Unit of PharmacoEpidemiology & PharmacoEconomics (PE2); Department of Pharmacy; University of Groningen; Groningen, The Netherlands.
Hum Vaccin Immunother. 2013 May;9(5):1139-41. doi: 10.4161/hv.23447. Epub 2013 Jan 30.
Performing a total health economic analysis of a vaccine newly introduced into the market today is a challenge when using the conventional cost-effectiveness analysis we normally apply on pharmaceutical products. There are many reasons for that, such as: the uncertainty in the total benefit (direct and indirect) to be measured in a population when using a cohort model; (1) appropriate rules about discounting the long-term impact of vaccines are absent jeopardizing therefore their value at the initial investment; (2) the presence of opposite contexts when introducing the vaccine in developed vs. the developing world with high benefits, low initial health care investment for the latter vs. marginal benefit and high cost for the former; with a corresponding paradox for the vaccine becoming very cost-effective in low income countries but rather medium in middle low to high middle income countries; (3) and the type of trial assessment for the newer vaccines is now often performed with immunogenicity reaction instead of clinical endpoints which still leaves questions on their real impact and their head-to-head comparison. (4.)
对今天新引入市场的疫苗进行全面的健康经济分析，使用我们通常应用于药品的常规成本效益分析是一项挑战。原因有很多，例如：在使用队列模型时，人群中要衡量的总效益（直接和间接）存在不确定性；(1) 缺乏关于疫苗长期影响的适当贴现规则，从而危及初始投资的价值；(2) 在发达国家和发展中国家引入疫苗时存在相反的情况，后者具有高收益、低初始医疗保健投资，而前者则具有边际收益和高成本；对于疫苗来说，这是一个相应的悖论，因为它在低收入国家非常具有成本效益，但在中低收入到中高收入国家则是中等效益；(3) 现在，新型疫苗的临床试验评估通常采用免疫原性反应，而不是临床终点，这仍然存在对其实际影响及其直接比较的问题。(4.)
