Epidemiology and Public Health Evaluation Group, Department of Public Health, Faculty of Medicine, Universidad Nacional de Colombia, Carrera 30 # 45-03, Office 150, Bogotá D.C., Colombia.
Vaccine. 2011 Oct 13;29(44):7644-50. doi: 10.1016/j.vaccine.2011.08.006. Epub 2011 Aug 18.
Streptococcus pneumoniae causes community-acquired pneumonia, otitis media and meningitis, with higher incidences at the extremes of life. PPV-23 vaccine is widely used in prevention of pneumonia and invasive pneumococcal disease in older adults in developed countries. We developed an evaluation of cost-effectiveness of implementing PPV-23 in Colombian population over 60 years.
The number of cases of pneumonia and meningitis in patients over 60 years and the proportion by S. pneumoniae was estimated based on a review of literature. A decision tree model with a 5-year time horizon was built to evaluate the cost-effectiveness of the implementation of the PPV-23 in this population. Direct health care costs of out- and in-patients were calculated based on expenditure records from the Bogota public health system. Incremental cost-effectiveness ratios per life saved and per year of life gained were estimated based on the decision tree model. Deterministic and probabilistic sensitivity analyses were performed.
Without vaccination 4460 (range 2384-8162) bacteremic pneumococcal pneumonias and 141 (range 73-183) pneumococcal meningitis would occur among people over 60 years old in Colombia. In the first year, vaccination with PPV-23 at US$8/dose would save 480 (range 100-1753) deaths due to Invasive and non-invasive pneumococcal disease. Vaccination would results in US$3400/deaths averted (range US$1028-10,862) and US$1514/life years gained (range US$408-5404).
Vaccination with PPV-23 in over 60 years is a highly cost-effective public health measure in Colombia. Despite some limitations, the results are robust, and may help developing countries to perform informed decisions about the introduction of the vaccine.
肺炎链球菌可引起社区获得性肺炎、中耳炎和脑膜炎，在生命的两端发病率更高。PPV-23 疫苗在发达国家被广泛用于预防老年人肺炎和侵袭性肺炎球菌病。我们开发了一种针对哥伦比亚 60 岁以上人群实施 PPV-23 的成本效益评估。
根据文献回顾，估计了 60 岁以上患者肺炎和脑膜炎的病例数以及由肺炎链球菌引起的比例。建立了一个 5 年时间跨度的决策树模型，以评估在该人群中实施 PPV-23 的成本效益。根据波哥大公共卫生系统的支出记录，计算了门诊和住院患者的直接医疗保健费用。根据决策树模型，估计了每挽救 1 人生命和每年获得 1 年生命的增量成本效益比。进行了确定性和概率敏感性分析。
如果不接种疫苗，哥伦比亚 60 岁以上人群中每年将发生 4460 例（范围 2384-8162 例）菌血症性肺炎球菌肺炎和 141 例（范围 73-183 例）肺炎球菌脑膜炎。在第一年，使用 8 美元/剂的 PPV-23 疫苗接种将预防 480 例（范围 100-1753 例）侵袭性和非侵袭性肺炎球菌疾病死亡。疫苗接种将使每例死亡人数减少 3400 美元（范围 1028-10862 美元），每例生命延长 1514 美元（范围 408-5404 美元）。
在哥伦比亚，60 岁以上人群接种 PPV-23 是一项非常具有成本效益的公共卫生措施。尽管存在一些限制，但结果是稳健的，这可能有助于发展中国家就疫苗的引入做出明智的决策。
