Centre for Infectious Disease Control Netherlands, Epidemiology and Surveillance Unit, National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, Netherlands.
BMJ. 2012 Jul 12;345:e4445. doi: 10.1136/bmj.e4445.
To investigate whether a single optimal vaccination strategy exists across countries to deal with a future influenza pandemic by comparing the cost effectiveness of different strategies in various pandemic scenarios for three European countries.
Economic and epidemic modelling study.
General populations in Germany, the Netherlands, and the United Kingdom.
Country specific patterns of social contact and demographic data.
An age structured susceptible-exposed-infected-recovered transmission model that describes how an influenza A virus will spread in the populations of Germany, the Netherlands, and the United Kingdom.
Comparison of four vaccination strategies: no vaccination, blanket vaccination, vaccination of elderly people (≥ 65 years), and vaccination of high transmitters (5-19 years). The four strategies were evaluated for scenarios in which a vaccine became available early or at the peak of the pandemic, and in which either everyone was initially susceptible or older age groups had pre-existing immunity.
Cost per quality adjusted life years (QALYs) gained.
All vaccination strategies were cost effective (incremental cost per QALY gained, comparing intervention with non-intervention). In scenarios where the vaccine became available at the peak of the pandemic and there was pre-existing immunity among elderly people the incremental cost effectiveness ratios for vaccinating high transmitters were €7325 (£5815; $10,470) per QALY gained for Germany, €10,216 per QALY gained for the Netherlands, and €7280 per QALY gained for the United Kingdom. The most cost effective strategy not only differed across the pandemic scenarios but also between countries. Specifically, when the vaccine was available early in the pandemic and there was no pre-existing immunity, in Germany it would be most cost effective to vaccinate elderly people ( €940 per QALY gained), whereas it would be most cost effective to vaccinate high transmitters in both the Netherlands (€525 per QALY gained) and the United Kingdom (€163 per QALY gained). This difference in optimal strategies was due to differences in the demographic characteristics of the countries: Germany has a significantly higher proportion of elderly people compared with the Netherlands and the United Kingdom.
No single vaccination strategy was most cost effective across countries. With aging populations, pre-existing immunity in particular could be of crucial importance for the cost effectiveness of options to mitigate a future influenza pandemic.
通过比较三种欧洲国家在不同大流行情景下不同策略的成本效益，研究是否存在针对未来流感大流行的单一最佳疫苗接种策略。
经济和流行病情模拟研究。
德国、荷兰和英国的普通人群。
具有国家特异性的社会接触和人口数据模式。
描述甲型流感病毒在德国、荷兰和英国人群中传播方式的年龄结构易感-暴露-感染-恢复传播模型。
比较四种疫苗接种策略：不接种疫苗、全面接种疫苗、接种老年人（≥65 岁）和接种高传播者（5-19 岁）。四种策略适用于疫苗早期或大流行高峰期可用的情景，以及最初所有人都易感或老年人有预先存在的免疫的情景。
每获得一个质量调整生命年（QALY）的成本（增量成本/QALY 获得）。
所有疫苗接种策略均具有成本效益（与非干预相比，干预的增量成本/QALY 获得）。在疫苗在大流行高峰期可用且老年人有预先存在免疫的情况下，对于高传播者接种疫苗的增量成本效益比分别为德国每 QALY 获得 7325 欧元（5815 英镑；10470 美元）、荷兰每 QALY 获得 10216 欧元，英国每 QALY 获得 7280 欧元。最具成本效益的策略不仅在大流行情景之间存在差异，而且在国家之间也存在差异。具体而言，在大流行早期疫苗可用且不存在预先存在的免疫时，在德国最具成本效益的策略是为老年人接种疫苗（每 QALY 获得 940 欧元），而在荷兰和英国最具成本效益的策略则是为高传播者接种疫苗（荷兰每 QALY 获得 525 欧元，英国每 QALY 获得 163 欧元）。这种最佳策略的差异是由于各国人口统计学特征的差异所致：与荷兰和英国相比，德国老年人的比例明显更高。
没有单一的疫苗接种策略在所有国家都是最具成本效益的。随着人口老龄化，特别是预先存在的免疫对于减轻未来流感大流行的成本效益具有至关重要的意义。
