Department of Preventive Medicine and Community Health, University of Medicine & Dentistry of New Jersey-New Jersey Medical School, 185 South Orange Avenue, MSB F506, Newark, NJ 07101, USA.
Int Health. 2011 Dec;3(4):259-69. doi: 10.1016/j.inhe.2011.08.003.
Policy-makers increasingly rely on cost-effectiveness analysis, in addition to clinical effectiveness, when considering the introduction of new childhood vaccines. A previous analysis determined vaccination of infants with 7-valent pneumococcal conjugate vaccine (PCV) to be highly cost effective in preventing child mortality in countries eligible for financial support from the Global Alliance for Vaccines and Immunization (GAVI). We aimed to update this analysis by incorporating recent data on global disease burden, indirect effects and higher valency vaccines. Decision analytic models were built using an incidence-based approach in order to evaluate a three-dose vaccination schedule of infants in 72 GAVI-eligible countries over a 10-year programme. Seven-, 10- and 13-valent vaccine formulations were each compared with no vaccination. Depending on the formulation used, PCV could avert 294 000-603 000 deaths and 9.3-17.6 million disability-adjusted life-years (DALY) annually. The majority (91%) of the DALYs averted would be through the vaccine's direct effects in children under-5. Using WHO thresholds and a negotiated average dose cost, PCV would be highly cost effective in 69 of 72 GAVI-eligible countries. This finding was robust when assumptions regarding disease epidemiology and vaccine-related effects were varied in sensitivity analyses. The current analysis supports PCV introduction in GAVI-eligible countries owing to its potential to avert substantial numbers of deaths at relatively low incremental costs.
政策制定者在考虑引入新的儿童疫苗时，除了临床效果外，越来越依赖成本效益分析。之前的分析确定，在有资格获得全球疫苗免疫联盟（GAVI）财政支持的国家，为婴儿接种 7 价肺炎球菌结合疫苗（PCV）在预防儿童死亡方面具有很高的成本效益。我们旨在通过纳入全球疾病负担、间接效应和更高效价疫苗的最新数据来更新这项分析。决策分析模型采用基于发病率的方法构建，以评估 72 个有资格获得 GAVI 支持的国家中婴儿的三剂疫苗接种计划，为期 10 年。7 价、10 价和 13 价疫苗制剂分别与不接种疫苗进行比较。根据使用的制剂，PCV 每年可预防 294 000 至 603 000 例死亡和 930 万至 1760 万残疾调整生命年（DALY）。通过疫苗在 5 岁以下儿童中的直接效应，避免的 DALY 中大部分（91%）将是 5 岁以下儿童。使用世卫组织的阈值和议定的平均剂量成本，PCV 在 72 个有资格获得 GAVI 支持的国家中有 69 个国家具有很高的成本效益。当在敏感性分析中改变与疾病流行病学和疫苗相关效应相关的假设时，这一发现是稳健的。由于 PCV 有可能以相对较低的增量成本避免大量死亡，因此当前分析支持在有资格获得 GAVI 支持的国家中引入 PCV。
