CESAV, Centre for Health Economics, IRCCS Institute for Pharmacological Research 'Mario Negri', Via Camozzi, 3 c/o Villa Camozzi, Ranica, 24020, Bergamo, Italy.
Pharmacoeconomics. 2014 Jan;32(1):29-45. doi: 10.1007/s40273-013-0113-y.
Diseases caused by Streptococcus pneumoniae (pneumococcus) are a major global public health problem. Despite their importance, information on the burden of the different pneumococcal diseases is limited and estimates vary widely.
We critically reviewed the full economic evaluations (FEEs) on the new pneumococcal conjugate vaccines (PCVs) conducted in the European Union (EU) to assess their potential contribution to public decision making. We selected the FEEs focussed on PCV-10 and PCV-13 and published in English from January 2007 until June 2013. We screened the selected articles to assess their main methodological features using a common checklist composed of epidemiological, clinical and economic items.
All the ten studies selected were based on modelling and the time horizon was always long term. Two studies focused on adults, the remaining eight on infants. Only one study based herd immunity on national data, eight used foreign data or modelling and the last did not consider it. National prices and tariffs were claimed to be sources for unit costs in all studies; however, half of them assumed price parity when one vaccine was not yet marketed, and the figures varied within the countries where more than one study was conducted. Conclusions supported the economic utility of pneumococcal vaccination in all studies, raising some concern only in (i) the independent study, which found that PCV-13 was borderline cost effective, and (ii) the study sponsored by both manufacturers, which estimated an incremental ratio slightly above the national threshold for both PCV-10 and PCV-13.
The European studies we analysed are mostly based on weak sources of data. Because of the limited information on vaccine effectiveness and lack of epidemiological and economic data, the need for extensive recourse to assumptions leads to great within- and between-study variability generated by authors' choices.
由肺炎链球菌（肺炎球菌）引起的疾病是一个重大的全球公共卫生问题。尽管这些疾病很重要，但有关其负担的信息有限，且估计差异很大。
我们批判性地回顾了在欧盟（EU）进行的针对新型肺炎球菌结合疫苗（PCV）的全经济评估（FEE），以评估它们对公共决策的潜在贡献。我们选择了重点关注 PCV-10 和 PCV-13 的 FEE，并于 2007 年 1 月至 2013 年 6 月期间以英文发表。我们筛选了选定的文章，使用由流行病学、临床和经济项目组成的通用清单来评估其主要方法特征。
所有选定的十项研究均基于模型，时间范围始终是长期的。两项研究针对成年人，其余八项研究针对婴儿。只有一项研究基于国家数据的群体免疫，八项研究使用外国数据或建模，最后一项研究则没有考虑。所有研究均声称国家价格和关税是单位成本的来源；然而，其中一半在一种疫苗尚未上市时假设价格均等，而且在进行了多项研究的国家中，价格存在差异。所有研究都支持肺炎球菌疫苗接种的经济效用，但也存在一些担忧，仅在（i）独立研究中发现 PCV-13 具有边缘成本效益，以及（ii）由制造商双方赞助的研究中发现 PCV-10 和 PCV-13 的增量比略高于国家阈值。
我们分析的欧洲研究大多基于数据来源薄弱。由于疫苗效力的信息有限，以及缺乏流行病学和经济数据，广泛依赖假设导致作者选择产生了巨大的研究内和研究间差异。
