Centre for Burden of Disease and Cost-effectiveness, School of Population Health, The University of Queensland.
Aust N Z J Public Health. 2011 Apr;35(2):180-6. doi: 10.1111/j.1753-6405.2010.00639.x. Epub 2010 Dec 9.
Influenza cost-effectiveness studies use models for influenza clinical evolution based on a range of assumptions. We explore the importance of these assumptions and its implications in policy decisions.
An influenza model was constructed to measure the cost-effectiveness of universal influenza vaccination of people over 50 years compared to current policy to vaccinate people over 65 years in Australia using available epidemiological data. We explored two scenarios, one with an Australian estimate of influenza like illness incidence, and one with a European estimate. Further, we estimated uncertainty of model structure and various parameter assumptions, and compared with a previous study.
The scenario and sensitivity analysis has shown the incremental cost-effectiveness ratio of the proposed compared to current policy varies from $112,000 to $6,000 per DALY. The model structure, parameter assumptions and limitations of existing epidemiological data lead to extensive unaccounted uncertainties in previous studies.
The lack of influenza epidemiological data makes the influenza cost-effectiveness studies that compare the universal influenza vaccinations of people over 50 years to current policy unreliable.
It is imperative to appraise unreliability of influenza cost-effectiveness studies in policy decisions. Research to acquire more data on influenza uncertainties in Australia should be funded.
流感成本效益研究使用基于一系列假设的流感临床演变模型。我们探讨这些假设的重要性及其对政策决策的影响。
构建了一个流感模型，以衡量与澳大利亚目前为 65 岁以上人群接种疫苗的政策相比，对 50 岁以上人群进行普遍流感疫苗接种的成本效益。我们探讨了两种情况，一种是使用澳大利亚的流感样疾病发病率估计值，另一种是使用欧洲的估计值。此外，我们还估计了模型结构和各种参数假设的不确定性，并与之前的研究进行了比较。
情景和敏感性分析表明，与现行政策相比，建议方案的增量成本效益比在每 DALY 112,000 美元至 6,000 美元之间。模型结构、参数假设和现有流行病学数据的局限性导致之前的研究存在广泛的未考虑到的不确定性。
缺乏流感流行病学数据使得比较 50 岁以上人群普遍接种流感疫苗和现行政策的流感成本效益研究不可靠。
在政策决策中评估流感成本效益研究的不可靠性至关重要。应该为在澳大利亚获取更多流感不确定性数据的研究提供资金。
