Jit Mark, Hutubessy Raymond, Png May Ee, Sundaram Neisha, Audimulam Jananie, Salim Safiyah, Yoong Joanne
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Modelling and Economics Unit, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.
BMC Med. 2015 Sep 3;13:209. doi: 10.1186/s12916-015-0446-9.
Microeconomic evaluations of public health programmes such as immunisation typically only consider direct health benefits and medical cost savings. Broader economic benefits around childhood development, household behaviour, and macro-economic indicators are increasingly important, but the evidence linking immunization to such benefits is unclear.
A conceptual framework of pathways between immunisation and its proposed broader economic benefits was developed through expert consultation. Relevant articles were obtained from previous reviews, snowballing, and expert consultation. Articles were associated with one of the pathways and quality assessed using modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria.
We found 20 studies directly relevant to one or more pathways. Evidence of moderate quality from experimental and observational studies was found for benefits due to immunisation in improved childhood physical development, educational outcomes, and equity in distribution of health gains. Only modelling evidence or evidence outside the immunization field supports extrapolating these benefits to household economic behaviour and macro-economic indicators.
Innovative use of experimental and observational study designs is needed to fill evidence gaps around key pathways between immunisation and many of its proposed economic benefits.
诸如免疫接种等公共卫生项目的微观经济评估通常仅考虑直接的健康效益和医疗成本节省。围绕儿童发育、家庭行为和宏观经济指标的更广泛经济效益日益重要，但将免疫接种与此类效益联系起来的证据尚不清楚。
通过专家咨询建立了免疫接种与其所带来的更广泛经济效益之间途径的概念框架。相关文章通过以往综述、滚雪球法和专家咨询获取。文章与其中一条途径相关联，并使用改良的推荐分级评估、制定和评价（GRADE）标准进行质量评估。
我们发现20项研究与一条或多条途径直接相关。实验性和观察性研究的中等质量证据表明，免疫接种在改善儿童身体发育、教育成果以及健康收益分配公平性方面具有效益。只有模型证据或免疫接种领域之外的证据支持将这些效益外推至家庭经济行为和宏观经济指标。
需要创新性地运用实验性和观察性研究设计，以填补免疫接种与其众多潜在经济效益之间关键途径的证据空白。
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