Akin Levent, Kaya Mehmet, Altinel Serdar, Durand Laure
Hacettepe University Department of Public Health, Ankara, Turkey.
Hum Vaccin. 2011 Apr;7(4):441-50. doi: 10.4161/hv.7.4.14188. Epub 2011 Apr 1.
Pneumococcal infections have a substantial burden in Turkey, particularly in the elderly (> 60 years) and at-risk adults (18-59 years). VCR are low at approximately 2%. The first aim of this study was the evaluation of the burden of pneumococcal infections (pneumonia and bacteremia) from a public payer perspective in elderly and at-risk adults. The second aim was the evaluation of cost effectiveness of implementing a large PPV program in these populations. A decision tree model was employed using demographic and epidemiological input obtained from Turkish official sources and international literature. Vaccination was assumed to protect for 5 years with 60% and 50% effectiveness against BPP in elderly and at-risk adults respectively. Vaccination effectiveness of 21% against NBPP was assumed for both populations. Costs input were obtained from a previous study conducted between 2002 and 2008 in a public university hospital in Ankara, Turkey. Univariate sensitivity analyses and Monte-Carlo simulations were performed. The vaccination program was cost effective and cost saving compared to no vaccination, pneumococcal vaccination with 60% coverage led to a mean of 4,695 LYG in the elderly and 2,134 LYG in at-risk adults with 40% coverage. Mean incremental savings reached 45.4 million YTL in the elderly and 21.8 million YTL in at-risk adults. This analysis suggests that pneumococcal vaccination of elderly and at-risk adults is associated with a positive return on investment from a public payer perspective and supports the continued recommendation of pneumococcal vaccines, as well as their full funding in Turkey.
肺炎球菌感染在土耳其造成了沉重负担，尤其是在老年人（>60岁）和高危成年人（18 - 59岁）中。疫苗接种覆盖率（VCR）较低，约为2%。本研究的首要目的是从公共支付者的角度评估老年人和高危成年人中肺炎球菌感染（肺炎和菌血症）的负担。第二个目的是评估在这些人群中实施大规模肺炎球菌多糖疫苗（PPV）接种计划的成本效益。采用决策树模型，使用从土耳其官方来源和国际文献中获取的人口统计学和流行病学数据。假设疫苗接种的保护期为5年，在老年人和高危成年人中对侵袭性肺炎球菌病（BPP）的有效性分别为60%和50%。假设在这两个人群中针对非侵袭性肺炎球菌病（NBPP）的疫苗接种有效性均为21%。成本数据来自2002年至2008年在土耳其安卡拉一所公立大学医院进行的一项先前研究。进行了单因素敏感性分析和蒙特卡洛模拟。与未接种疫苗相比，接种疫苗计划具有成本效益且节省成本，肺炎球菌疫苗接种覆盖率为60%时，老年人平均获得4695个质量调整生命年（LYG），高危成年人覆盖率为40%时平均获得2134个LYG。老年人平均增量节省达到4540万土耳其里拉（YTL），高危成年人平均增量节省达到2180万YTL。该分析表明，从公共支付者的角度来看，老年人和高危成年人接种肺炎球菌疫苗具有正投资回报，并支持继续推荐肺炎球菌疫苗以及在土耳其为其提供全额资金。
