Demicheli V, Jefferson T O
Department of Medical Statistics, University of Pavia, Italy.
J Public Health Med. 1992 Dec;14(4):367-75. doi: 10.1093/oxfordjournals.pubmed.a042774.
The aim of the study was to evaluate the costs and benefits of introducing mass vaccination against hepatitis B in Italy, given the announcement of compulsory vaccination of all newborn babies from 1991. Benefits were calculated by summarizing the clinical course of hepatitis B in Italy and projecting its incidence rates to the next 30 years using Brown's exponential smoothing technique. Incidence rates were then applied to the survivors of a cohort of newborns in 1992, and the total number of cases avoidable through vaccination was derived. Direct and indirect marginal costs were estimated for these cases. The marginal costs of the vaccination campaign were estimated. Cost and benefits were compared for 99 years following the introduction of the vaccination, using an 8 per cent discount rate and a sensitivity analysis. Despite difficulties in data gathering, susceptibility to discounting and estimating costs, results show an unfavourable cost-benefit ratio which is influenced by a declining incidence of the disease. Vaccination of high-risk groups is probably more efficient.
鉴于意大利自1991年起宣布对所有新生儿进行强制接种乙肝疫苗，本研究旨在评估在意大利推行大规模乙肝疫苗接种的成本与效益。通过总结意大利乙肝的临床病程，并运用布朗指数平滑技术预测未来30年的发病率来计算效益。然后将发病率应用于1992年一组新生儿的幸存者，得出通过接种疫苗可避免的病例总数。对这些病例的直接和间接边际成本进行了估算。估算了疫苗接种运动的边际成本。采用8%的贴现率并进行敏感性分析，比较了接种疫苗后99年的成本和效益。尽管在数据收集、贴现敏感性和成本估算方面存在困难，但结果显示成本效益比不利，这受到疾病发病率下降的影响。对高危人群进行疫苗接种可能更有效。
