Nichol Kristin L, Mallon Kenneth P, Mendelman Paul M
VA Medical Center, Medicine Service (111), One Veterans Drive, Minneapolis, MN 55417, USA.
Vaccine. 2003 May 16;21(17-18):2207-17. doi: 10.1016/s0264-410x(03)00029-x.
Trivalent, intranasal, live attenuated influenza virus vaccine (LAIV) is safe and clinically effective in healthy, working adults. However, the potential economic benefits of vaccinating this population are still uncertain. We therefore conducted a cost benefit analysis of influenza vaccination of healthy working adults utilizing clinical outcome data from a trial of LAIV in healthy working adults.
This cost benefit analysis was based on the results of a multi-center, randomized, double blind placebo controlled trial that assessed the clinical effectiveness of LAIV in healthy working adults. Outcomes from the trial that were included in the cost benefit analysis were days of work missed, days working but at reduced effectiveness, and days with a health care provider visit due to at least one of the following symptoms: fever, runny nose, sore throat, cough, headache, muscle aches, chills, or tiredness/weakness. Cost data were obtained from nationally representative databases. Probability distributions for the key model variables were defined, and Monte Carlo simulation was used to estimate the mean break even costs for vaccine and its administration. Sensitivity analyses explored how changes in the variables affected these estimates.
There were 4561 participants in the clinical trial. LAIV lowered work loss due to illness symptoms by 18% (relative rate [RR] 0.82, 95% confidence interval [CI] 0.74-0.91), days of working at reduced effectiveness by 18% (RR 0.82, 95% CI 0.74-0.91), and days with a health care provider visit by 13% (RR 0.87, 95% CI 0.77-0.98). The mean break even cost for vaccine and its administration was 43.07 US dollars per person vaccinated (5-95% percentiles, 25.72-58.92 US dollars). Major cost drivers were hourly wage and vaccine effectiveness in reducing productivity losses and health care use.
This cost benefit analysis based on the results of the LAIV trial provides additional evidence that influenza vaccination may provide both health and economic benefits for healthy, working adults.
三价鼻内减毒活流感病毒疫苗(LAIV)对健康的在职成年人来说是安全且临床有效的。然而,为这一人群接种疫苗的潜在经济效益仍不明确。因此,我们利用一项针对健康在职成年人的LAIV试验的临床结果数据,对健康在职成年人接种流感疫苗进行了成本效益分析。
这项成本效益分析基于一项多中心、随机、双盲、安慰剂对照试验的结果,该试验评估了LAIV对健康在职成年人的临床有效性。成本效益分析中纳入的试验结果包括缺勤天数、工作但效率降低的天数,以及因以下至少一种症状而去看医疗服务提供者的天数:发烧、流鼻涕、喉咙痛、咳嗽、头痛、肌肉疼痛、寒战或疲劳/虚弱。成本数据来自具有全国代表性的数据库。定义了关键模型变量的概率分布,并使用蒙特卡洛模拟来估计疫苗及其接种的平均收支平衡成本。敏感性分析探讨了变量变化如何影响这些估计值。
临床试验中有4561名参与者。LAIV使因疾病症状导致的工作损失减少了18%(相对率[RR]0.82,95%置信区间[CI]0.74 - 0.91),工作效率降低的天数减少了18%(RR 0.82,95% CI 0.74 - 0.91),因看医疗服务提供者而就诊天数减少了13%(RR 0.87,95% CI 0.77 - 0.98)。疫苗及其接种的平均收支平衡成本为每人43.07美元(第5 - 95百分位数,25.72 - 58.92美元)。主要成本驱动因素是小时工资以及疫苗在降低生产力损失和医疗保健使用方面的有效性。
基于LAIV试验结果的这项成本效益分析提供了额外证据,表明流感疫苗接种可能为健康的在职成年人带来健康和经济效益。