Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
J Infect Dis. 2011 Jul;204 Suppl 1(Suppl 1):S107-15. doi: 10.1093/infdis/jir131.
Supplemental Immunization Activities (SIAs) have become an important adjunct to measles control efforts in countries that endeavor to achieve higher levels of population immunity than can be achieved in a growing routine immunization system. Because SIAs are often supported with funds that have alternative uses, decision makers need to know how cost-effective they are compared with other options. This study integrated a dynamic stochastic model of measles transmission in Uganda (2010-2050) with a cost model to compare a strategy of maintaining Uganda's current (2008) levels of the first dose of routine measles-containing vaccine (MCV1) coverage at 68% with SIAs with a strategy using the same levels of MCV1 coverage without SIAs. The stochastic model was fitted with parameters drawn from district-level measles case reports from Uganda, and the cost model was fitted to administrative data from the Ugandan Expanded Program on Immunization and from the literature. A discount rate of 0.03, time horizon of 2010-2050, and a societal perspective on costs were assumed. Costs expressed in US dollars (2010) included vaccination costs, disease treatment costs including lost productivity of mothers, as well as costs of outbreaks and surveillance. The model estimated that adding on triennial SIAs that covered 95% of children aged 12-59 months to a system that achieved routine coverage rates of 68% would have an incremental cost-effectiveness ratio (ICER) of $1.50 ($US 2010) per disability-adjusted life year averted. The ICER was somewhat higher if the discount rate was set at either 0 or 0.06. The addition of SIAs was found to make outbreaks less frequent and lower in magnitude. The benefit was reduced if routine coverage rates were higher. This cost-effectiveness ratio compares favorably to that of other commonly accepted public health interventions in sub-Saharan Africa.
补充免疫活动（SIAs）已成为在努力实现高于常规免疫接种系统所能达到的人群免疫水平的国家中控制麻疹的重要辅助手段。由于 SIA 通常是用具有其他用途的资金来支持的，决策者需要知道它们与其他方案相比的成本效益如何。本研究将乌干达麻疹传播的动态随机模型（2010-2050 年）与成本模型相结合，比较了维持乌干达当前（2008 年）第一剂常规含麻疹疫苗（MCV1）覆盖率 68%的策略（即维持现状）与不进行 SIA 而保持相同 MCV1 覆盖率的策略。该随机模型使用来自乌干达地区麻疹病例报告的参数进行拟合，成本模型则使用乌干达扩大免疫规划的行政数据和文献中的数据进行拟合。假设贴现率为 0.03，时间范围为 2010-2050 年，成本为社会视角。以美元表示的成本（2010 年）包括疫苗接种成本、包括母亲生产力损失在内的疾病治疗成本，以及暴发和监测成本。该模型估计，在常规覆盖率达到 68%的系统中，每三年进行一次覆盖 12-59 个月儿童 95%的 SIA，其增量成本效益比（ICER）为每避免一个残疾调整生命年 1.50 美元（2010 年美元）。如果贴现率设定为 0 或 0.06，ICER 会略高一些。添加 SIA 会使暴发的频率和规模降低。如果常规覆盖率较高，则受益会减少。这一成本效益比与撒哈拉以南非洲地区其他常见的公共卫生干预措施相当。
