Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London NW9 6BT, United Kingdom.
Vaccine. 2010 Dec 10;29(1):115-22. doi: 10.1016/j.vaccine.2010.08.078. Epub 2010 Nov 4.
We assessed the cost-effectiveness of vaccinating pregnant women against seasonal influenza in England and Wales, taking into account the timing of vaccination relative to both the influenza season and trimester of pregnancy. Women were assumed to be vaccinated in their second or third trimester. Vaccination between September and December was found to have an incremental cost-effectiveness ratio of £23,000 per quality adjusted life year (QALY) (95% CI £10,000-£140,000) if it is assumed that infants are partially protected through their mothers, and of £28,000 per QALY gained (95% CI £13,000-£200,000) if infants are not protected. If some vaccine protection lasts for a second season, then the ratio is only £15,000 per QALY gained (95% CI £6,000-£93,000). Most of the benefit of vaccination is in preventing symptomatic episodes, regardless of health care resource use. Extending vaccination beyond December is unlikely to be cost-effective unless there is good protection into a second influenza season. Key sources of uncertainty are the cost of vaccine delivery and the quality of life detriment due to a clinically apparent episode of confirmed influenza. The cost of vaccine purchase itself is relatively low.
我们评估了在英格兰和威尔士为孕妇接种季节性流感疫苗的成本效益，同时考虑了疫苗接种相对于流感季节和妊娠 trimester 的时间安排。假设孕妇在第二或第三 trimester 接种疫苗。如果假设婴儿通过母亲得到部分保护，那么 9 月至 12 月之间接种疫苗的增量成本效益比为每质量调整生命年（QALY）23,000 英镑（95%置信区间为 10,000 英镑至 140,000 英镑），如果婴儿不受保护，则每 QALY 增加 28,000 英镑（95%置信区间为 13,000 英镑至 200,000 英镑）。如果部分疫苗保护持续到第二个季节，那么每个 QALY 的比值仅为 15,000 英镑（95%置信区间为 6,000 英镑至 93,000 英镑）。无论医疗保健资源的使用情况如何，疫苗接种的主要益处都在于预防有症状的发作。除非有良好的保护作用进入第二个流感季节，否则延长疫苗接种时间不太可能具有成本效益。不确定性的主要来源是疫苗接种的成本和因临床明显确诊流感而导致的生活质量下降。疫苗购买本身的成本相对较低。
