Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
J Pediatr. 2013 Jul;163(1 Suppl):S60-72. doi: 10.1016/j.jpeds.2013.03.032.
To estimate the potential health impact and cost-effectiveness of nationwide Haemophilus influenzae type b (Hib) vaccination in India.
A decision support model was used, bringing together estimates of demography, epidemiology, Hib vaccine effectiveness, Hib vaccine costs, and health care costs. Scenarios favorable and unfavorable to the vaccine were evaluated. State-level analyses indicate where the vaccine might have the greatest impact and value.
Between 2012 and 2031, Hib conjugate vaccination is estimated to prevent over 200 000 child deaths (∼1% of deaths in children <5 years of age) in India at an incremental cost of US$127 million per year. From a government perspective, state-level cost-effectiveness ranged from US$192 to US$1033 per discounted disability adjusted life years averted. With the inclusion of household health care costs, cost-effectiveness ranged from US$155-US$939 per discounted disability adjusted life year averted. These values are below the World Health Organization thresholds for cost effectiveness of public health interventions.
Hib conjugate vaccination is a cost-effective intervention in all States of India. This conclusion does not alter with plausible changes in key parameters. Although investment in Hib conjugate vaccination would significantly increase the cost of the Universal Immunization Program, about 15% of the incremental cost would be offset by health care cost savings. Efforts should be made to expedite the nationwide introduction of Hib conjugate vaccination in India.
评估在印度全国范围内推广乙型流感嗜血杆菌（Hib）疫苗接种的潜在健康影响和成本效益。
采用决策支持模型，综合考虑人口统计学、Hib 疫苗效力、Hib 疫苗成本和医疗保健成本的估计值。评估了对疫苗有利和不利的情况。州级分析表明了疫苗可能产生最大影响和价值的地方。
在 2012 年至 2031 年期间，Hib 结合疫苗接种估计可预防印度 20 多万名儿童死亡（占 5 岁以下儿童死亡人数的约 1%），每年新增成本为 1.27 亿美元。从政府角度来看，州级成本效益在每避免一个残疾调整生命年的贴现成本为 192 美元至 1033 美元之间。如果包括家庭医疗保健成本，成本效益在每避免一个残疾调整生命年的贴现成本为 155 美元至 939 美元之间。这些数值低于世界卫生组织公共卫生干预措施成本效益的门槛。
Hib 结合疫苗接种在印度所有邦都是一种具有成本效益的干预措施。这一结论在关键参数发生合理变化时不会改变。尽管 Hib 结合疫苗接种的投资将显著增加普遍免疫计划的成本，但约 15%的增量成本将被医疗保健成本节省所抵消。应努力加快在印度全国范围内推广 Hib 结合疫苗接种。
