Tormans G, Van Damme P, Van Doorslaer E
Department of Epidemiology and Community Medicine, University of Antwerp, Belgium.
Vaccine. 1992;10 Suppl 1:S88-92. doi: 10.1016/0264-410x(92)90554-w.
The advent of new vaccines and the changing epidemiology of hepatitis A call for an update of the economic evaluation of costs and benefits associated with the various alternative preventative strategies. A decision-tree-based model has been developed which enables the calculation of expected costs and expected numbers of hepatitis A virus HAV infections based on different intervention strategies. The model is sufficiently generic to allow for the evaluation of both population-wide strategies and strategies targeted at particular risk groups. An economic analysis focusing on travellers from Europe to high-endemic countries compared a non-intervention strategy to the following three strategies: active immunization with HAV vaccine; screening for HAV antibodies and vaccinating only susceptibles; passive immunization by means of immunoglobulin. The net cost per HAV infection prevented proved very sensitive to a number of important input parameters of the model. These included epidemiological characteristics such as HAV attack rate and prevalence of immunity, behavioural characteristics such as compliance with the vaccination scheme and vaccine characteristics such as rate and duration of protection. Our estimated expected cost per HAV infection prevented among Belgian travellers to high-endemic countries for three weeks per year over ten years amounts to approximately US$4880 for active immunization, US$5621 for screening followed by vaccination of susceptibles and US$29932 for passive immunization. Although these estimates are clearly sensitive to a number of crucial assumptions pertaining to the input parameters of the model, it seems safe to conclude that vaccination is more cost-effective than the currently recommended passive immunization with immunoglobulin.(ABSTRACT TRUNCATED AT 250 WORDS)
新疫苗的出现以及甲型肝炎流行病学的变化，要求对与各种替代预防策略相关的成本和效益进行经济评估更新。已开发出一种基于决策树的模型，该模型能够根据不同的干预策略计算甲型肝炎病毒（HAV）感染的预期成本和预期数量。该模型具有足够的通用性，可用于评估全人群策略和针对特定风险群体的策略。一项针对从欧洲前往高流行国家旅行者的经济分析，将非干预策略与以下三种策略进行了比较：使用HAV疫苗进行主动免疫；筛查HAV抗体，仅对易感者进行疫苗接种；通过免疫球蛋白进行被动免疫。事实证明，每预防一例HAV感染的净成本对该模型的一些重要输入参数非常敏感。这些参数包括流行病学特征，如HAV发病率和免疫流行率；行为特征，如对疫苗接种方案的依从性；以及疫苗特征，如保护率和持续时间。我们估计，对于每年前往高流行国家三周、为期十年的比利时旅行者，每预防一例HAV感染的预期成本，主动免疫约为4880美元，筛查易感者后接种疫苗为5621美元，被动免疫为29932美元。尽管这些估计显然对与模型输入参数相关的一些关键假设敏感，但可以有把握地得出结论，疫苗接种比目前推荐的用免疫球蛋白进行被动免疫更具成本效益。（摘要截选至250词）
