Jiménez F J, Guallar-Castillón P, Rubio Terrés C, Guallar E
Research Unit, Fundación Jiménez Díaz, Madrid, Spain.
Pharmacoeconomics. 1999 Jan;15(1):75-83. doi: 10.2165/00019053-199915010-00005.
Invasive disease caused by Haemophilus influenzae type b (Hib), including meningitis, pneumonia, sepsis and epiglottitis, is associated with high mortality and serious neurological sequelae in children under 5 years of age. The availability of an efficacious vaccine suggests the need to perform an economic evaluation of its use. The objective of this study was to evaluate the costs and benefits of introducing a universal vaccination programme for children under 1 year of age in Spain.
DESIGN & SETTING: A cost-benefit analysis (CBA) was conducted over a 5-year period from the societal perspective in the Spanish healthcare setting. Both direct and indirect costs were included in the analysis [using 1996 Spanish pesetas (Pta); Pta126.5 = $US1 in April 1996].
The target population used for cost and benefit estimation was the 384,883 Spaniards aged 1 year or less in the last Spanish Population and Housing Census of 1991.
The introduction of the universal Hib vaccination programme would imply vaccinating 346,395 children under 1 year of age, with a global expense of Pta2,444,855,910. For an average incidence of 15 cases of invasive disease per 100,000 children per year nationwide, the programme would prevent 219 cases of invasive disease and 8 deaths over a 5-year period, with a benefit of Pta2,182,868,907, a net benefit (i.e. benefit minus cost) of -Pta261,987,003, a benefit/cost ratio of 0.89 and a benefit per case prevented of -Pta1,196,288. Benefit/cost ratios above 1 would be obtained in the regions of highest incidence of invasive disease.
The decision to implement a universal vaccination programme should not be based only on economic factors, but our results suggest that the economic returns of the programme for children under 1 year of age in Spain would be at least of a similar magnitude as its expenses.
b型流感嗜血杆菌（Hib）引起的侵袭性疾病，包括脑膜炎、肺炎、败血症和会厌炎，与5岁以下儿童的高死亡率和严重神经后遗症相关。有效疫苗的出现表明有必要对其使用进行经济学评估。本研究的目的是评估在西班牙为1岁以下儿童引入通用疫苗接种计划的成本和效益。
从西班牙医疗保健环境的社会角度进行了为期5年的成本效益分析（CBA）。分析中包括直接和间接成本[使用1996年西班牙比塞塔（Pta）；1996年4月Pta126.5 = 1美元]。
用于成本和效益估算的目标人群是1991年西班牙上一次人口与住房普查中1岁及以下的384,883名西班牙人。
引入通用Hib疫苗接种计划意味着为346,395名1岁以下儿童接种疫苗，总费用为Pta2,444,855,910。全国每年每10万名儿童中侵袭性疾病的平均发病率为15例，该计划在5年内将预防219例侵袭性疾病和8例死亡，效益为Pta2,182,868,907，净效益（即效益减去成本）为-Pta261,987,003，效益成本比为0.89，每预防一例的效益为-Pta1,196,288。在侵袭性疾病发病率最高的地区，效益成本比将高于1。
实施通用疫苗接种计划的决定不应仅基于经济因素，但我们的结果表明，该计划对西班牙1岁以下儿童的经济回报至少与其费用规模相似。
