Asensi Francisco, De Jose Maribel, Lorente Manuel, Moraga Fernando, Ciuryla Vincent, Arikian Steve, Casciano Roman, Vento Maximo
Hospital Universitario La Fe, Valencia, Spain.
Value Health. 2004 Jan-Feb;7(1):36-51. doi: 10.1111/j.1524-4733.2004.71263.x.
Streptococcus pneumoniae is a leading cause of illness in children. Seven-valent pneumococcal conjugate vaccine (PCV-7), recently approved in the United States, is the first vaccine to provide protective immunity against pneumococcal disease in children under the age of 2. PCV-7 is nearly 100% effective in preventing invasive pneumococcal infections and has been shown to significantly decrease the incidence of pneumonia and otitis media.
The objective of this study was to evaluate the health outcomes, costs, and cost-effectiveness of vaccination with PCV-7, compared with no vaccination for children in Spain.
A health state model was used to determine the health and economic outcomes in vaccinated and unvaccinated groups among children less than 5 years old. This analysis was conducted for a 10-year time horizon, beginning with initial vaccinations. Information on the burden of pneumococcal disease, in terms of data on the incidence and seroprevalence of disease, was collected from published and unpublished records, supplemented, and verified by Spanish pediatric and infectious disease experts. The efficacy of PCV-7 was based on updated findings of the Kaiser Permanente Efficacy Study. A cost-of-illness estimate for each pneumococcal disease was determined using decision tree analysis that considered direct and indirect costs. A birth cohort analysis compared the expected cost of vaccinated populations to age-matched unvaccinated populations.
Implementing a PCV-7 vaccine program in Spain in a birth cohort of 360000 is expected to save approximately 16 lives and 132000 cases of pneumococcal disease over 10 years, resulting in total savings estimated at Euros 81 million (ESP13.5 billion), of which Euros 43.5 million (ESP7.1 billion) are direct medical savings. At a vaccine cost up to Euros 56.87 per dose (ESP9,462, the total cost of vaccinating a birth cohort of 360000 will be offset by the total savings owing to reduced morbidity.
Implementing a universal PCV-7 vaccination program in Spain will significantly decrease the mortality and morbidity associated with pneumococcal infections in young children. At an assumed cost of Euros 48.56 (ESP8080) per dose, PCV-7 vaccination of Spanish children under the age of 5, followed over a 10-year period, is cost saving from the societal perspective and cost-effective from the payer perspective at Euros 22500 per LYG (ESP3,734713), comparing favorably with other preventive programs in Spain.
肺炎链球菌是儿童患病的主要病因。七价肺炎球菌结合疫苗（PCV-7）最近在美国获得批准，是第一种为2岁以下儿童提供针对肺炎球菌疾病保护性免疫的疫苗。PCV-7在预防侵袭性肺炎球菌感染方面几乎100%有效，并且已显示可显著降低肺炎和中耳炎的发病率。
本研究的目的是评估与西班牙未接种疫苗的儿童相比，接种PCV-7疫苗的健康结果、成本和成本效益。
使用健康状态模型来确定5岁以下接种疫苗和未接种疫苗儿童组的健康和经济结果。该分析从初始接种疫苗开始，为期10年。关于肺炎球菌疾病负担的信息，包括疾病发病率和血清阳性率的数据，从已发表和未发表的记录中收集，并由西班牙儿科和传染病专家进行补充和核实。PCV-7的疗效基于凯撒医疗集团疗效研究的最新结果。使用考虑直接和间接成本的决策树分析确定每种肺炎球菌疾病的疾病成本估计值。出生队列分析比较了接种疫苗人群与年龄匹配的未接种疫苗人群的预期成本。
在西班牙对36万出生队列实施PCV-7疫苗计划，预计在10年内可挽救约16条生命，预防13.2万例肺炎球菌疾病，总节省估计为8100万欧元（135亿西班牙比塞塔），其中4350万欧元（71亿西班牙比塞塔）为直接医疗节省。每剂疫苗成本高达56.87欧元（9462西班牙比塞塔）时，对36万出生队列进行疫苗接种的总成本将被因发病率降低而产生的总节省所抵消。
在西班牙实施普遍的PCV-7疫苗接种计划将显著降低幼儿肺炎球菌感染相关的死亡率和发病率。假设每剂成本为48.56欧元（8080西班牙比塞塔），对西班牙5岁以下儿童接种PCV-7疫苗，在10年期间进行跟踪，从社会角度来看是节省成本的，从支付者角度来看，每获得一个质量调整生命年（LYG）成本效益为22500欧元（3734713西班牙比塞塔），与西班牙的其他预防计划相比具有优势。
