Rheingans Richard D, Heylen Johan, Giaquinto Carlo
Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Pediatr Infect Dis J. 2006 Jan;25(1 Suppl):S48-55. doi: 10.1097/01.inf.0000197566.47750.3d.
Rotavirus is a major cause of gastroenteritis in children throughout Europe and the world. In addition to causing morbidity and mortality in children, rotavirus gastroenteritis (RVGE) creates a major economic burden on health care systems and families in Europe. The costs of hospital admissions for RVGE and nosocomial infections generate significant medical treatment costs throughout the region. Less information is available on the costs associated with less severe episodes and the costs borne by families, including lost time from work. The availability of rotavirus vaccines presents an effective opportunity to prevent RVGE and these associated economic costs, as well as providing protection to each child and hence benefiting the child's family. The adoption of rotavirus vaccine by health authorities in Europe will require a comparison of the costs and benefits. Economic evaluations that compare the costs of vaccination to the economic benefits of rotavirus vaccination will provide an estimate of its financial impact on health care systems and society. However, to provide a complete picture, economic evaluations of rotavirus vaccines will need to account for both the reduced costs and the reduced morbidity from prevented RVGE. Cost-effectiveness analyses based on quality-adjusted life years (QALYs) provide a systematic approach for assessing vaccination as a health investment, comparing the incremental costs associated with rotavirus vaccination and the reduced morbidity and mortality. QALYs provide a standardized approach for quantifying and comparing reductions in health-related quality of life and premature mortality. Although methodologic limitations exist in applying the QALY approach to childhood vaccines, their use in cost effectiveness analyses allows decision makers to consider the full health benefits of rotavirus and other vaccines.
轮状病毒是欧洲乃至全球儿童肠胃炎的主要病因。除了导致儿童发病和死亡外，轮状病毒肠胃炎（RVGE）还给欧洲的医疗保健系统和家庭带来了巨大的经济负担。RVGE住院治疗费用和医院感染费用在整个地区产生了高昂的医疗成本。关于病情较轻发作的相关成本以及家庭所承担的成本（包括误工时间）的信息较少。轮状病毒疫苗的出现为预防RVGE及其相关经济成本提供了一个有效机会，同时也为每个儿童提供保护，从而使儿童家庭受益。欧洲卫生当局采用轮状病毒疫苗需要对成本和效益进行比较。将疫苗接种成本与轮状病毒疫苗接种的经济效益进行比较的经济评估，将提供其对医疗保健系统和社会的财务影响估计。然而，为了全面了解情况，轮状病毒疫苗的经济评估需要同时考虑预防RVGE带来的成本降低和发病率降低。基于质量调整生命年（QALYs）的成本效益分析为评估疫苗接种作为一项健康投资提供了一种系统方法，比较了轮状病毒疫苗接种的增量成本以及发病率和死亡率的降低。QALYs为量化和比较与健康相关的生活质量下降和过早死亡的减少提供了一种标准化方法。尽管将QALY方法应用于儿童疫苗存在方法学上的局限性，但在成本效益分析中使用该方法可以让决策者考虑轮状病毒疫苗和其他疫苗的全部健康益处。
