Blommaert Adriaan, Bilcke Joke, Vandendijck Yannick, Hanquet Germaine, Hens Niel, Beutels Philippe
Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium; Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Hasselt University, Hasselt, Belgium.
Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.
Vaccine. 2014 Oct 21;32(46):6075-83. doi: 10.1016/j.vaccine.2014.08.085. Epub 2014 Sep 18.
Risk groups with increased vulnerability for influenza complications such as pregnant women, persons with underlying illnesses as well as persons who come into contact with them, such as health care workers, are currently given priority (along with other classic target groups) to receive seasonal influenza vaccination in Belgium. We aimed to evaluate this policy from a health care payer perspective by cost-effectiveness analysis in the three specific target groups above, while accounting for effects beyond the target group. Increasing the coverage of influenza vaccination is likely to be cost-effective for pregnant women (median €6589 per quality-adjusted life-year (QALY) gained [€4073-€10,249]) and health care workers (median €24,096/QALY gained [€16,442-€36,342]), if this can be achieved without incurring additional administration costs. Assuming an additional physician's consult is charged to administer each additional vaccine dose, the cost-effectiveness of vaccinating pregnant women depends strongly on the extent of its impact on the neonate's health. For health care workers, the assumed number of preventable secondary infections has a strong influence on the cost-effectiveness. Vaccinating people with underlying illnesses is likely highly cost-effective above 50 years of age and borderline cost-effective for younger persons, depending on relative life expectancy and vaccine efficacy in this risk group compared to the general population. The case-fatality ratios of the target group, of the secondary affected groups and vaccine efficacy are key sources of uncertainty.
在比利时，孕妇、患有基础疾病的人以及与他们接触的人（如医护人员）等流感并发症易感性增加的风险群体，目前（与其他传统目标群体一起）在季节性流感疫苗接种方面享有优先权。我们旨在从医疗保健支付方的角度，通过对上述三个特定目标群体进行成本效益分析来评估这一政策，同时考虑目标群体之外的影响。如果在不产生额外管理成本的情况下提高流感疫苗接种覆盖率，对于孕妇（每获得一个质量调整生命年（QALY）的中位数成本为6589欧元[4073欧元 - 10249欧元]）和医护人员（每获得一个QALY的中位数成本为24096欧元[16442欧元 - 36342欧元]）来说可能具有成本效益。假设每额外接种一剂疫苗需收取一次额外的医生诊疗费，为孕妇接种疫苗的成本效益在很大程度上取决于其对新生儿健康的影响程度。对于医护人员，假设的可预防二次感染数量对成本效益有很大影响。为患有基础疾病的人接种疫苗在50岁以上人群中可能具有很高的成本效益，而对于年轻人则处于成本效益的临界状态，这取决于该风险群体与普通人群相比的相对预期寿命和疫苗效力。目标群体、二次受影响群体的病死率以及疫苗效力是不确定性的关键来源。
