Vizzotti C, Pippo T, Urueña A, Altuna J, Palópoli G, Hernández M L, Artola M F, Fernández H, Orellano P, Cañero-Velasco M C, Ciocca M, Ramonet M, Diosque M
Ministerio de Salud de la Nación, Av. 9 de Julio 1925, C1073ABA Ciudad Autónoma de Buenos Aires, Argentina.
Ministerio de Salud de la Nación, Av. 9 de Julio 1925, C1073ABA Ciudad Autónoma de Buenos Aires, Argentina.
Vaccine. 2015 May 7;33 Suppl 1:A227-32. doi: 10.1016/j.vaccine.2014.12.077.
Vaccination against hepatitis A (HA) was carried out only as part of a limited outbreak control strategy in Argentina until June 2005, when universal immunization in infants was introduced into the national immunization calendar. A single-dose strategy was chosen instead of the standard two-dose schedule used elsewhere. This study aimed to estimate preventive, medical, and non-medical costs related to HA and to compare these costs in the periods before and after mass vaccination.
A retrospective analysis estimated treatment costs of HA and unspecified hepatitis cases reported to the National Health Surveillance System from 2000 to 2010. Costs related to immunization, fulminant hepatitis (FH), liver transplantation, and death were projected as well. Using a social perspective and a healthcare system perspective, costs in two 5-year periods were compared: 2000-2004 versus 2006-2010. Finally, we evaluated the impact of different discount rates, FH risk, and exclusion of unspecified hepatitis cases in the sensitivity analysis.
Total HA and unspecified hepatitis cases decreased from 157,871 in 2000-2004 to 17,784 in 2006-2010. Medical and non-medical costs decreased from US$11,811,600 and US$30,118,222 to US$1,252,694 and US$4,995,895 in those periods, respectively. Immunization costs increased from US$6,506,711 to US$40,912,132. Total preventive, medical, and non-medical costs decreased from US$48,436,534 to US$47,160,721, representing a 2.6% reduction in total costs between the two periods. When a healthcare system perspective was considered or unspecified hepatitis cases were excluded, total costs were 130.2% and 30.8% higher in 2006-2010 than in the previous period, respectively.
After implementation of the universal single-dose vaccination against HA in infants in Argentina, an impressive decline was observed in HA cases, with a decrease in medical and non-medical costs in the first 5 years. The single-dose strategy, which is simpler and less expensive than the standard two-dose scheme, can be a good alternative for future vaccination policies in other countries where HA is endemic.
在阿根廷，直到2005年6月甲型肝炎（HA）疫苗接种仅作为有限的疫情控制策略的一部分，之后婴儿普遍免疫被纳入国家免疫规划。采用了单剂量策略而非其他地方使用的标准两剂量方案。本研究旨在估算与HA相关的预防、医疗和非医疗成本，并比较大规模疫苗接种前后这些成本的情况。
一项回顾性分析估算了2000年至2010年向国家卫生监测系统报告的HA及未明确诊断的肝炎病例的治疗成本。还预测了与免疫接种、暴发性肝炎（FH）、肝移植和死亡相关的成本。从社会视角和医疗保健系统视角，比较了两个5年期的成本：2000 - 2004年与2006 - 2010年。最后，在敏感性分析中评估了不同贴现率、FH风险以及排除未明确诊断的肝炎病例的影响。
HA及未明确诊断的肝炎病例总数从2000 - 2004年的157,871例降至2006 - 2010年的17,784例。在这些时期，医疗和非医疗成本分别从11,811,600美元和30,118,222美元降至1,252,694美元和4,995,895美元。免疫接种成本从6,506,711美元增至40,912,132美元。预防、医疗和非医疗总成本从48,436,534美元降至47,160,721美元，表明两个时期之间总成本降低了2.6%。当考虑医疗保健系统视角或排除未明确诊断的肝炎病例时，2006 - 2010年的总成本分别比上一时期高130.2%和30.8%。
在阿根廷对婴儿实施普遍的单剂量HA疫苗接种后，观察到HA病例显著下降，且头5年医疗和非医疗成本降低。单剂量策略比标准两剂量方案更简单且成本更低，对于其他HA流行国家未来的疫苗接种政策可能是一个不错的选择。
