四价与三价流感疫苗接种在芬兰的临床影响及成本效益
The Clinical Impact and Cost Effectiveness of Quadrivalent Versus Trivalent Influenza Vaccination in Finland.
作者信息
Nagy Lisa, Heikkinen Terho, Sackeyfio Alfred, Pitman Richard
机构信息
ICON Health Economics and Epidemiology, 100 Park Drive, Milton Park, Oxfordshire, OX14 4RY, Oxford, UK.
Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland.
出版信息
Pharmacoeconomics. 2016 Sep;34(9):939-51. doi: 10.1007/s40273-016-0430-z.
BACKGROUND
Trivalent influenza vaccines encompass one influenza B lineage; however, predictions have been unreliable on which of two antigenically distinct circulating lineages will dominate. Quadrivalent seasonal influenza vaccines contain strains from both lineages. This analysis assesses the cost effectiveness of switching from trivalent inactivated influenza vaccination (TIV) in Finland to quadrivalent vaccination, using inactivated (QIV) or live-attenuated (Q-LAIV) vaccines.
METHODS
A transmission model simulated the dynamics of influenza infection while accounting for indirect (herd) protection. Prior distributions for key transmission parameters were repeatedly sampled and simulations that fitted the available information on influenza in Finland were recorded. The resulting posterior parameter distributions were used in a probabilistic sensitivity analysis in which economic parameters were sampled, simultaneously encompassing uncertainty in the transmission and economic parameters. The cost effectiveness of a range of trivalent and quadrivalent vaccine policies over a 20-year time horizon was assessed from both a societal and payer perspective in 2014 Euros.
RESULTS
The simulated temporal incidence pattern of symptomatic infections corresponded well with case surveillance data. A switch from the current TIV to Q-LAIV in children (2 to <18 years) and to QIV in other ages was estimated to annually avert approximately 76,100 symptomatic infections (95 % range 36,700-146,700), 11,500 primary care consultations (6100-20,000), 540 hospitalisations (240-1180), and 72 deaths (32-160), and was cost-saving relative to TIV (€374 million averted [€161-€752], in 2014 Euros, discounted at 3 %). This scenario had the highest probability of being the most cost-effective scenario considered.
CONCLUSIONS
This analysis demonstrates that quadrivalent vaccination is expected to be highly cost effective, reducing the burden of influenza-related disease.
背景
三价流感疫苗包含一种乙型流感谱系；然而，对于两种抗原性不同的流行谱系中哪一种将占主导地位的预测一直不可靠。四价季节性流感疫苗包含来自两种谱系的毒株。本分析评估了在芬兰从三价灭活流感疫苗（TIV）转换为四价疫苗（使用灭活疫苗（QIV）或减毒活疫苗（Q-LAIV））的成本效益。
方法
一个传播模型模拟了流感感染的动态过程，同时考虑了间接（群体）保护。对关键传播参数的先验分布进行反复抽样，并记录符合芬兰流感现有信息的模拟结果。所得的后验参数分布用于概率敏感性分析，其中对经济参数进行抽样，同时涵盖传播和经济参数的不确定性。从社会和支付方的角度，以2014年欧元为单位，评估了一系列三价和四价疫苗策略在20年时间范围内的成本效益。
结果
模拟的有症状感染的时间发病率模式与病例监测数据吻合良好。估计从当前的TIV转换为儿童（2至<18岁）接种Q-LAIV以及其他年龄段接种QIV，每年可避免约76,100例有症状感染（95%范围为36,700 - 146,700）、11,500次初级保健会诊（6100 - 20,000）、540次住院治疗（240 - 1180）以及72例死亡（32 - 160），并且相对于TIV具有成本节约效益（避免3.74亿欧元[1.61 - 7.52亿欧元]，2014年欧元，按3%贴现）。该方案成为所考虑的最具成本效益方案的概率最高。
结论
本分析表明，四价疫苗接种预计具有很高的成本效益，可减轻流感相关疾病的负担。
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