Martin A, Batty A, Roberts J A, Standaert B
GlaxoSmithKline Ltd., Stockley Park, Middlesex, UK.
Vaccine. 2009 Jul 16;27(33):4520-8. doi: 10.1016/j.vaccine.2009.05.006. Epub 2009 May 27.
This study estimated the cost-effectiveness of infant rotavirus vaccination with Rotarix in the UK, taking into account community rotavirus infections that do not present to the healthcare system. A Markov model compared the costs and outcomes of vaccination versus no vaccination in a hypothetical birth cohort of children followed over a lifetime, from a societal perspective and the perspective of the National Health Service (NHS). The model estimated costs and quality-adjusted life-years (QALYs) lost due to death, hospitalisation, general practitioner (GP) consultation, emergency attendance and calls to NHS Direct for rotavirus infection in children aged <5 years. Time lost from work and parents' travel costs were also included in the societal perspective. The base case cost-effectiveness ratio for vaccination compared with no vaccination was pound23,298/QALY from the NHS perspective and pound11,459 from the societal perspective. In sensitivity analysis, the most important parameters were hospitalisation cost and number of GP consultations. Addition of Rotarix to the paediatric vaccination schedule would be a cost-effective policy option in the UK at the threshold range ( pound20,000-30,000/QALY) currently adopted by the National Institute for Health and Clinical Excellence.
本研究评估了在英国使用Rotarix疫苗接种预防婴儿轮状病毒感染的成本效益,其中考虑了未就医的社区轮状病毒感染情况。一个马尔可夫模型从社会视角和英国国家医疗服务体系(NHS)的视角,比较了在一个假设的出生队列中儿童一生接种疫苗与不接种疫苗的成本和结果。该模型估计了5岁以下儿童因轮状病毒感染导致死亡、住院、看全科医生(GP)、急诊就诊以及拨打NHS Direct热线所造成的成本损失和质量调整生命年(QALY)损失。从社会视角来看,还包括了工作时间损失和家长的交通费用。从NHS视角来看,接种疫苗与不接种疫苗的基本成本效益比为每QALY 23,298英镑,从社会视角来看为每QALY 11,459英镑。在敏感性分析中,最重要的参数是住院成本和看全科医生的次数。在英国,按照英国国家卫生与临床优化研究所目前采用的阈值范围(每QALY 20,000 - 30,000英镑),将Rotarix疫苗纳入儿童疫苗接种计划将是一种具有成本效益的政策选择。