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。

A cost-effectiveness analysis on universal infant rotavirus vaccination strategy in China

Objective To evaluate the cost-effectiveness of current universal infant rotavirus vaccination strategy, in China.Methods Through constructing decision tree-Markov model, we simulated rotavirus diarrhea associated cost and health outcome on those newborns in 2012 regarding different vaccination programs as:group with no vaccination, Rotavirus vaccination group and Rotateq vaccination group, respectively.We determined the optimal program, based on the comparison between incremental cost-effectiveness ratio(ICER) and China''s 2012 per capital gross domestic product(GDP).Results Compared with non-vaccination group, the Rotavirus vaccination and Rotateq vaccination groups had to pay 3 760 Yuan and 7 578 Yuan(both less than 2012 GDP per capital) to avert one disability adjusted life years(DALY) loss, respectively.Results from sensitivity analysis indicated that both Results were robust.Compared with Rotavirus vaccination program, the Rotateq vaccination program had to pay extra 81 068 Yuan(between 1 and 3 times GDP per capital) to avert one DALY loss.Data from the sensitivity analysis indicated that the result was not robust.Conclusion From the perspective of health economics, both two-dose Rotarix vaccine and three-dose''s Rotateq vaccine programs were highly cost-effective, when compared to the non-vaccination program.It was appropriate to integrate rotavirus vaccine into the routine immunization program.Considering the large amount of extra cost that had to spend on Rotateq vaccination program, Results from the sensitivity analysis showed that it was not robust.Rotateq vaccine required one more dose than the Rotarix vaccine, to be effective.However, it appeared more difficult to practice, suggesting that it was better to choose the Rotarix vaccine, at current stage.