Jiang Yiling, Gervais Frédéric, Gauthier Aline, Baptiste Charles, Martinon Prescilla, Bresse Xavier
a Amaris; London , UK.
Hum Vaccin Immunother. 2015;11(9):2188-97. doi: 10.1080/21645515.2015.1011957. Epub 2015 Aug 12.
In 2002, a pneumococcal conjugate vaccine (PCV) was introduced to French infants and toddlers. A change has been witnessed in the incidence of pneumococcal diseases in adults: the incidence of invasive pneumococcal disease (IPD) of serotypes covered by PCV decreased, and serotypes not covered by PCV increased. This study aimed to quantify the public health and budget impact of pneumococcal vaccination strategies in at-risk adults in France over 5 years. A previously published population-based Markov model was adapted to the French situation. At-risk adults received either PPV23 (pneumococcal polysaccharide vaccine; for the immunocompetent) or PCV13 (for the immunosuppressed). The strategy was compared to PCV13 alone. Uncertainty was addressed using extreme scenario analyses. Between 2014 and 2018, vaccination with PPV23/PCV13 led to a higher reduction in terms of IPD and non-bacteremic pneumococcal pneumonia cases avoided in most scenarios analyzed when compared to PCV13 alone. For budget impact, none of the scenarios was in favor of PCV13. Under conservative coverage assumptions, the total incremental budget impact ranged from € 39.8 million to € 69.3 million if PCV13 were to replace PPV23 in the immunocompetent. With the epidemiological changes of pneumococcal diseases and the broader serotype coverage of PPV23, the current program remains an optimal strategy from public health perspective. Given the additional budget required for the use of PCV13 alone and its uncertain public health benefits, vaccination with PPV23 remains the preferred strategy.
2002年，一种肺炎球菌结合疫苗（PCV）被引入法国婴幼儿群体。成人肺炎球菌疾病的发病率出现了变化：PCV所覆盖血清型的侵袭性肺炎球菌疾病（IPD）发病率下降，而PCV未覆盖的血清型发病率上升。本研究旨在量化法国高危成人5年期间肺炎球菌疫苗接种策略对公共卫生和预算的影响。一个先前发表的基于人群的马尔可夫模型被调整以适用于法国的情况。高危成人接种PPV23（肺炎球菌多糖疫苗；用于免疫功能正常者）或PCV13（用于免疫抑制者）。该策略与单独使用PCV13进行了比较。使用极端情景分析来处理不确定性。在2014年至2018年期间，与单独使用PCV13相比，在大多数分析情景中，接种PPV23/PCV13在避免IPD和非菌血症性肺炎球菌肺炎病例方面导致了更高的降幅。对于预算影响，没有一个情景有利于PCV13。在保守的覆盖率假设下，如果免疫功能正常者中PCV13取代PPV23，总增量预算影响范围为3980万欧元至6930万欧元。随着肺炎球菌疾病的流行病学变化以及PPV23更广泛的血清型覆盖范围，从公共卫生角度来看，当前方案仍然是最佳策略。鉴于单独使用PCV13所需的额外预算及其不确定的公共卫生效益，接种PPV23仍然是首选策略。
