYs and cost, and increased overall NHB for screening schedules with a start age of 25–35 years and 3–10-year intervals for most scenarios.ConclusionDelaying screening start age and/or extending screening intervals in vaccinated cohorts is likely to be cost-effective. Consideration should be given to both the short- and long-term implications of health policy decisions, particularly for infectious disease interventions that require long time intervals to reach steady state.     

Targeting Diabetes Prevention to More Disadvantaged Groups Improves Cost-Effectiveness: Implications of Inequality in Type 2 Diabetes From Theoretical Interventions

ObjectivesTo determine the effect of socioeconomic status on efficacy and cost thresholds at which theoretical diabetes prevention policies become cost-effective.MethodsWe designed a life table model using real-world data that captured diabetes incidence and all-cause mortality in people with and without diabetes by socioeconomic disadvantage. The model used data from the Australian diabetes registry for people with diabetes and the Australian Institute of Health and Welfare for the general population. We simulated theoretical diabetes prevention policies and estimated the threshold at which they would be cost-effective and cost saving, overall, and by socioeconomic disadvantage, from the public healthcare perspective.ResultsFrom 2020 to 2029, 653 980 people were projected to develop type 2 diabetes, 101 583 in the least disadvantaged quintile and 166 744 in the most. Theoretical diabetes prevention policies that reduce diabetes incidence by 10% and 25% would be cost-effective in the total population at a maximum per person cost of Australian dollar (AU$) 74 (95% uncertainty interval: 53-99) and AU$187 (133-249) and cost saving at AU$26 (20-33) and AU$65 (50-84). Theoretical diabetes prevention policies remained cost-effective at a higher cost in the most versus least disadvantaged quintile (eg, a policy that reduces type 2 diabetes incidence by 25% would be cost-effective at AU$238 [169-319] per person in the most disadvantaged quintile vs AU$144 [103-192] in the least).ConclusionsPolicies targeted at more disadvantaged populations will likely be cost-effective at higher costs and lower efficacy compared to untargeted policies. Future health economic models should incorporate measures of socioeconomic disadvantage to improve targeting of interventions.     

Economic Evaluation of Prenatal and Postpartum Care in Women With Gestational Diabetes and Hypertensive Disorders of Pregnancy: A Systematic Review

ObjectivesThis study aimed to summarize evidence on the economic outcomes of prenatal and postpartum interventions for the management of gestational diabetes mellitus and hypertensive disorders of pregnancy (HDP), assess the quality of each study, and identify research gaps that may inform future research.MethodsElectronic databases including PubMed/MEDLINE, Embase, the Cochrane Library, and Cochrane Central Register of Controlled Trials were searched from January 1, 2000, to October 1, 2021. Selected studies were included in narrative synthesis and extracted data were presented in narrative and tabular forms. The quality of each study was assessed using the Consolidated Health Economic Evaluation Reporting Standards and Consensus on Health Economic Criteria list.ResultsAmong the 22 studies identified through the systematic review, 19 reported favorable cost-effectiveness of the intervention. For prenatal management of HDP, home blood pressure monitoring was found to be cost-effective compared with in-person visits in improving maternal and neonatal outcomes. For postpartum care, regular screening for hypertension or metabolic syndrome followed by subsequent treatment was found to be cost-effective compared with no screening in women with a history of gestational diabetes mellitus or HDP.ConclusionsExisting economic evaluation studies showed that prenatal home blood pressure monitoring and postpartum screening for hypertension or metabolic syndrome were cost-effective. Nevertheless, limitations in the approach of the current economic evaluations may dampen the quality of the evidence and warrant further investigation.     

Accounting for Intergenerational Cascade Testing in Economic Evaluations of Clinical Genomics: A Scoping Review

ObjectivesClinical genomics is emerging as a diagnostic tool in the identification of blood relatives at risk of developing heritable diseases. Our objective was to identify how genetic cascade screening has been incorporated into health economic evaluations.MethodsA scoping review was conducted to identify how multiple generations of a family were included in economic evaluations of clinical genomic sequencing, how many and which relatives were included, and uptake rates. Databases were searched for full economic evaluations of genetic interventions that screened multiple generations of families and were in English language, and no restrictions were made for disease or publication type. Data were synthesized using a narrative approach.ResultsTwenty-five studies were included covering a range of diseases in various countries. Markov cohort models were mostly used with hypothetical populations and unsupported by clinical evidence. Cascade testing was either the primary intervention or secondary to the index cases. The number and type of relatives were based on assumptions or identified through population or family records, clinical registry data, or clinical literature. Studies included only immediate family members and the uptake of testing ranged between 20% and 100%. All interventions were reported as cost-effective, and a higher number of relatives was a key driver.ConclusionsSeveral economic evaluations have considered the impacts of cascade testing interventions within clinical genomics. Ideally, models supported with high-quality clinical data are needed and, in their absence, transparent and justifiable assumptions of uptake rates and choices about including relatives. Consideration of more appropriate modeling types is required.