Beutels Philippe, Scuffham Paul A, MacIntyre C Raina
Centre for Health Economics Research and Modelling Infectious Diseases, Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
Lancet Infect Dis. 2008 Nov;8(11):727-33. doi: 10.1016/S1473-3099(08)70258-5.
Vaccines have features that require special consideration when assessing their cost-effectiveness. These features are related to herd immunity, quality-of-life losses in young children, parental care and work loss, time preference, uncertainty, eradication, macroeconomics, and tiered pricing. Advisory committees on public funding for vaccines, or for pharmaceuticals in general, should be knowledgable about these special features. We discuss key issues and difficulties in decision making for vaccines against rotavirus, human papillomavirus, varicella-zoster virus, influenza virus, and Streptococcus pneumoniae. We argue that guidelines for economic evaluation should be reconsidered generally to recommend (1) modelling options for the assessment of interventions against infectious diseases; (2) a wider perspective to account for impacts on third parties, if relevant; (3) a wider scope of costs than health-care system costs alone, if appropriate; and (4) alternative discounting techniques to explore social time preference over long periods.
疫苗具有一些特性，在评估其成本效益时需要特别考虑。这些特性与群体免疫、幼儿生活质量损失、父母护理和工作损失、时间偏好、不确定性、根除、宏观经济学以及分层定价有关。负责疫苗或一般药品公共资金的咨询委员会应了解这些特殊特性。我们讨论了针对轮状病毒、人乳头瘤病毒、水痘-带状疱疹病毒、流感病毒和肺炎链球菌的疫苗决策中的关键问题和困难。我们认为，应总体上重新考虑经济评估指南，以建议：（1）针对传染病干预措施评估的建模选项；（2）如果相关，采用更广泛的视角来考虑对第三方的影响；（3）如果合适，成本范围应比仅医疗保健系统成本更广泛；（4）采用替代贴现技术来探索长期的社会时间偏好。
