Lieu T A, Black S B, Ray G T, Martin K E, Shinefield H R, Weniger B G
Division of Research, Kaiser Permanente, Oakland, CA, USA.
Vaccine. 2000 Aug 15;19(1):33-41. doi: 10.1016/s0264-410x(00)00154-7.
Combination vaccines to minimize injections required for infant vaccination, and new vaccines with improved safety profiles, will pose increasingly complex choices for vaccine purchasers in the future. How much of a premium to pay for such vaccines might be determined by taking into account (1) the psychological burden of multiple injections during a single clinic visit, and the costs of any additional visits to minimize these, and (2) the medical, work-loss, and incidental costs of common vaccine-associated symptoms. This cross-sectional survey included randomly-selected parents of 1-8-month-old infants who received vaccines in a Northern California health maintenance organization (HMO) in 1997. Interviewers called parents 14 days after the infant's vaccination to administer a 10-minute closed-ended interview in English or Spanish. Parents were asked about infant symptoms after vaccination, their preferences regarding multiple injections and their (theoretical) willingness to pay to reduce the number of injections their infant would receive, or to avoid the adverse symptoms experienced. Among 1769 eligible infants, interviews were completed with parents of 1657 (93%). The psychological cost of multiple injections was estimated by the willingness of parents to pay a median of $25 to reduce injections from 4 to 3, $25 from 3 to 2, and $50 from 2 to 1. Vaccine-associated symptoms caused mean costs of $42 in medical utilization and $192 in work-loss among the families who experienced those events (Ns=62 and 35, respectively). When averaged among all 1657 study infants, vaccine-associated symptoms after the index vaccination visit resulted in $2.91 in medical utilization, $4.05 in work-loss, and $0.74 in direct nonmedical costs, yielding total financial costs of $7.70. Parents of infants who had vaccine-associated symptoms said they would have paid a median of $50 to avoid these symptoms. Fever and fussiness were associated in logistic regression analysis with a two-fold increase in the odds of medical utilization, and fever with more than a three-fold increase in work loss. We conclude that multiple injections during a single clinic visit entail psychological costs. The psychological costs of vaccine-associated symptoms, as measured by willingness-to-pay methods, are higher than those resulting from multiple injections. The financial costs of medical utilization and work-loss resulting from common vaccine-associated symptoms are non-negligible and should be incorporated in economic analyses.
联合疫苗可减少婴儿接种所需的注射次数，而安全性更高的新型疫苗，未来会给疫苗采购者带来日益复杂的选择。为这类疫苗支付多少额外费用，可能取决于以下因素：（1）单次门诊多次注射带来的心理负担，以及为尽量减少这种负担而额外就诊的费用；（2）常见疫苗相关症状导致的医疗、误工及附带成本。这项横断面调查纳入了1997年在北加利福尼亚健康维护组织（HMO）为1至8个月大婴儿接种疫苗的随机选取的家长。访员在婴儿接种疫苗14天后致电家长，用英语或西班牙语进行10分钟的封闭式访谈。询问家长婴儿接种疫苗后的症状、他们对多次注射的偏好，以及他们（理论上）愿意支付多少钱来减少婴儿的注射次数，或避免婴儿出现不良反应症状。在1769名符合条件的婴儿中，完成了对1657名（93%）婴儿家长的访谈。多次注射的心理成本通过家长的支付意愿来估算，将注射次数从4次减至3次，家长愿意支付的中位数为25美元；从3次减至2次为25美元；从2次减至1次为50美元。经历过疫苗相关症状的家庭中，疫苗相关症状导致的医疗利用平均成本为42美元，误工成本为192美元（分别为62例和35例）。在所有1657名研究婴儿中平均计算，首次接种疫苗后出现的疫苗相关症状导致医疗利用成本为2.91美元，误工成本为4.05美元，直接非医疗成本为0.74美元，总财务成本为7.70美元。有疫苗相关症状的婴儿家长表示，他们愿意支付的中位数为50美元来避免这些症状。在逻辑回归分析中，发热和烦躁与医疗利用几率增加两倍相关，发热与误工几率增加三倍以上相关。我们得出结论，单次门诊多次注射会带来心理成本。通过支付意愿方法衡量，疫苗相关症状的心理成本高于多次注射带来的心理成本。常见疫苗相关症状导致的医疗利用和误工的财务成本不可忽视，应纳入经济分析。
