National Immunization Programme, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Beijing 100050, China.
Vaccine. 2012 Aug 10;30(37):5569-77. doi: 10.1016/j.vaccine.2012.05.068. Epub 2012 Jun 12.
Historically, China's Japanese encephalitis vaccination program was a mix of household purchase of vaccine and government provision of vaccine in some endemic provinces. In 2006, Guizhou, a highly endemic province in South West China, integrated JE vaccine into the provincial Expanded Program on Immunization (EPI); later, in 2007 China fully integrated 28 provinces into the national EPI, including Guizhou, allowing for vaccine and syringe costs to be paid at the national level. We conducted a retrospective economic analysis of JE integration into EPI in Guizhou province.
We modeled two theoretical cohorts of 100,000 persons for 65 years; one using JE live-attenuated vaccine in EPI (first dose: 95% coverage and 94.5% efficacy; second dose: 85% coverage and 98% efficacy) and one not. We assumed 60% sensitivity of surveillance for reported JE rates, 25% case fatality, 30% chronic disability and 3% discounting. We reviewed acute care medical records and interviewed a sample of survivors to estimate direct and indirect costs of illness. We reviewed the EPI offices expenditures in 2009 to estimate the average Guizhou program cost per vaccine dose.
Use of JE vaccine in EPI for 100,000 persons would cost 434,898 US$ each year (46% of total cost due to vaccine) and prevent 406 JE cases, 102 deaths, and 122 chronic disabilities (4554 DALYs). If we ignore future cost savings and only use EPI program cost, the program would cost 95.5 US$/DALY, less than China Gross Domestic Product per capita in 2009 (3741 US$). From a cost-benefit perspective taking into account future savings, use of JE vaccine in EPI for a 100,000-person cohort would lead to savings of 1,591,975 US$ for the health system and 11,570,989 US$ from the societal perspective.
In Guizhou, China, use of JE vaccine in EPI is a cost effective investment. Furthermore, it would lead to savings for the health system and society.
历史上，中国的乙型脑炎疫苗接种计划是家庭购买疫苗和政府在一些流行省份提供疫苗的混合体。2006 年，中国西南部高度流行的贵州省将乙型脑炎疫苗纳入省级扩大免疫规划（EPI）；后来，2007 年中国将包括贵州在内的 28 个省份全面纳入国家 EPI，允许国家支付疫苗和注射器费用。我们对贵州省乙型脑炎疫苗纳入 EPI 进行了回顾性经济分析。
我们对两个理论队列中的 10 万人进行了 65 年的建模；一组使用 EPI 中的乙型脑炎减毒活疫苗（第一剂：95%覆盖率和 94.5%效力；第二剂：85%覆盖率和 98%效力），另一组不使用。我们假设报告的乙型脑炎发病率监测的敏感性为 60%，病死率为 25%，慢性残疾率为 30%，贴现率为 3%。我们审查了急性护理医疗记录，并采访了幸存者样本，以估计疾病的直接和间接费用。我们审查了 2009 年 EPI 办公室的支出，以估计每剂疫苗的贵州省平均项目成本。
为 10 万人使用 EPI 中的乙型脑炎疫苗每年将花费 434898 美元（46%的总成本归因于疫苗），可预防 406 例乙型脑炎病例、102 例死亡和 122 例慢性残疾（4554 DALYs）。如果我们忽略未来的成本节约，只使用 EPI 项目成本，该项目的成本将为 95.5 美元/残疾调整生命年（DALY），低于 2009 年中国的人均国内生产总值（3741 美元）。从成本效益的角度考虑未来的节约，为 10 万人的队列使用 EPI 中的乙型脑炎疫苗将使卫生系统节省 1591975 美元，从社会角度节省 11570989 美元。
在中国贵州，EPI 中使用乙型脑炎疫苗是一项具有成本效益的投资。此外，它将为卫生系统和社会带来节约。
