Department of Environmental and Global Health, Center for African Studies, Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA.
Vaccine. 2012 Apr 27;30 Suppl 1:A15-23. doi: 10.1016/j.vaccine.2012.01.018.
Other studies have demonstrated that the impact and cost effectiveness of rotavirus vaccination differs among countries, with greater mortality reduction benefits and lower cost-effectiveness ratios in low-income and high-mortality countries. This analysis combines the results of a country level model of rotavirus vaccination published elsewhere with data from Demographic and Health Surveys on within-country patterns of vaccine coverage and diarrhea mortality risk factors to estimate within-country distributional effects of rotavirus vaccination. The study examined 25 countries eligible for funding through the GAVI Alliance.
For each country we estimate the benefits and cost-effectiveness of vaccination for each wealth quintile assuming current vaccination patterns and for a scenario where vaccine coverage is equalized to the highest quintile's coverage. In the case of India, variations in coverage and risk proxies by state were modeled to estimate geographic distributional effects.
In all countries, rates of vaccination were highest and risks of mortality were lowest in the top two wealth quintiles. However countries differ greatly in the relative inequities in these two underlying variables. Similarly, in all countries examined, the cost-effectiveness ratio for vaccination ($/Disability-Adjusted Life Year averted, DALY) is substantially greater in the higher quintiles (ranging from 2-10 times higher). In all countries, the greatest potential benefit of vaccination was in the poorest quintiles. However, due to reduced vaccination coverage, projected benefits for these quintiles were often lower. Equitable coverage was estimated to result in an 89% increase in mortality reduction for the poorest quintile and a 38% increase overall.
Rotavirus vaccination is most cost-effective in low-income groups and regions. However in many countries, simply adding new vaccines to existing systems targets investments to higher income children, due to disparities in vaccination coverage. Maximizing health benefits for the poorest children and value for money require increased attention to these distributional effects.
其他研究表明，轮状病毒疫苗接种的影响和成本效益因国家而异，在低收入和高死亡率国家，死亡率降低的益处更大，成本效益比更低。本分析将在其他地方发表的国家层面轮状病毒疫苗接种模型的结果与国家内疫苗覆盖率和腹泻死亡率危险因素的人口与健康调查数据相结合，以估计轮状病毒疫苗接种的国家内分布效应。该研究考察了 25 个有资格通过 GAVI 联盟获得资金的国家。
对于每个国家，我们根据当前的疫苗接种模式，估计每个财富五分位数的疫苗接种效益和成本效益，以及将疫苗覆盖率均等化到最高五分位数的覆盖率的情况下。对于印度，通过州的覆盖范围和风险代理的变化进行建模，以估计地理分布效应。
在所有国家，最高收入五分位数的疫苗接种率最高，死亡率最低。然而，各国在这两个基本变量的相对不平等方面存在很大差异。同样，在所研究的所有国家中，疫苗接种的成本效益比（每避免一个残疾调整生命年的美元数，DALY）在较高五分位数（从 2 倍到 10 倍不等）要高得多。在所有国家，最贫穷的五分位数最有可能从疫苗接种中受益。然而，由于疫苗覆盖率降低，这些五分位数的预期收益往往较低。公平覆盖估计将使最贫穷的五分位数的死亡率降低 89%，总体增加 38%。
轮状病毒疫苗接种在低收入群体和地区最具成本效益。然而，在许多国家，由于疫苗覆盖率的差异，仅仅向现有系统添加新疫苗就将投资目标锁定在高收入儿童身上。为了使最贫穷儿童获得最大的健康益处和物有所值，需要更加关注这些分配效应。
