Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispostnummer STR,6,131, Postbus 85500, Utrecht 3508 GA, The Netherlands.
BMC Med. 2013 Apr 26;11:112. doi: 10.1186/1741-7015-11-112.
The cost-effectiveness of universal rotavirus (RV) vaccination is controversial in developed countries. As a result, RV vaccination programs do not currently exist in most European countries. Hospitalization is the main driver of RV disease costs, and prematurity, low birth weight (LBW) and underlying medical conditions have been associated with RV hospitalization and complications. We investigated the cost-effectiveness of targeted RV vaccination of high-risk infants and universal RV vaccination versus no vaccination.
Disease burden, mortality and healthcare costs of RV hospitalization for children with and without prematurity, LBW and congenital pathology were quantified in two hospital-based observational studies in the Netherlands. Cost-effectiveness analysis was based on an age-structured stochastic multi-cohort model of the Dutch population comparing universal RV vaccination and targeted vaccination of high-risk infants to no vaccination. The primary endpoint was the incremental cost-effectiveness ratio (ICER), with a threshold of €35,000/quality-adjusted life year (QALY) from the healthcare provider perspective. Sensitivity analyses included vaccine price and coverage, herd-immunity and QALY losses.
A total of 936 children with RV infection were included. Prematurity, LBW and congenital pathology were associated with increased risks of RV hospitalization (relative risks (RR) ranging from 1.6 to 4.4), ICU admission (RR ranging from 4.2 to 7.9), prolonged hospital stay (1.5 to 3.0 excess days) and higher healthcare costs (€648 to €1,533 excess costs). Seven children succumbed due to RV complications, all belonging to the high-risk population. Targeted RV vaccination was highly cost-effective and potentially cost-saving from the healthcare provider perspective with ICERs below €20,000/QALY in all scenarios with total (undiscounted) annual healthcare costs between -€0.1 and €0.5 million/year. Results were most sensitive to mortality rates, but targeted vaccination remained highly cost-effective up to reductions of 90% compared to observed mortality. Universal RV vaccination was not considered cost-effective (mean ICER: €60,200/QALY) unless herd-immunity and caretaker QALY losses were included and vaccine prices were €60 at most (mean ICER: €21,309/QALY).
We recommend targeted RV vaccination for high-risk infants in developed countries.
在发达国家，普遍使用轮状病毒（RV）疫苗的成本效益存在争议。因此，大多数欧洲国家目前没有 RV 疫苗接种计划。住院治疗是 RV 疾病成本的主要驱动因素，早产、低出生体重（LBW）和基础疾病与 RV 住院治疗和并发症有关。我们调查了对高危婴儿进行靶向 RV 疫苗接种以及对所有婴儿进行 RV 疫苗接种与不接种疫苗的成本效益。
在荷兰的两项基于医院的观察性研究中，对有和没有早产、LBW 和先天性疾病的 RV 住院患儿的疾病负担、死亡率和医疗保健成本进行了量化。成本效益分析基于荷兰人群的年龄结构随机多队列模型，比较了对所有婴儿进行 RV 疫苗接种和对高危婴儿进行靶向疫苗接种与不接种疫苗的情况。主要终点是增量成本效益比（ICER），从医疗保健提供者的角度来看，阈值为 35,000 欧元/质量调整生命年（QALY）。敏感性分析包括疫苗价格和覆盖率、群体免疫和 QALY 损失。
共纳入 936 例 RV 感染患儿。早产、LBW 和先天性疾病与 RV 住院风险增加有关（相对风险范围为 1.6 至 4.4）、ICU 入院（RR 范围为 4.2 至 7.9）、住院时间延长（1.5 至 3.0 天）和医疗保健费用增加（648 至 1533 欧元）。由于 RV 并发症而死亡的 7 名患儿均属于高危人群。从医疗保健提供者的角度来看，针对 RV 的疫苗接种具有高度成本效益，并且可能具有成本效益，在所有情况下，ICER 均低于 20,000 欧元/QALY，每年的总（未贴现）医疗保健成本在-0.1 至 0.5 百万欧元/年之间。结果对死亡率最为敏感，但即使与观察到的死亡率相比降低 90%，针对疫苗接种的疫苗接种仍具有高度成本效益。除非包括群体免疫和照顾者 QALY 损失并且疫苗价格最高为 60 欧元（平均 ICER：60200 欧元/QALY），否则对所有婴儿进行 RV 疫苗接种不被认为具有成本效益（平均 ICER：60200 欧元/QALY）。
我们建议在发达国家对高危婴儿进行靶向 RV 疫苗接种。
