Canadian Center for Vaccinology, IWK Health Centre, Capital District Health Authority and Dalhousie University, Halifax, NS.
Can J Public Health. 2011 Nov-Dec;102(6):445-50. doi: 10.1007/BF03404197.
Pregnancy is associated with increased influenza hospitalizations and physician visits (events) in healthy women and those with co-morbidities. Annual influenza immunization is recommended for all pregnant women. Although vaccination is expected to reduce influenza-related events, the economic implications are unclear. We developed an economic model to estimate the cost-effectiveness (CE) of different vaccination strategies in Nova Scotia.
A decision tree characterized the one-year costs and consequences of targeted (pregnant women with co-morbidities only) and universal (all pregnant women) vaccination strategies relative to a no-vaccination strategy. Baseline event probabilities, vaccine effectiveness, costs and quality-of-life weights were derived from individual-level Nova Scotia administrative databases, health system sources and published reports. Sensitivity analyses tested the impact of varying key parameters, including vaccine effectiveness and mode of delivery.
Targeted vaccination was cost-saving relative to no vaccination when delivered by public health clinics (PHC) or routine family practitioner (FP) visit. Cost per quality-adjusted life year gained by universal vaccination relative to targeted strategy was < $40,000 when delivered by PHC or routine FP visit. Net cost of universal vaccination by PHC or a routine FP visit was < $10 per pregnant woman.
Universal vaccination of pregnant women appears cost-effective when delivered by PHC or as part of a routine FP prenatal visit. Targeted vaccination of pregnant women with co-morbidities can be cost-saving, but the possibility of higher vaccine uptake with a universal compared to a targeted strategy must be considered in addition to costs in program planning.
妊娠与健康女性和合并症女性的流感住院和就诊（事件）增加有关。建议所有孕妇接种年度流感疫苗。尽管接种疫苗有望减少流感相关事件，但经济影响尚不清楚。我们开发了一种经济模型，以估计新斯科舍省不同疫苗接种策略的成本效益（CE）。
决策树描述了针对（仅患有合并症的孕妇）和普遍（所有孕妇）疫苗接种策略相对于不接种疫苗策略的一年成本和后果。基线事件概率、疫苗效力、成本和生活质量权重来自个人层面的新斯科舍省行政数据库、卫生系统来源和已发表的报告。敏感性分析测试了包括疫苗效力和分娩方式在内的关键参数变化的影响。
当通过公共卫生诊所（PHC）或常规家庭医生（FP）就诊进行靶向接种时，与不接种疫苗相比，靶向接种具有成本效益。与靶向策略相比，通过 PHC 或常规 FP 就诊进行普遍接种获得的每增加一个质量调整生命年的成本低于 40,000 加元。通过 PHC 或常规 FP 就诊进行普遍接种的净成本为每位孕妇低于 10 加元。
当通过 PHC 或作为常规 FP 产前就诊的一部分进行时，对孕妇进行普遍疫苗接种似乎具有成本效益。对患有合并症的孕妇进行靶向接种可能具有成本效益，但在规划方案时，除了成本外，还必须考虑到与靶向策略相比普遍策略可能具有更高的疫苗接种率。
