Deuson R R, Hoekstra E J, Sedjo R, Bakker G, Melinkovich P, Daeke D, Hammer A L, Goldsman D, Judson F N
National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Ga. 30333, USA.
Am J Public Health. 1999 Nov;89(11):1722-7. doi: 10.2105/ajph.89.11.1722.
This study sought to compare the cost-effectiveness of a school-based hepatitis B vaccine delivery program with that of a vaccine delivery program associated with a network health maintenance organization (HMO).
The vaccination program enrolled 3359 sixth-grade students from 18 middle schools in Denver, Colo. Immunization status and direct and indirect program costs were compiled. The sensitivity of the outcomes was assessed by simulation methods.
The per-dose cost-effectiveness ratio for the school-based delivery system was $31. This cost-effectiveness ratio remained stable when the model was simulated with costs that were underestimated or overestimated by 20%. In the network HMO, the direct cost per dose was $68 and the societal cost was $118 when the child's father worked full-time and the mother worked part-time. There is less than a 5% chance that the network HMO-based vaccination program could be more cost-effective than the school-based program.
The cost per dose of the school-based program was significantly less than that of the network HMO-based program, because in the school program government-purchased vaccine was available at a lower cost and parents did not incur work-loss costs.
本研究旨在比较以学校为基础的乙肝疫苗接种项目与与网络健康维护组织（HMO）相关的疫苗接种项目的成本效益。
该疫苗接种项目招募了科罗拉多州丹佛市18所中学的3359名六年级学生。收集了免疫状况以及项目的直接和间接成本。通过模拟方法评估结果的敏感性。
以学校为基础的接种系统每剂的成本效益比为31美元。当模型模拟成本被低估或高估20%时，该成本效益比保持稳定。在网络健康维护组织中，当孩子的父亲全职工作且母亲兼职工作时，每剂的直接成本为68美元，社会成本为118美元。基于网络健康维护组织的疫苗接种项目比基于学校的项目更具成本效益的可能性不到5%。
基于学校的项目每剂成本显著低于基于网络健康维护组织的项目，因为在学校项目中，政府购买的疫苗成本更低，且家长不会产生误工成本。
