Department of Influenza Research, Head, National Influenza Center, National Institute of Public Health, Warsaw, Poland.
Clin Drug Investig. 2012 Feb 1;32(2):73-85. doi: 10.2165/11594030-000000000-00000.
Influenza is a common respiratory disease occurring in seasonal patterns, and may lead to severe complications in frail populations such as the elderly. In Poland, influenza vaccination is recommended for people aged ≥65 years; however the vaccine coverage rate in the elderly is very low. The fact that influenza vaccine is neither reimbursed by the National Health Insurance (Narodowy Fundusz Zdrowia [NFZ]) nor financed via a National Immunization Program (NIP) could be a reason for the low coverage rate. This study assessed the cost effectiveness of the full reimbursement of an influenza vaccination programme in Poland for people aged ≥65 years.
A decision-analytic model was developed to compare costs and outcomes associated with the current situation in which influenza vaccination is not reimbursed and a new situation in which it would be fully covered by the NFZ. The model was parameterized to Poland using data from the literature and from the Central Statistic Office of Poland. Within the elderly population, 50% were considered to be at high risk of influenza complications. An influenza attack rate of 3.5% was used for calculation purposes. Influenza-associated hospitalizations and death rates were estimated at 439.9 per 100 000 person-years and 79.1 per 100 000 person-years, respectively. Cost estimates were derived from a cost study conducted in Poland. Costs are presented in Polish Zloty (PLN) [2009 mean exchange rate: 1 PLN = €0.232]. Only direct medical costs were included to fit to the NFZ perspective. To reflect the seasonality of influenza, a time horizon of 1 year was chosen. Life-years and quality-adjusted life-years (QALYs) accumulated over future years were discounted at a rate of 5% as recommended by Polish guidelines. Deterministic and probabilistic sensitivity analyses were conducted.
In Poland, the introduction of the public funding of influenza vaccination for people aged ≥65 years would cost PLN 79 million when an increase in coverage rate from 13.5% to 40% is assumed. 23 900 cases of influenza, 1777 hospitalizations and 548 premature deaths would be averted each year due to the influenza vaccination programme. Fifty-seven persons would need to be vaccinated to prevent one case of influenza. To prevent one hospitalization and one death due to influenza, 842 and 2809 individuals would need to be vaccinated, respectively. The new strategy would be very cost effective compared with the current situation with an incremental cost-effectiveness ratio (ICER) of PLN26 118/QALY, which is below the 2009 yearly gross domestic product (GDP) per capita. Deterministic sensitivity analyses demonstrated that the most influential variables for the ICER were vaccine efficacy against death, excess hospitalization rate, utility norms, influenza attack rate, vaccine efficacy against hospitalization, and discount rates. All ICERs computed were below the threshold of 3 GDP per capita. From the probabilistic analysis, the proposed new influenza vaccination programme, if implemented, was predicted to be cost effective from the NFZ perspective with a probability of 100%, given the same threshold.
Implementing a vaccination programme in Poland in which influenza vaccination would be fully reimbursed by the NFZ for people aged ≥65 years would be a very cost-effective strategy.
流感是一种常见的呼吸道疾病，呈季节性发病，可能导致老年人等脆弱人群发生严重并发症。在波兰，建议≥65 岁的人群接种流感疫苗；然而，老年人的疫苗接种率非常低。流感疫苗既不受国家健康保险基金（Narodowy Fundusz Zdrowia [NFZ]）报销，也不纳入国家免疫计划（Narodowa Immunizacja Program [NIP]）资助，这可能是接种率低的原因。本研究评估了为≥65 岁人群全额报销流感疫苗接种计划在波兰的成本效益。
开发了一个决策分析模型，以比较当前流感疫苗不报销和新情况下的成本和结果，新情况下的疫苗将由 NFZ 全额报销。该模型使用来自文献和波兰中央统计局的数据进行了波兰参数化。在老年人群中，有 50%的人被认为有发生流感并发症的高风险。使用 3.5%的流感发病率进行计算。估计流感相关住院率和死亡率分别为每 100000 人年 439.9 人和每 100000 人年 79.1 人。成本估算来自在波兰进行的一项成本研究。成本以波兰兹罗提（PLN）表示[2009 年平均汇率：1 PLN=0.232€]。仅包括符合 NFZ 观点的直接医疗成本。为了反映流感的季节性，选择了 1 年的时间范围。未来几年累计的生命年和质量调整生命年（QALY）按波兰指南建议的 5%贴现率贴现。进行了确定性和概率敏感性分析。
在波兰，假设覆盖率从 13.5%增加到 40%，为≥65 岁人群全额报销流感疫苗接种费用将达到 7900 万波兰兹罗提。每年将预防 23900 例流感、1777 例住院和 548 例过早死亡。需要接种 57 人才能预防 1 例流感。为了预防 1 例流感住院和 1 例死亡，需要接种 842 人和 2809 人。与当前情况相比，新策略非常具有成本效益，增量成本效益比（ICER）为 26118 波兰兹罗提/QALY，低于 2009 年人均国内生产总值（GDP）。确定性敏感性分析表明，对 ICER 影响最大的变量是疫苗对死亡的疗效、超额住院率、效用规范、流感发病率、疫苗对住院的疗效和贴现率。所有计算的 ICER 均低于人均 GDP 的 3 倍。从概率分析来看，如果实施，新的流感疫苗接种计划将从 NFZ 的角度来看是非常具有成本效益的，在相同的阈值下，其概率为 100%。
在波兰实施一项计划，为≥65 岁人群全额报销流感疫苗接种费用，由 NFZ 承担，这将是一项非常具有成本效益的策略。
