Mangtani Punam, Roberts Jennifer A, Hall Andrew J, Cutts Felicity T
London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Int J Epidemiol. 2005 Jun;34(3):565-74. doi: 10.1093/ije/dyh341. Epub 2005 Mar 11.
Polysaccharide pneumococcal vaccination for older adults is being introduced in developed country settings. Evidence of protection by this vaccine against pneumococcal pneumonia, or confirmation that illness and death from bacteraemia are prevented, is currently limited. Decisions are often made based on partial information. We examined the policy implications by exploring the potential economic benefit to society and the health sector of pneumococcal vaccination in older adults.
A model to estimate the potential cost savings and cost-effectiveness of a polysaccharide pneumococcal vaccine programme was based on costs collected from patients, the literature, and routine health-services data. The effect of a pneumococcal vaccine (compared with no vaccination) was examined in a hypothetical cohort aged over 64 years. The duration of protection was assumed to be 10 years, with or without a booster at 5 years.
If it were effective against morbidity from pneumococcal pneumonia, the main burden from pneumococcal disease, the vaccine could be cost-neutral to society or the health sector at low efficacy (28 and 37.5%, respectively, without boosting and with 70% coverage). If it were effective against morbidity from bacteraemia only, the vaccine's efficacy would need to be 75 and 89%, respectively. If protection against both morbidity and mortality from pneumococcal bacteraemia was 50%, the net cost to society would be 2500 pounds per year of life saved ( 3365 pounds from the health-sector perspective). Results were sensitive to incidence, case-fatality rates, and costs of illness.
A vaccine with moderate efficacy against bacteraemic illness and death would be cost-effective. If it also protected against pneumonia, it would be cost-effective even if its efficacy were low.
发达国家正在为老年人引入肺炎球菌多糖疫苗。目前，关于该疫苗预防肺炎球菌肺炎的保护证据，或证实其可预防菌血症导致的疾病和死亡的证据有限。决策往往基于不完整的信息。我们通过探讨肺炎球菌疫苗对老年人的潜在社会效益和卫生部门效益，研究了其政策影响。
基于从患者、文献和常规卫生服务数据收集的成本，建立了一个模型来估计肺炎球菌多糖疫苗计划的潜在成本节约和成本效益。在一个假设的64岁以上队列中，研究了肺炎球菌疫苗（与未接种疫苗相比）的效果。假设保护期为10年，无论是否在5年时进行加强接种。
如果该疫苗对肺炎球菌肺炎（肺炎球菌疾病的主要负担）的发病有效，那么在低效力（分别为28%和37.5%，不加强接种且覆盖率为70%）的情况下，对社会或卫生部门而言，该疫苗在成本上可能是中性的。如果仅对菌血症发病有效，那么该疫苗的效力分别需要达到75%和89%。如果对肺炎球菌菌血症的发病和死亡的保护率为50%，那么从社会角度每年每挽救一条生命的净成本将为2500英镑（从卫生部门角度为3365英镑）。结果对发病率、病死率和疾病成本敏感。
一种对菌血症疾病和死亡具有中等效力的疫苗将具有成本效益。如果它还能预防肺炎，那么即使其效力较低，也将具有成本效益。
