Jacobs R J, Margolis H S, Coleman P J
Capitol Outcomes Research Inc, 6188 Old Franconia Rd, Alexandria, VA 22310, USA.
Arch Pediatr Adolesc Med. 2000 Aug;154(8):763-70. doi: 10.1001/archpedi.154.8.763.
The Advisory Committee on Immunization Practices has recommended routine childhood hepatitis A vaccination in states and communities where the incidence of disease exceeds the national average, but most adolescents are currently unprotected from infection.
To estimate clinical and economic consequences of vaccinating adolescents against hepatitis A in the 10 states with the highest disease rates.
Decision analysis was used to assess cost-effectiveness from societal and health system perspectives. Parameter estimates were obtained from national surveillance data, a study of hepatitis A cases, and an expert panel.
Reduction in disease incidence; costs of vaccination, treatment, and work loss; years of life saved (YOLS); and costs per YOLS.
In states with the highest disease rates, vaccination of adolescents against hepatitis A would reduce the lifetime risk of symptomatic infection from 3.3% to 0.7% and prevent loss of 2117 years of life. Vaccination of a single birth cohort would cost $30.9 million, yet treatment and work loss costs would decline $14.2 million and $23.8 million, respectively. Hepatitis A vaccination would cost the health system $7902 per YOLS or $13,722 per discounted YOLS. Results are most sensitive to variation in the discount rate and assumptions regarding long-term vaccine protective efficacy.
Hepatitis A vaccination of adolescents in states with high disease rates would reduce costs to society. Although health system costs would increase, cost-effectiveness is comparable to other recommended vaccines and superior to many commonly used medical interventions. Arch Pediatr Adolesc Med. 2000;154:763-770
免疫实践咨询委员会已建议，在疾病发病率超过全国平均水平的州和社区，对儿童进行常规甲型肝炎疫苗接种，但目前大多数青少年仍未得到感染防护。
估计在疾病发病率最高的10个州为青少年接种甲型肝炎疫苗的临床和经济后果。
采用决策分析从社会和卫生系统角度评估成本效益。参数估计值来自国家监测数据、一项甲型肝炎病例研究以及一个专家小组。
疾病发病率的降低；疫苗接种、治疗和工作损失的成本；挽救的生命年数（YOLS）；以及每YOLS的成本。
在疾病发病率最高的州，为青少年接种甲型肝炎疫苗可将有症状感染的终生风险从3.3%降至0.7%，并预防2117个生命年的损失。为单一出生队列接种疫苗将花费3090万美元，但治疗和工作损失成本将分别下降1420万美元和2380万美元。甲型肝炎疫苗接种将使卫生系统每挽救一个生命年花费7902美元，或每贴现生命年花费13722美元。结果对贴现率的变化以及关于长期疫苗保护效力的假设最为敏感。
在疾病发病率高的州为青少年接种甲型肝炎疫苗将降低社会成本。尽管卫生系统成本会增加，但其成本效益与其他推荐疫苗相当，且优于许多常用的医疗干预措施。《儿科学与青少年医学档案》。2000年；154:763 - 770
