接种 2009 年大流行性流感（H1N1）疫苗的效果和成本效益。
Effectiveness and cost-effectiveness of vaccination against pandemic influenza (H1N1) 2009.
机构信息
Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, 300 Pasteur Drive, H3143, Stanford, CA 94305, USA.
出版信息
Ann Intern Med. 2009 Dec 15;151(12):829-39. doi: 10.7326/0003-4819-151-12-200912150-00157.
BACKGROUND
Decisions on the timing and extent of vaccination against pandemic (H1N1) 2009 virus are complex.
OBJECTIVE
To estimate the effectiveness and cost-effectiveness of pandemic influenza (H1N1) vaccination under different scenarios in October or November 2009.
DESIGN
Compartmental epidemic model in conjunction with a Markov model of disease progression.
DATA SOURCES
Literature and expert opinion.
TARGET POPULATION
Residents of a major U.S. metropolitan city with a population of 8.3 million.
TIME HORIZON
Lifetime.
PERSPECTIVE
Societal.
INTERVENTIONS
Vaccination in mid-October or mid-November 2009.
OUTCOME MEASURES
Infections and deaths averted, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness.
RESULTS OF BASE-CASE ANALYSIS: Assuming each primary infection causes 1.5 secondary infections, vaccinating 40% of the population in October or November would be cost-saving. Vaccination in October would avert 2051 deaths, gain 69 679 QALYs, and save $469 million compared with no vaccination; vaccination in November would avert 1468 deaths, gain 49 422 QALYs, and save $302 million.
RESULTS OF SENSITIVITY ANALYSIS
Vaccination is even more cost-saving if longer incubation periods, lower rates of infectiousness, or increased implementation of nonpharmaceutical interventions delay time to the peak of the pandemic. Vaccination saves fewer lives and is less cost-effective if the epidemic peaks earlier than mid-October.
LIMITATIONS
The model assumed homogenous mixing of case-patients and contacts; heterogeneous mixing would result in faster initial spread, followed by slower spread. Additional costs and savings not included in the model would make vaccination more cost-saving.
CONCLUSION
Earlier vaccination against pandemic (H1N1) 2009 prevents more deaths and is more cost-saving. Complete population coverage is not necessary to reduce the viral reproductive rate sufficiently to help shorten the pandemic.
PRIMARY FUNDING SOURCE
Agency for Healthcare Research and Quality and National Institute on Drug Abuse.
背景
针对大流行性流感（H1N1）病毒的接种时间和范围的决策非常复杂。
目的
估计在 2009 年 10 月或 11 月实施大流行性流感（H1N1）疫苗接种的效果和成本效益，假设每个原发性感染导致 1.5 次继发性感染，那么在 10 月或 11 月对 40%的人群进行接种将具有成本效益。10 月接种疫苗可避免 2051 人死亡，获得 69679 个质量调整生命年（QALY），并节省 4.69 亿美元，而不接种疫苗则会导致 2051 人死亡，获得 49422 个质量调整生命年（QALY），节省 3.02 亿美元。
敏感性分析结果
如果潜伏期较长、传染性较低或非药物干预措施的实施时间推迟到大流行高峰期，那么疫苗接种将更加节省成本。如果大流行高峰早于 10 月中旬，疫苗接种的死亡率降低，成本效益也会降低。
局限性
该模型假设病例患者和接触者之间的混合是同质的；异质混合将导致更快的初始传播，随后传播速度会变慢。模型中未包含的额外成本和节省将使疫苗接种更具成本效益。
结论
早期接种大流行性流感（H1N1）疫苗可以预防更多的死亡，并且更具成本效益。完全覆盖人群并不是减少病毒繁殖率以帮助缩短大流行所需的。
主要资金来源
医疗保健研究与质量局和国家药物滥用研究所。
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