Centre for Pharmacoeconomics Research, School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
J Epidemiol Community Health. 2009 Nov;63(11):906-11. doi: 10.1136/jech.2008.081885. Epub 2009 Jul 15.
To compare cost and quality-adjusted life-years (QALYs) gained by influenza vaccination with or without pneumococcal vaccination in the elderly living in long-term care facilities (LTCFs).
Cost-effectiveness analysis based on Markov modelling over 5 years, from a Hong Kong public health provider's perspective, on a hypothetical cohort of LTCF residents aged > or = 65 years. Benefit-cost ratio (BCR) and net present value (NPV) of two vaccination strategies versus no vaccination were estimated. The cost and QALYs gained by two vaccination strategies were compared by Student's t-test in probabilistic sensitivity analysis (10,000 Monte Carlo simulations).
Both vaccination strategies had high BCRs and NPVs (6.39 and US$334 for influenza vaccination; 5.10 and US$332 for influenza plus pneumococcal vaccination). In base case analysis, the two vaccination strategies were expected to cost less and gain higher QALYs than no vaccination. In probabilistic sensitivity analysis, the cost of combined vaccination and influenza vaccination was significantly lower (p<0.001) than the cost of no vaccination. Both vaccination strategies gained significantly higher (p<0.001) QALYs than no vaccination. The QALYs gained by combined vaccination were significantly higher (p = 0.030) than those gained by influenza vaccination alone. The total cost of combined vaccination was significantly lower (p = 0.011) than that of influenza vaccination.
Influenza vaccination with or without pneumococcal vaccination appears to be less costly with higher QALYs gained than no vaccination, over a 5-year period, for elderly people living in LTCFs from the perspective of a Hong Kong public health organisation. Combined vaccination was more likely to gain higher QALYs with lower total cost than influenza vaccination alone.
比较在长期护理机构（LTCF）中老年人接种流感疫苗和/或肺炎球菌疫苗的成本和质量调整生命年（QALYs）。
基于 Markov 模型的成本效益分析，以香港公共卫生机构的角度，针对年龄≥65 岁的 LTCF 居民进行了假设队列。分别估计了两种疫苗接种策略（不接种疫苗）相对于不接种疫苗的效益成本比（BCR）和净现值（NPV）。在概率敏感性分析中（10000 次蒙特卡罗模拟），通过学生 t 检验比较了两种疫苗接种策略的成本和获得的 QALYs。
两种疫苗接种策略均具有较高的 BCR 和 NPV（流感疫苗接种为 6.39 和 334 美元；流感加肺炎球菌疫苗接种为 5.10 和 332 美元）。在基础案例分析中，两种疫苗接种策略预计比不接种疫苗花费更少，获得的 QALYs 更高。在概率敏感性分析中，联合疫苗接种和流感疫苗接种的成本明显低于（p<0.001）不接种疫苗的成本。两种疫苗接种策略获得的 QALYs 明显高于（p<0.001）不接种疫苗的。联合疫苗接种获得的 QALYs 明显高于（p = 0.030）单独接种流感疫苗的。联合疫苗接种的总成本明显低于（p = 0.011）流感疫苗接种的。
从香港公共卫生机构的角度来看，在 5 年内，与不接种疫苗相比，LTCF 中的老年人接种流感疫苗和/或肺炎球菌疫苗的成本更低，获得的 QALYs 更高。与单独接种流感疫苗相比，联合疫苗接种更有可能获得更高的 QALYs 和更低的总成本。
