Komakhidze T, Hoestlandt C, Dolakidze T, Shakhnazarova M, Chlikadze R, Kopaleishvili N, Goginashvili K, Kherkheulidze M, Clark A D, Blau J
Georgia National Centre for Disease Control and Public Health (NCDC), Tbilisi, Georgia.
Agence de Médecine Préventive (AMP), Paris, France.
Vaccine. 2015 May 7;33 Suppl 1:A219-26. doi: 10.1016/j.vaccine.2014.12.070.
Financial support from the Global Alliance for Vaccines and Immunization (GAVI) to introduce the 10-valent pneumococcal conjugate vaccine (PCV10) into the routine childhood immunization schedule in Georgia is ending in 2015. As a result, the Interagency Coordination Committee (ICC) decided to carry out a cost-effectiveness analysis to gather additional evidence to advocate for an appropriate evidence-based decision after GAVI support is over. The study also aimed to strengthen national capacity to conduct cost-effectiveness studies, and to introduce economic evaluations into Georgia's decision-making process.
A multidisciplinary team of national experts led by a member of the ICC carried out the analysis that compared two scenarios: introducing PCV10 vs no vaccination. The TRIVAC model was used to evaluate 10 cohorts of children over the period 2014-2023. National data was used to inform demographics, disease burden, vaccine coverage, health service utilization, and costs. Evidence from clinical trials and the scientific literature was used to estimate the impact of the vaccine. A 3+0 schedule and a vaccine price increasing to US$ 3.50 per dose was assumed for the base-case scenario. Alternative univariate and multivariate scenarios were evaluated.
Over the 10-year period, PCV10 was estimated to prevent 7170 (8288 undiscounted) outpatient visits due to all-cause acute otitis media, 5325 (6154 undiscounted) admissions due to all-cause pneumonia, 87 (100 undiscounted) admissions due to pneumococcal meningitis, and 508 (588 undiscounted) admissions due to pneumococcal non-pneumonia and non-meningitis (NPNM). In addition, the vaccine was estimated to prevent 41 (48 undiscounted) deaths. This is equivalent to approximately 5 deaths and 700 admissions prevented each year in Georgia. Over the 10-year period, PCV10 would cost the government approximately US$ 4.4 million ($440,000 per year). However, about half of this would be offset by the treatment costs prevented. The discounted cost-effectiveness ratio was estimated to be US$ 1599 per DALY averted with scenarios ranging from US$ 286 to US$ 7787.
This study led to better multi-sectoral collaboration and improved national capacity to perform economic evaluations. Routine infant vaccination against Streptococcus pneumoniae would be highly cost-effective in Georgia. The decision to introduce PCV10 was already made some time before the study was initiated but it provided important economic evidence in support of that decision. There are several uncertainties around many of the parameters used, but a multivariate scenario analysis with several conservative assumptions (including no herd effect in older individuals) shows that this recommendation is robust. This study supports the decision to introduce PCV10 in Georgia.
全球疫苗免疫联盟（GAVI）为格鲁吉亚将10价肺炎球菌结合疫苗（PCV10）纳入儿童常规免疫计划提供的财政支持将于2015年结束。因此，跨部门协调委员会（ICC）决定开展一项成本效益分析，以收集更多证据，以便在GAVI支持结束后做出基于证据的恰当决策。该研究还旨在加强国家开展成本效益研究的能力，并将经济评估引入格鲁吉亚的决策过程。
由ICC一名成员牵头的多学科国家专家团队进行了此项分析，比较了两种方案：引入PCV10与不进行疫苗接种。使用TRIVAC模型对2014年至2023年期间的10组儿童进行评估。利用国家数据来了解人口统计学、疾病负担、疫苗接种覆盖率、卫生服务利用情况和成本。临床试验和科学文献中的证据用于估计疫苗的影响。基础方案假设采用3+0接种程序，且疫苗价格涨至每剂3.50美元。对替代单变量和多变量方案进行了评估。
在这10年期间，估计PCV10可预防因各种原因导致的急性中耳炎而进行的7170次（未贴现的为8288次）门诊就诊、因各种原因导致的肺炎而进行的5325次（未贴现的为6154次）住院治疗、因肺炎球菌性脑膜炎而进行的87次（未贴现的为100次）住院治疗以及因肺炎球菌非肺炎和非脑膜炎（NPNM）而进行的508次（未贴现的为588次）住院治疗。此外，估计该疫苗可预防41例（未贴现的为48例）死亡。这相当于格鲁吉亚每年约预防5例死亡和700次住院治疗。在这10年期间，PCV10将使政府花费约440万美元（每年44万美元）。然而，其中约一半将被预防的治疗成本所抵消。贴现后的成本效益比估计为每避免一个伤残调整生命年1599美元，各方案范围为286美元至7787美元。
这项研究促成了更好的多部门合作，并提高了国家进行经济评估的能力。在格鲁吉亚，常规婴儿接种肺炎链球菌疫苗具有很高的成本效益。引入PCV10的决定在该研究启动之前就已做出，但它为这一决定提供了重要的经济证据支持。所使用的许多参数存在若干不确定性，但一项包含若干保守假设（包括老年人群体中无群体效应）的多变量方案分析表明这一建议是可靠的。本研究支持在格鲁吉亚引入PCV10的决定。
