Ortega-Sanchez Ismael R, Meltzer Martin I, Shepard Colin, Zell Elizabeth, Messonnier Mark L, Bilukha Oleg, Zhang Xinzhi, Stephens David S, Messonnier Nancy E
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Clin Infect Dis. 2008 Jan 1;46(1):1-13. doi: 10.1086/524041.
In June 2005, the Advisory Committee on Immunization Practices recommended the newly licensed quadrivalent meningococcal conjugate vaccine for routine use among all US children aged 11 years. A 1-time catch-up vaccination campaign for children and adolescents aged 11-17 years, followed by routine annual immunization of each child aged 11 years, could generate immediate herd immunity benefits. The objective of our study was to analyze the cost-effectiveness of a catch-up vaccination campaign with quadrivalent meningococcal conjugate vaccine for children and adolescents aged 11-17 years.
We built a probabilistic model of disease burden and economic impacts for a 10-year period with and without a program of adolescent catch-up meningococcal vaccination, followed by 9 years of routine immunization of children aged 11 years. We used US age- and serogroup-specific surveillance data on incidence and mortality. Assumptions related to the impact of herd immunity were drawn from experience with routine meningococcal vaccination in the United Kingdom. We estimated costs per case, deaths prevented, life-years saved, and quality-adjusted life-years saved.
With herd immunity, the catch-up and routine vaccination program for adolescents would prevent 8251 cases of meningococcal disease in a 10-year period (a 48% decrease). Excluding program costs, this catch-up and routine vaccination program would save US$551 million in direct costs and $920 million in indirect costs, including costs associated with permanent disability and premature death. At $83 per vaccinee, the catch-up vaccination would cost society approximately $223,000 per case averted, approximately $2.6 million per death prevented, approximately $127,000 per life-year saved, and approximately $88,000 per quality-adjusted life-year saved. Targeting counties with a high incidence of disease decreased the cost per life-year saved by two-thirds.
Although costly, catch-up and routine vaccination of adolescents can have a substantial impact on meningococcal disease burden. Because of herd immunity, catch-up and routine vaccination cost per life-year saved could be up to one-third less than that previously assessed for routine vaccination of children aged 11 years.
2005年6月，免疫实践咨询委员会建议将新获批的四价脑膜炎球菌结合疫苗用于美国所有11岁儿童的常规接种。针对11至17岁儿童和青少年开展一次补种疫苗活动，随后对每名11岁儿童进行年度常规免疫接种，可立即产生群体免疫效益。我们研究的目的是分析针对11至17岁儿童和青少年开展四价脑膜炎球菌结合疫苗补种活动的成本效益。
我们构建了一个疾病负担和经济影响的概率模型，涵盖有和没有青少年补种脑膜炎球菌疫苗计划的10年期间，随后是对11岁儿童进行9年的常规免疫接种。我们使用了美国按年龄和血清群分类的发病率和死亡率监测数据。与群体免疫影响相关的假设取自英国常规脑膜炎球菌疫苗接种的经验。我们估计了每例病例的成本、预防的死亡数、挽救的生命年数以及挽救的质量调整生命年数。
通过群体免疫，青少年补种和常规疫苗接种计划在10年内可预防8251例脑膜炎球菌病（减少48%）。不包括项目成本，该补种和常规疫苗接种计划将节省5.51亿美元的直接成本和9.2亿美元的间接成本，包括与永久性残疾和过早死亡相关的成本。按每名接种者83美元计算，补种疫苗将使社会平均每避免一例病例花费约22.3万美元，每预防一例死亡花费约260万美元，每挽救一个生命年花费约12.7万美元，每挽救一个质量调整生命年花费约8.8万美元。针对疾病高发县进行接种可将每挽救一个生命年的成本降低三分之二。
尽管成本高昂，但青少年补种和常规疫苗接种可对脑膜炎球菌病负担产生重大影响。由于群体免疫，补种和常规疫苗接种每挽救一个生命年的成本可能比之前评估的11岁儿童常规疫苗接种成本低多达三分之一。
