Postma M J, Bos J M, Beutels Ph, Schilthuis H, van den Hoek J A R
Groningen University Institute for Drug Exploration/University of Groningen Research Institute of Pharmacy (GUIDE/GRIP), Groningen, The Netherlands.
Vaccine. 2004 May 7;22(15-16):1862-7. doi: 10.1016/j.vaccine.2003.11.012.
Estimate cost-effectiveness of vaccination against hepatitis A virus (HAV) for children of ethnic minorities in Amsterdam.
Pharmaco-economic analysis is relevant for motivating reimbursement of vaccination costs in the framework of a programmatic approach to vaccination of ethnic minorities.
Pharmaco-economic modeling.
In cost-effectiveness analysis, costs, benefits and health gains were estimated for a large-scale HAV-vaccination for children of Turkish and Maroccan origin. Analysis was performed from the societal perspective, as recommended in the Dutch guidelines for pharmaco-economic research. This implies that indirect costs of production losses are included in the analysis. Cost-effectiveness was expressed in net costs per adult HAV-infection averted in incremental and aggregate analysis. Incremental analysis compares targeted vaccination with the current limited-scale HAV-vaccination that exists, whereas aggregate analysis compares targeted vaccination with the sheer absence of vaccination.
Net aggregate costs of targeted HAV-vaccination for Turkish and Maroccan children in Amsterdam amounts to 61.000. Cost-effectiveness was estimated, in aggregate and incremental analysis, at 13.500 and 11.100 respectively per adult HAV-infection averted. Uni- and multivariate sensitivity analyses show that major impact on cost-effectiveness may be expected from reductions in the vaccine price through economies of scale. Probabilistic sensitivity analysis indicates possible large fluctuations in cost-effectiveness from 1 year to another, related to varying incidence of disease.
HAV-vaccination for children from ethnic minorities in Amsterdam is not cost saving, but may have a favourable cost-effectiveness. Such a vaccination program fits into the recent Dutch policy of specific vaccinations directed at groups of ethnic minorities, such as for hepatitis B.
评估阿姆斯特丹市少数民族儿童接种甲型肝炎病毒（HAV）疫苗的成本效益。
药物经济学分析对于推动在少数民族疫苗接种计划框架内报销疫苗接种费用具有重要意义。
药物经济学建模。
在成本效益分析中，估算了针对土耳其和摩洛哥裔儿童大规模接种HAV疫苗的成本、效益和健康收益。按照荷兰药物经济学研究指南的建议，从社会角度进行分析。这意味着分析中纳入了生产损失的间接成本。在增量分析和总体分析中，成本效益以每避免一例成人HAV感染的净成本来表示。增量分析将目标接种与现有的有限规模HAV接种进行比较，而总体分析则将目标接种与完全不接种进行比较。
阿姆斯特丹市针对土耳其和摩洛哥儿童的目标HAV接种的总净成本为61,000。在总体分析和增量分析中，每避免一例成人HAV感染的成本效益估计分别为13,500和11,100。单变量和多变量敏感性分析表明，通过规模经济降低疫苗价格可能会对成本效益产生重大影响。概率敏感性分析表明，由于疾病发病率的变化，成本效益可能在不同年份出现较大波动。
阿姆斯特丹市少数民族儿童接种HAV疫苗虽不节省成本，但可能具有良好的成本效益。这样的疫苗接种计划符合荷兰近期针对少数民族群体的特定疫苗接种政策，如乙型肝炎疫苗接种政策。
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