Postma Maarten J, Jansema Paul, van Genugten Marianne L L, Heijnen Marie-Louise A, Jager Johannes C, de Jong-van den Berg Lolkje T W
Groningen University Institute for Drug Exploration / University of Groningen Research Institute of Pharmacy (GUIDE/GRIP), Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
Drugs. 2002;62(7):1013-24. doi: 10.2165/00003495-200262070-00003.
A favourable pharmacoeconomic profile has been well established for influenza vaccination in the elderly. For employers relevant benefits seem to exist for vaccinating healthy working adults to avert absenteeism and related production losses. From a pharmacoeconomic point of view it is relevant to consider whether societal benefits of vaccination for healthy working adults is worthwhile given the costs of vaccination for the community. We searched Medline and Embase using the key words influenza (vaccination) in combination with cost, cost-benefit, cost-effectiveness, efficiency, economic evaluation, health-policy and pharmacoeconomics. From this primary search, we selected 11 studies concerned with the group of healthy working adults. We reviewed these studies according to several criteria: benefit-to-cost (B/C) ratio;vaccine effectiveness, influenza incidence, number of days of work absence due to illness; and relative cost of the vaccine. Three studies on vaccinating healthy working adults found costs exceeding the benefits (B/C-ratio <1). The remaining eight pharmacoeconomic studies found a B/C-ratio of almost two or more. Cost savings are strongly related to the inclusion of indirect benefits related to averted production losses. After exclusion of indirect costs and benefits of production gains/losses, only one of the eight studies remains cost saving. Considering the available pharmacoeconomic evidence, vaccination of healthy working adults in Western countries may be an intervention with favourable cost-effectiveness and cost-saving potentials if indirect benefits of averted production losses are included. Excluding indirect benefits and costs of production losses/gains, cost-saving potentials are limited. Recent international guidelines for pharmacoeconomic research advise the inclusion of production gains and losses in the preferred societal perspective. Hence, on the basis of the available evidence, influenza vaccination of healthy working adults may be recommended from pharmacoeconomic point of view. Pharmacoeconomics do, however, present only one argument for consideration aside from ethical issues, budgetary limits and psychosocial aspects.
流感疫苗接种对老年人具有良好的药物经济学效益，这一点已得到充分证实。对于雇主而言，为健康的在职成年人接种疫苗以避免旷工及相关生产损失似乎存在切实益处。从药物经济学角度来看，鉴于社区疫苗接种成本，有必要考虑为健康在职成年人接种疫苗所带来的社会效益是否值得。我们使用关键词“流感（疫苗接种）”与成本、成本效益、成本效果、效率、经济评估、卫生政策和药物经济学相结合，对Medline和Embase进行了检索。通过此次初步检索，我们挑选出了11项针对健康在职成年人这一群体的研究。我们依据若干标准对这些研究进行了综述：效益成本（B/C）比、疫苗效力、流感发病率、因病缺勤天数以及疫苗的相对成本。三项针对健康在职成年人接种疫苗的研究发现成本超过了效益（B/C比<1）。其余八项药物经济学研究发现B/C比几乎为2或更高。成本节约与纳入因避免生产损失而产生的间接效益密切相关。在排除生产收益/损失的间接成本和效益后，八项研究中只有一项仍具有成本节约效果。考虑到现有的药物经济学证据，如果将避免生产损失的间接效益纳入考量，那么在西方国家为健康在职成年人接种疫苗可能是一种具有良好成本效果和成本节约潜力的干预措施。若排除生产损失/收益的间接效益和成本，成本节约潜力则较为有限。近期的药物经济学研究国际指南建议，在首选的社会视角中纳入生产收益和损失。因此，基于现有证据，从药物经济学角度来看，可能会推荐为健康在职成年人接种流感疫苗。然而，除了伦理问题、预算限制和社会心理因素外，药物经济学只是需要考虑的一个因素。
