Pathania V S, Trnka L, Krejbich F, Dye C
Department of Health Systems, World Health Organization, Geneva, Switzerland.
Vaccine. 1999 Apr 9;17(15-16):1926-35. doi: 10.1016/s0264-410x(98)00462-9.
We assessed the direct and indirect economic costs and benefits of the current policy of revaccinating tuberculin-negative schoolchildren in the Czech Republic. The analysis is conducted from the perspective of the payer for health care. In considering whether revaccination should be discontinued, we consistently made assumptions which tend to favor revaccination. The direct costs of revaccination are estimated at Czech Koruna (KCR) 15.0 million (US$0.46 million) annually. The direct benefits are the treatment costs saved for future cases averted by revaccination. These range from KCR 0.5 million (US$0.015 million, ambulatory care, excluding transmission benefits) to KCR 13.7 million (US$0.4 million, hospitalization, including transmission benefits). Costs exceed benefits even if children are revaccinated without prior tuberculin testing. The major indirect cost is the loss of work output attributable to tuberculosis morbidity. Counting the averted loss in output as a benefit does not change the results qualitatively, although there is a 50% chance that the benefits will be greater than costs if treatment continues to be hospital-based. Thus, the costs of revaccination in the Czech Republic are found to exceed benefits over most, plausible variations in parameter values. The cost-benefit ratio is especially large if patients are given ambulatory treatment, as recommended by the World Health Organization.
我们评估了捷克共和国现行对结核菌素阴性学童进行再接种政策的直接和间接经济成本及效益。该分析是从医疗保健支付方的角度进行的。在考虑是否应停止再接种时，我们始终做出倾向于再接种的假设。再接种的直接成本估计为每年1500万捷克克朗（46万美元）。直接效益是通过再接种避免未来病例所节省的治疗成本。这些成本从50万捷克克朗（1.5万美元，门诊护理，不包括传播效益）到1370万捷克克朗（40万美元，住院治疗，包括传播效益）不等。即使儿童在未进行结核菌素检测之前就进行再接种，成本也超过效益。主要的间接成本是因结核病发病导致的工作产出损失。将避免的产出损失算作效益，在质量上不会改变结果，尽管如果继续以住院治疗为主，效益大于成本的可能性为50%。因此，在捷克共和国，再接种的成本在参数值的大多数合理变化情况下都超过效益。如果按照世界卫生组织的建议对患者进行门诊治疗，成本效益比会特别大。
