Lloyd Adam, Patel Nishma, Scott David A, Runge Claus, Claes Christa, Rose Markus
Fourth Hurdle Consulting Ltd, London, WC1V 6PL, UK.
Eur J Health Econ. 2008 Feb;9(1):7-15. doi: 10.1007/s10198-006-0013-6. Epub 2007 Mar 2.
In Germany, the seven-valent conjugate vaccine Prevenar is recommended for use in children at high risk of pneumococcal disease. Recent data suggest that giving conjugate vaccine to all children may lead to a decline in pneumococcal disease in unvaccinated adults, a phenomenon known as herd immunity. This analysis evaluated the cost and economic consequences in Germany of vaccinating (1) children at high risk, (2) all children when considering only benefits for vaccinated individuals and (3) all children when also considering herd immunity benefits. Costs in the model included vaccination, management of meningitis, bacteraemia, pneumonia and acute otitis media, insurance payments to parents and the costs of care for long-term disabilities. The model estimated that the cost-effectiveness of vaccination would be 38,222 euros per life year gained in children at high risk and 100,636 euros per life year gained in all children when not considering herd immunity. When considering herd immunity effects, the model estimated that offering vaccination for all children would reduce adult deaths by 3,027 per year, and vaccination would be broadly cost neutral. The findings are sensitive to the effect of conjugate vaccine on the rates of pneumonia and invasive disease in the elderly. If the herd immunity effect of conjugate vaccination in Germany is similar to that observed elsewhere, offering vaccine to all children will be more attractive than the current policy of restricting vaccination to children at high risk of pneumococcal disease.
在德国，七价结合疫苗沛儿被推荐用于肺炎球菌疾病高危儿童。近期数据表明，给所有儿童接种结合疫苗可能会导致未接种疫苗的成年人中肺炎球菌疾病发病率下降，这一现象被称为群体免疫。本分析评估了在德国对以下人群进行疫苗接种的成本和经济后果：（1）高危儿童；（2）仅考虑接种疫苗个体的益处时的所有儿童；（3）同时考虑群体免疫益处时的所有儿童。模型中的成本包括疫苗接种、脑膜炎、菌血症、肺炎和急性中耳炎的管理、向家长支付的保险金以及长期残疾的护理成本。该模型估计，在不考虑群体免疫的情况下，高危儿童接种疫苗的成本效益为每获得一个生命年38,222欧元，所有儿童接种疫苗的成本效益为每获得一个生命年100,636欧元。在考虑群体免疫效应时，该模型估计为所有儿童提供疫苗接种每年可减少3,027例成人死亡，并且疫苗接种在总体上成本持平。研究结果对结合疫苗对老年人肺炎和侵袭性疾病发病率的影响较为敏感。如果德国结合疫苗的群体免疫效应与其他地方观察到的相似，那么为所有儿童提供疫苗将比目前将疫苗接种限制在肺炎球菌疾病高危儿童的政策更具吸引力。
