Coudeville Laurent, Brunot Alain, Giaquinto Carlo, Lucioni Carlo, Dervaux Benoit
Cresge-Labores, Catholic University of Lille, Lille, France.
Pharmacoeconomics. 2004;22(13):839-55. doi: 10.2165/00019053-200422130-00003.
To determine the economic impact (cost-benefit analysis) of childhood varicella vaccination, with the Oka/Merck varicella zoster virus vaccine live (Varivax) in Italy.
This analysis is based on an epidemiological model of varicella zoster virus (VZV) dynamics adapted to the Italian situation. Cost data (Euro, 2002 values) were collected through a literature review. Several vaccination scenarios were analysed: (i) routine vaccination programme for children aged 1-2 years with different levels of vaccination coverage (90%, 70% and 45%) without any catch-up programme; (ii) routine vaccination programme for children aged 1-2 years with different levels of vaccination coverage (90%, 70% and 45%) completed by a catch-up programme for 6-year-old children over the first 5 years of vaccine marketing; and (iii) routine vaccination programme for children aged 1-2 years with different levels of vaccination coverage (90%, 70% and 45%) completed by a catch-up programme during the first year of vaccine marketing for children aged 2-11 years.
A societal perspective, including both direct and indirect costs, and a health-system perspective, limited to costs supported by Italian Health Authorities, were considered.
A routine vaccination programme has a clearly positive impact on chickenpox morbidity. Respectively, 68% and 57% of chickenpox-related hospitalisations and deaths could be prevented with a 90% coverage rate. With vaccination costs being more than offset by a reduction in chickenpox treatment costs in the base case, such a programme could also induce savings from both a societal and a health-system perspective (40% and 12% savings, respectively for a 90% coverage rate). A lower coverage rate reduces cost savings, but there is still a 9% decrease in overall societal costs for a 45% coverage rate. Although the reduction in total societal costs was robust to the sensitivity analyses performed, a slight uncertainty remains regarding cost reduction from a health-system perspective. However, in this latter perspective, even in the worst-case scenario of the sensitivity analysis, routine vaccination programmes may be cost effective, the worst-case scenario for cost parameters leading to cost per life-year gained of Euro2853. Catch-up programmes combined with routine vaccination should lead to further cost reductions from a societal perspective: 15% for a massive catch-up during the first year of vaccine marketing compared with toddlers' vaccination alone, and 11% for a catch-up focused on 6-year-old children for a period of 5 years. However, the impact of catch-up programmes on the costs from an Italian health-system perspective remains close to zero (+/-1%).
This model suggests, with its underlying assumptions and data, that routine ZVZ vaccination may be cost saving from both a societal and a health system perspective in the base case. In the worst-case scenario of the sensitivity analysis, vaccination remains cost effective.
运用默克公司生产的水痘-带状疱疹病毒减毒活疫苗（Varivax），确定在意大利进行儿童水痘疫苗接种的经济影响（成本效益分析）。
本分析基于一个针对意大利情况调整的水痘-带状疱疹病毒（VZV）动力学流行病学模型。成本数据（欧元，2002年价值）通过文献综述收集。分析了几种疫苗接种方案：（i）针对1 - 2岁儿童的常规疫苗接种计划，接种覆盖率不同（90%、70%和45%），无任何补种计划；（ii）针对1 - 2岁儿童的常规疫苗接种计划，接种覆盖率不同（90%、70%和45%），在疫苗上市的前5年对6岁儿童进行补种计划；（iii）针对1 - 2岁儿童的常规疫苗接种计划，接种覆盖率不同（90%、70%和45%），在疫苗上市的第一年对2 - 11岁儿童进行补种计划。
考虑了社会视角，包括直接和间接成本，以及卫生系统视角，仅限于意大利卫生当局承担的成本。
常规疫苗接种计划对水痘发病率有明显的积极影响。接种覆盖率为90%时，分别可预防68%和57%与水痘相关的住院和死亡。在基础情况下，疫苗接种成本被水痘治疗成本的降低所抵消，这样一个计划从社会和卫生系统视角都能带来节省（接种覆盖率为90%时分别节省40%和12%）。较低的接种覆盖率会减少成本节省，但接种覆盖率为45%时，总体社会成本仍会降低9%。尽管对进行的敏感性分析而言，社会总成本的降低是稳健的，但从卫生系统视角来看，成本降低仍存在轻微不确定性。然而，从后一个视角来看，即使在敏感性分析的最坏情况下，常规疫苗接种计划可能具有成本效益，成本参数的最坏情况导致每获得一个生命年的成本为2853欧元。从社会视角来看，补种计划与常规疫苗接种相结合应能进一步降低成本：与仅对幼儿进行疫苗接种相比，在疫苗上市的第一年进行大规模补种可降低15%，对6岁儿童进行为期5年的补种可降低11%。然而，从意大利卫生系统视角来看，补种计划对成本的影响仍接近零（±1%）。
该模型及其基本假设和数据表明，在基础情况下，常规水痘疫苗接种从社会和卫生系统视角都可能节省成本。在敏感性分析的最坏情况下，疫苗接种仍具有成本效益。
