Kim Sun-Young, Salomon Joshua A, Goldie Sue J
Program in Health Decision Science, Health Policy and Management Department, Harvard School of Public Health, Boston, MA 02115, USA.
Bull World Health Organ. 2007 Nov;85(11):833-42. doi: 10.2471/blt.06.038893.
We sought to describe a method that explicitly considers both a health-care programmes cost-effectiveness and its affordability. For illustration, we apply the method to the programme to vaccinate infants against hepatitis B in the Gambia.
We synthesized selected data and developed a computer-based model from the societal and payer perspectives to evaluate the cost-effectiveness of routine infant vaccination against hepatitis B in the Gambia compared with no vaccination. The primary outcome measure was cost per averted disability-adjusted life year (DALY), which was expressed in 2002 US dollars. We used Monte Carlo methods for uncertainty analysis to examine the affordability of the programme from the payers perspective, and we derived an affordability curve and cost-effectiveness affordability curves for the programme.
In the Gambia, vaccinating infants against hepatitis B is highly cost-effective. Compared with offering no intervention, the vaccination programme would cost US$ 28 per DALY averted from the societal perspective or US$ 47 per DALY averted from the payers perspective. The programme also has the potential to be affordable, starting at a relatively low budget of US$ 160,000 per year. Combining the two dimensions of the outcome measure, the probability that vaccinating infants would be both cost-effective and affordable is 40% at an annual programme budget of US$ 182,000 (the estimated total programme cost from the payers perspective), given a threshold cost-effectiveness value of US$ 47 per DALY averted.
In the face of uncertainties about both the health and economic consequences of a vaccine programme, as well as the availability and magnitude of resources needed to fund the programme, cost-effectiveness affordability curves can provide information to decision-makers about the probability that a programme will be both cost-effective and affordable: these are distinct but equally relevant considerations in resource-poor settings.
我们试图描述一种能明确兼顾医疗保健项目成本效益及其可承受性的方法。为举例说明，我们将该方法应用于冈比亚的婴儿乙型肝炎疫苗接种项目。
我们综合了选定的数据，并从社会和付款方的角度开发了一个基于计算机的模型，以评估冈比亚常规婴儿乙型肝炎疫苗接种与不接种相比的成本效益。主要结果指标是避免每例伤残调整生命年（DALY）的成本，以2002年美元表示。我们使用蒙特卡罗方法进行不确定性分析，从付款方的角度审视该项目的可承受性，并得出该项目的可承受性曲线和成本效益可承受性曲线。
在冈比亚，给婴儿接种乙型肝炎疫苗具有很高的成本效益。与不采取干预措施相比，从社会角度看，疫苗接种项目每避免一例DALY的成本为28美元，从付款方角度看为47美元。该项目也有实现可承受性的潜力，每年从相对较低的16万美元预算起步。结合结果指标的两个维度，在每年18.2万美元的项目预算（从付款方角度估计的项目总成本）下，给婴儿接种疫苗既具有成本效益又具有可承受性的概率为40%，设定的成本效益阈值为每避免一例DALY 47美元。
面对疫苗项目在健康和经济后果方面的不确定性，以及为该项目提供资金所需资源的可得性和规模，成本效益可承受性曲线可以向决策者提供关于一个项目既具有成本效益又具有可承受性的概率的信息：在资源匮乏的环境中，这些是不同但同样相关的考虑因素。
