a Unit of PharmacoEpidemiology&PharmacoEconomics (PE2); Department of Pharmacy; University of Groningen; Groningen, The Netherlands.
Hum Vaccin Immunother. 2014;10(8):2342-9. doi: 10.4161/hv.29353.
This study aims to assess the cost-effectiveness of hepatitis A immunization in Indonesia, including an explicit comparison between one-dose and two-dose vaccines.
An age-structured cohort model based on a decision tree was developed for the 2012 Indonesia birth cohort. Using the model, we made a comparison on the use of two-dose and one-dose vaccines. The model involved a 70-year time horizon with 1-month cycles for children less than 2 years old and annually thereafter. Monte Carlo simulations were used to examine the economic acceptability and affordability of the hepatitis A vaccination.
Vaccination would save US$ 3,795,148 and US$ 2,892,920 from the societal perspective, for the two-dose and one-dose vaccine schedules, respectively, in the context of hepatitis A treatment. It also would save 8917 and 6614 discounted quality-adjusted-life-years (QALYs), respectively. With the vaccine price of US$ 3.21 per dose, the implementation of single dose vaccine would yield an incremental cost-effectiveness ratio (ICER) of US$ 4933 per QALY gained versus no vaccination, whereas the two-dose versus one-dose schedule would cost US$ 14 568 per QALY gained. Considering the 2012 gross-domestic-product (GDP) per capita in Indonesia of US$ 3557, the results indicate that hepatitis A vaccination would be a cost-effective intervention, both for the two-dose and one-dose vaccine schedules in isolation, but two-dose vaccination would no longer be cost-effective if one-dose vaccination is a feasible option. Vaccination would be 100% affordable at budgets of US$ 71,408 000 and US$ 37,690,000 for the implementation of the two-dose and one-dose vaccine schedules, respectively.
The implementation of hepatitis A vaccination in Indonesia would be a cost-effective health intervention under the market vaccine price. Given the budget limitations, the use of a one-dose-vaccine schedule would be more realistic to be applied than a two-dose schedule. The vaccine price, mortality rate and discount rate were the most influential parameters impacting the ICERs.
本研究旨在评估印度尼西亚甲型肝炎免疫接种的成本效益，包括对一剂和两剂疫苗的明确比较。
我们基于决策树开发了一个基于年龄结构的队列模型，针对 2012 年印度尼西亚出生队列进行比较。我们使用该模型对两剂和一剂疫苗的使用进行了比较。该模型涉及 70 年的时间范围，2 岁以下儿童每 1 个月一个周期，此后每年一次。蒙特卡罗模拟用于检验甲型肝炎疫苗接种的经济可接受性和负担能力。
从社会角度来看，在甲型肝炎治疗的背景下，两剂和一剂疫苗接种方案将分别节省 3795148 美元和 2892920 美元，同时还将分别节省 8917 和 6614 个贴现质量调整生命年（QALY）。如果单价为 3.21 美元，则实施单剂疫苗接种的增量成本效益比（ICER）将为每获得一个 QALY 增加 4933 美元，而两剂与一剂相比，每获得一个 QALY 将增加 14568 美元。考虑到印度尼西亚 2012 年人均国内生产总值（GDP）为 3557 美元，结果表明，无论是两剂还是一剂疫苗接种方案，甲型肝炎疫苗接种都是一种具有成本效益的干预措施，但如果一剂疫苗接种是可行的选择，则两剂疫苗接种将不再具有成本效益。如果实施两剂和一剂疫苗接种方案，预算分别为 7140.8 万美元和 3769 万美元，那么疫苗接种将 100%可负担得起。
在市场疫苗价格下，在印度尼西亚实施甲型肝炎疫苗接种将是一项具有成本效益的卫生干预措施。考虑到预算限制，使用一剂疫苗接种方案比两剂方案更现实。疫苗价格、死亡率和贴现率是影响 ICER 的最具影响力的参数。
