Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
PLoS Med. 2010 Apr 6;7(4):e1000256. doi: 10.1371/journal.pmed.1000256.
In July 2000, the province of Ontario, Canada, initiated a universal influenza immunization program (UIIP) to provide free seasonal influenza vaccines for the entire population. This is the first large-scale program of its kind worldwide. The objective of this study was to conduct an economic appraisal of Ontario's UIIP compared to a targeted influenza immunization program (TIIP).
A cost-utility analysis using Ontario health administrative data was performed. The study was informed by a companion ecological study comparing physician visits, emergency department visits, hospitalizations, and deaths between 1997 and 2004 in Ontario and nine other Canadian provinces offering targeted immunization programs. The relative change estimates from pre-2000 to post-2000 as observed in other provinces were applied to pre-UIIP Ontario event rates to calculate the expected number of events had Ontario continued to offer targeted immunization. Main outcome measures were quality-adjusted life years (QALYs), costs in 2006 Canadian dollars, and incremental cost-utility ratios (incremental cost per QALY gained). Program and other costs were drawn from Ontario sources. Utility weights were obtained from the literature. The incremental cost of the program per QALY gained was calculated from the health care payer perspective. Ontario's UIIP costs approximately twice as much as a targeted program but reduces influenza cases by 61% and mortality by 28%, saving an estimated 1,134 QALYs per season overall. Reducing influenza cases decreases health care services cost by 52%. Most cost savings can be attributed to hospitalizations avoided. The incremental cost-effectiveness ratio is Can$10,797/QALY gained. Results are most sensitive to immunization cost and number of deaths averted.
Universal immunization against seasonal influenza was estimated to be an economically attractive intervention.
2000 年 7 月，加拿大安大略省启动了一项普及流感免疫计划（UIIP），为全体民众提供免费的季节性流感疫苗。这是全球首个此类大规模计划。本研究旨在对安大略省的 UIIP 与目标性流感免疫计划（TIIP）进行经济评估。
我们使用安大略省卫生行政数据进行了成本-效用分析。该研究的依据是一项伴随性生态学研究，该研究比较了 1997 年至 2004 年安大略省与其他 9 个提供目标性免疫计划的加拿大省份的医生就诊、急诊就诊、住院和死亡情况。将其他省份在 2000 年后观察到的相对变化估计值应用于 UIIP 前的安大略省事件发生率，以计算如果安大略省继续提供目标性免疫，预计会发生的事件数量。主要结局指标为质量调整生命年（QALY）、2006 年加拿大元成本以及增量成本-效用比（每获得一个 QALY 的增量成本）。项目和其他成本源自安大略省。效用权重取自文献。从卫生保健支付方的角度计算了该项目每获得一个 QALY 的增量成本。安大略省的 UIIP 成本大约是目标性计划的两倍，但可将流感病例减少 61%，并将死亡率降低 28%，总体上每个季节可节省约 1134 个 QALY。流感病例减少可使医疗保健服务成本降低 52%。大部分成本节省可归因于避免了住院。增量成本-效果比为 10797 加元/QALY。结果对免疫成本和避免死亡人数最为敏感。
普遍接种季节性流感疫苗被认为是一种具有成本效益的干预措施。
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