Kieninger Martha Peña, Caballero Edgar Giménez, Sosa Antonio Arbo, Amarilla Carlos Torres, Jáuregui Bárbara, Janusz Cara Bess, Clark Andrew David, Castellanos Raúl Montesano
National Consultant on Health Economics, Pan American Health Organization/World Health Organization (PAHO/WHO), Asunción, Paraguay.
Ministry of Health, Asunción, Paraguay.
Vaccine. 2015 May 7;33 Suppl 1:A143-53. doi: 10.1016/j.vaccine.2014.12.078.
To describe a cost-effectiveness analysis of 10- or 13-valent pneumococcal conjugate vaccine (PCV10 or 13) introduction in Paraguay compared to no vaccination.
The integrated TRIVAC vaccine cost-effectiveness model (version 2.0) jointly developed by the Pan American Health Organization's ProVac Initiative and the London School of Hygiene & Tropical Medicine was applied from the government and societal perspectives to estimate the cost-effectiveness (CE) of PCV introduction during 2010 and 2011. The cost-effectiveness ratios of PCV10 and PCV13 were separately compared to non-vaccination. The model calculated health and economic benefits of vaccination for 10 birth cohorts of children <5 years of age. A base case scenario with two primary doses at 2 and 4 months and a booster dose at 12 months (2+1 schedule) and alternate scenarios with varying parameters were considered.
With PCV10 introduction, the incremental costs of the vaccination program would be approximately US$ 67 million to vaccinate all 10 cohorts of children; with PCV13, US$ 87 million. Health services costs avoided by the government with PCV10 would be US$ 19.5 million; with PCV 13, US$ 17.7 million. From the societal perspective, savings were much greater: with PCV10, US$ 43 million; with PCV13, US$ 35 million. For the higher priced PCV13, the average cost-effectiveness ratio was better than for PCV10 when compared to no vaccination, but regardless both were cost effective for government and society based on a threshold of 3× GDP per capita in Paraguay (2009 US$ 2516). The number of averted meningitis and all-cause pneumonia cases and deaths was greater with PCV13 than with PCV10 when compared to no vaccination.
The introduction of either PCV10 or PCV13 would be cost effective when compared to no vaccination, and in some scenarios, highly cost effective in Paraguay. The outcomes of these analyses demonstrate that a pneumococcal vaccine could substantially reduce morbidity and mortality in children <5 years in Paraguay.
描述在巴拉圭引入10价或13价肺炎球菌结合疫苗（PCV10或PCV13）与不接种疫苗相比的成本效益分析。
应用泛美卫生组织的ProVac倡议与伦敦卫生与热带医学院联合开发的综合TRIVAC疫苗成本效益模型（2.0版），从政府和社会角度估算2010年和2011年引入PCV的成本效益（CE）。分别将PCV10和PCV13的成本效益比与不接种疫苗进行比较。该模型计算了10个5岁以下儿童出生队列接种疫苗的健康和经济效益。考虑了基础方案（2个月和4个月各接种2剂，12个月接种1剂加强剂，即2+1方案）以及参数不同的替代方案。
引入PCV10时，为所有10个儿童队列接种疫苗的疫苗接种计划增量成本约为6700万美元；引入PCV13时为8700万美元。政府因引入PCV10避免的卫生服务成本为1950万美元；引入PCV13时为1770万美元。从社会角度看，节省的费用要多得多：引入PCV10时为4300万美元；引入PCV13时为3500万美元。对于价格更高的PCV13，与不接种疫苗相比，其平均成本效益比优于PCV10，但基于巴拉圭人均国内生产总值阈值（2009年为2516美元），两者对政府和社会而言均具有成本效益。与不接种疫苗相比，PCV13预防的脑膜炎、全因肺炎病例和死亡数量比PCV10更多。
与不接种疫苗相比，引入PCV10或PCV13在成本效益方面均可行，在某些情况下，在巴拉圭具有很高的成本效益。这些分析结果表明，肺炎球菌疫苗可大幅降低巴拉圭5岁以下儿童的发病率和死亡率。
