Wisløff Torbjørn, Abrahamsen Tore G, Bergsaker Marianne A Riise, Løvoll Øistein, Møller Per, Pedersen Maren Kristine, Kristiansen Ivar Sønbø
Norwegian Knowledge Centre for the Health Services, Department of Pediatrics, Rikshospitalet-Radiumhospitalet Medical Center, University of Oslo, Norway.
Vaccine. 2006 Jul 17;24(29-30):5690-9. doi: 10.1016/j.vaccine.2006.04.042. Epub 2006 May 5.
Streptococcus pneumoniae is a frequent bacterial cause of serious infections that may cause permanent sequelae and death. A 7-valent conjugate vaccine may reduce the incidence of pneumococcal disease, but some previous studies have questioned the cost-effectiveness of the vaccine. The aim of this study was to estimate costs and health consequences of adding this pneumococcal vaccine to the Norwegian childhood vaccination programme, taking the possibility of herd immunity into account.
We developed a simulation model (Markov-model) using data on the risk of pneumococcal disease in Norway, the efficacy of the vaccine as observed in clinical trials from other countries and adjusted for serotype differences, the cost of the vaccine and quality of life for patients with sequelae from pneumococcal disease. The results were expressed as incremental (additional) costs (in euros; euro1.00 approximately NOK8.37), incremental life years and incremental quality adjusted life years. Four different sets of main results are presented: costs and (quality adjusted) life years, with and without indirect costs (the value of lost production due to work absenteeism) and with and without potential herd immunity (i.e. childhood vaccination protects adults against pneumococcal disease).
When indirect costs were disregarded, and four vaccine doses used, the incremental cost per life year gained was euro153,000 when herd immunity was included, and euro311,000 when it was not. When accounting for indirect costs as well, the cost per life year gained was euro58,000 and euro124,000, respectively. Assuming that three vaccine doses provide the same protection as four, the cost per life year gained with this regimen was euro90,000 with herd immunity and euro184,000 without (when indirect costs are disregarded). If indirect costs are also included, vaccination both saves costs and gains life years.
INTERPRETATION/CONCLUSION: In Norway, governmental guidelines indicate that only interventions with cost per life year of less than euro54,000 should be implemented. This implies that four dose vaccination is not cost-effective even if decision makers includes both herd immunity and indirect costs in their decisions. If three doses offer the same protection as four doses, however, vaccination would be cost-saving when indirect costs are included, but not with only herd immunity.
In the autumn of 2005, the Norwegian Government decided to include PCV-7 in the vaccination program. This analysis was used by the Ministry of Health and Ministry of Finance during the decision process.
肺炎链球菌是严重感染的常见细菌病因，可导致永久性后遗症和死亡。一种7价结合疫苗可能会降低肺炎球菌疾病的发病率，但之前的一些研究对该疫苗的成本效益提出了质疑。本研究的目的是评估将这种肺炎球菌疫苗添加到挪威儿童疫苗接种计划中的成本和健康后果，并考虑群体免疫的可能性。
我们使用挪威肺炎球菌疾病风险数据、在其他国家临床试验中观察到的疫苗效力并根据血清型差异进行调整、疫苗成本以及肺炎球菌疾病后遗症患者的生活质量等数据，开发了一个模拟模型（马尔可夫模型）。结果以增量（额外）成本（以欧元计；1.00欧元约合8.37挪威克朗）、增量生命年和增量质量调整生命年表示。给出了四组不同的主要结果：有间接成本和无间接成本（因旷工导致的生产损失价值）以及有潜在群体免疫和无潜在群体免疫（即儿童接种疫苗可保护成年人免受肺炎球菌疾病侵害）情况下的成本和（质量调整）生命年。
当不考虑间接成本且使用四剂疫苗时，纳入群体免疫时每获得一个生命年的增量成本为153,000欧元，未纳入时为311,000欧元。若同时考虑间接成本，每获得一个生命年的成本分别为58,000欧元和124,000欧元。假设三剂疫苗与四剂疫苗提供相同的保护，采用该方案时，纳入群体免疫且不考虑间接成本时每获得一个生命年的成本为90,000欧元，未纳入时为184,000欧元。若也包括间接成本，接种疫苗既能节省成本又能增加生命年。
解读/结论：在挪威，政府指南表明，每生命年成本低于54,000欧元的干预措施才应实施。这意味着即使决策者在决策中同时考虑群体免疫和间接成本，四剂接种也不具有成本效益。然而，如果三剂疫苗与四剂疫苗提供相同的保护，纳入间接成本时接种疫苗将节省成本，但仅考虑群体免疫时则不然。
2005年秋季，挪威政府决定将7价肺炎球菌结合疫苗纳入疫苗接种计划。卫生部和财政部在决策过程中使用了本分析。
