Giorgi-Rossi Paolo, Merito Monica, Borgia Piero
Agency for Public Health, Lazio Region, Via di S. Costanza, 53, 00198 Rome, Italy.
Health Policy. 2009 Feb;89(2):225-38. doi: 10.1016/j.healthpol.2008.05.016. Epub 2008 Jul 18.
To examine the health outcomes and costs of a hypothetical pneumococcal vaccination campaign among the general infant population in the Lazio region (Italy).
We developed a model simulating direct medical costs and health outcomes of vaccinating infants with conjugated pneumococcal vaccine (PCV-7) compared to the costs (in and outpatient) of treating the disease, from a public health service perspective. According to vaccine trials' outcomes, we considered vaccine effectiveness in preventing part of the invasive pneumococcal disease (IPD), pneumonia of any aetiology, and acute otitis moedia. Age-specific incidence, mortality and health care costs came from local surveillance and surveys; the vaccine costs euro40/dose. Annual budgetary impact and macro-health benefits were predicted for 2005-2014. Cost-effectiveness was expressed as net healthcare costs per disability-adjusted life-year (DALY) gained.
After 10 years, five cases of meningitis, 20 IPD, 933 pneumonia, 406 pneumonia-related hospitalisations, and 3160 otitis cases would be averted annually by vaccinating. The annual cost of vaccination would be euro4.9m, and annual costs averted would be euro1.4m. Additional healthcare costs of a mass vaccination would decrease over time from euro5.1m to euro3.5m per year. At baseline, net cost per averted DALY was euro18.0k, if health benefits are not discounted, and euro51.7k adopting a 3.5% discount rate; it was 12% lower with a hypothesis of high IPD incidence and 68% lower if the vaccine cost 50% less.
The cost of the vaccine makes the campaign more expensive than today's recommended infant vaccinations. Nevertheless, the cost-effectiveness of introducing PCV-7 in Lazio compares favourably with previous estimates in similar countries.
研究在意大利拉齐奥地区普通婴儿群体中开展假设性肺炎球菌疫苗接种活动的健康结果和成本。
从公共卫生服务角度出发，我们建立了一个模型，模拟为婴儿接种结合型肺炎球菌疫苗（PCV-7）的直接医疗成本和健康结果，并与治疗该疾病的成本（门诊和住院）进行比较。根据疫苗试验结果，我们考虑了疫苗在预防部分侵袭性肺炎球菌疾病（IPD）、任何病因的肺炎以及急性中耳炎方面的有效性。特定年龄的发病率、死亡率和医疗保健成本来自当地监测和调查；疫苗成本为每剂40欧元。预测了2005 - 2014年的年度预算影响和宏观健康效益。成本效益以每获得一个伤残调整生命年（DALY）的净医疗成本来表示。
接种疫苗10年后，每年可避免5例脑膜炎、20例IPD、933例肺炎、406例与肺炎相关的住院以及3160例中耳炎病例。疫苗接种的年度成本将为490万欧元，每年避免的成本将为140万欧元。大规模疫苗接种的额外医疗成本将随着时间从每年510万欧元降至350万欧元。在基线时，如果不考虑健康效益的贴现，每避免一个DALY的净成本为1.8万欧元；采用3.5%的贴现率时为5.17万欧元；如果假设IPD发病率高，成本将降低12%；如果疫苗成本降低50%，成本将降低68%。
疫苗成本使得该活动比目前推荐的婴儿疫苗接种更昂贵。然而，在拉齐奥地区引入PCV-7的成本效益与类似国家先前的估计相比具有优势。
