Wu David Bin-Chia, Chaiyakunapruk Nathorn, Chong Huey-Yi, Beutels Philippe
School of Pharmacy, Monash University Malaysia, Malaysia.
School of Pharmacy, Monash University Malaysia, Malaysia; Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; School of Pharmacy, University of Wisconsin, Madison, USA; School of Population Health, University of Queensland, Brisbane, Australia.
Vaccine. 2015 Mar 30;33(14):1633-58. doi: 10.1016/j.vaccine.2015.01.081. Epub 2015 Feb 11.
Seven-valent pneumococcal conjugate vaccines (PCV7) have been used in children for more than a decade. Given the observed increase in disease caused by pneumococcal serotypes not covered by PCV7, an increasing number of countries are switching from 7-valent to 10- and 13-valent PCVs ("PCV10" and "PCV13"). Economic evaluations are important tools to inform decisions and price negotiations to make such a switch.
This review aims to provide a critical assessment of economic evaluations involving PCV10 or PCV13, published since 2006.
We searched Scopus, ISI Web of Science (SCI and SSCI) and Pubmed to retrieve, select and review relevant studies, which were archived between 1st January 2006 and 31st January 2014. The review protocol involved standard extraction of assumptions, methods, results and sponsorships from the original studies.
Sixty-three economic evaluations on PCVs published since January 2006 were identified. About half of these evaluated PCV10 and/or PCV13, the subject of this review. At current prices, both PCV13 and PCV10 were likely judged preferable to PCV7. However, the combined uncertainty related to price differences, burden of disease, vaccine effectiveness, herd and serotype replacement effects determine the preference base for either PCV10 or PCV13. The pivotal assumptions and results of these analyses also depended on which manufacturer sponsored the study.
A more thorough exploration of uncertainty should be made in future analyses on this subject, as we lack understanding to adequately model herd and serotype replacement effects to reliably predict the population impact of PCVs. The introduction of further improved PCVs in an environment of evolving antibiotic resistance and under the continuing influence of previous PCVs implies that the complexity and data requirements for relevant analyses will further increase. Decision makers using these analyses should not just rely on an analysis from a single manufacturer.
七价肺炎球菌结合疫苗（PCV7）已在儿童中使用了十多年。鉴于观察到由PCV7未覆盖的肺炎球菌血清型引起的疾病有所增加，越来越多的国家正在从七价转向十价和十三价肺炎球菌结合疫苗（“PCV10”和“PCV13”）。经济评估是为做出这种转换的决策和价格谈判提供信息的重要工具。
本综述旨在对2006年以来发表的涉及PCV10或PCV13的经济评估进行批判性评价。
我们检索了Scopus、ISI科学网（SCI和SSCI）以及Pubmed，以检索、选择和审查相关研究，这些研究存档于2006年1月1日至2014年1月31日之间。综述方案包括从原始研究中标准提取假设、方法、结果和资助情况。
确定了2006年1月以来发表的63项关于肺炎球菌结合疫苗的经济评估。其中约一半评估了PCV10和/或PCV13，即本综述的主题。按当前价格，PCV13和PCV10可能都被认为比PCV7更可取。然而，与价格差异、疾病负担、疫苗效力、群体和血清型替换效应相关的综合不确定性决定了PCV10或PCV13的偏好基础。这些分析的关键假设和结果还取决于哪个制造商资助了该研究。
在未来关于该主题的分析中，应更全面地探讨不确定性，因为我们缺乏足够的理解来对群体和血清型替换效应进行充分建模，以可靠地预测肺炎球菌结合疫苗对人群的影响。在抗生素耐药性不断演变的环境中以及在先前肺炎球菌结合疫苗的持续影响下引入进一步改进的肺炎球菌结合疫苗意味着相关分析的复杂性和数据要求将进一步增加。使用这些分析的决策者不应仅仅依赖单一制造商的分析。
