Swiss Tropical and Public Health Institute, Basel, Switzerland.
Value Health. 2011 Dec;14(8):1028-38. doi: 10.1016/j.jval.2011.06.004. Epub 2011 Aug 15.
To evaluate the cost-effectiveness of introducing the RTS,S malaria vaccine into the Expanded Programme on Immunization (EPI) in Sub-Saharan Africa (SSA), the contributions of different sources of uncertainty, and the associated expected value of perfect information (EVPI).
Vaccination was simulated in populations of 100,000 people at 10 different entomological inoculation rates (EIRs), using an existing stochastic model and a 10-year time horizon. Incremental cost-effectiveness ratios (ICERs) and EVPI were computed from weighted averages of outputs using two different assignments of the EIR distribution in 2007. Uncertainty was evaluated by resampling of epidemiological, vaccination, and health systems model parameters.
Health benefits were predicted consistently only at low transmission, and program costs always substantially exceeded case management savings. Optimal cost-effectiveness was at EIR of about 10 infectious bites per annum (ibpa). Main contributors to ICER uncertainty were uncertainty in transmission intensity, price per vaccine dose, decay rate of the vaccine effect, degree of homogeneity in host response, and some epidemiological model parameters. Other health system costs were unimportant. With a ceiling ratio of 207 international dollars per disability-adjusted life-year averted, 52.4% of parameterizations predicted cost-effectiveness in the primary analysis.
Cost-effectiveness of RTS,S will be maximal in low endemicity settings (EIR 2-20 ibpa). Widespread deployment of other transmission-reducing interventions will thus improve cost-effectiveness, suggesting a selective introduction strategy. EVPI is substantial. Accrual of up-to-date information on local endemicity to guide deployment decisions would be highly efficient.
评估在撒哈拉以南非洲（SSA）扩大免疫规划（EPI）中引入 RTS,S 疟疾疫苗的成本效益，评估不同不确定性来源的贡献，以及相关的完全信息期望价值（EVPI）。
使用现有的随机模型和 10 年时间范围，在 10 个不同的昆虫接种率（EIR）下，对 100,000 人的人群进行疫苗接种模拟。使用两种不同的 2007 年 EIR 分布分配方式，从输出的加权平均值计算增量成本效益比（ICER）和 EVPI。通过对流行病学、疫苗接种和卫生系统模型参数进行重新抽样来评估不确定性。
健康效益仅在低传播时得到一致预测，而项目成本总是大大超过病例管理节省。最佳成本效益出现在每年约 10 个传染性叮咬（ibpa）的 EIR。ICER 不确定性的主要贡献因素是传播强度、疫苗剂量价格、疫苗效果衰减率、宿主反应同质性程度以及一些流行病学模型参数的不确定性。其他卫生系统成本不重要。以避免残疾调整生命年（DALY）的 207 美元国际上限为基准，52.4%的参数化方案在主要分析中预测了成本效益。
RTS,S 的成本效益将在低流行地区（EIR 2-20 ibpa）达到最大值。因此，广泛部署其他降低传播干预措施将提高成本效益，这表明了一种有选择性的引入策略。EVPI 是大量的。积累有关当地流行情况的最新信息以指导部署决策将是非常高效的。
