Mo Xiuting, Gai Tobe Ruoyan, Liu Xiaoyan, Mori Rintaro
From the *School of Public Health, Shandong University, Jinan, China; †Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan; ‡Qilu Hospital of Shandong University, Jinan, China.
Pediatr Infect Dis J. 2016 Nov;35(11):e353-e361. doi: 10.1097/INF.0000000000001288.
Each year in China, approximately 700,000 children under 5 years old are diagnosed with pneumonia, and 30,000 die of the disease. Although 7-valent pneumococcal conjugate vaccine (PCV-7) and 23-valent pneumococcal polysaccharide vaccine (PPV-23) are available in China, the costs are borne by the consumer, resulting in low coverage for PCV-7. We aimed to conduct a simulation study to assess the cost-effectiveness and health benefits of PCV-7, 13-valent pneumococcal conjugate vaccine (PCV-13) and PPV-23 to prevent childhood pneumonia and other vaccine-preventive diseases in China.
An economic evaluation was performed using a Markov simulation model. Parameters including demographic, epidemiological data, costs and efficacy of vaccines were obtained from previous studies. A hypothetical cohort of 100,000 newborns (focusing on pneumococcal diseases ≤7 years old) was followed up until death or 100 years of age. The model incorporated the impact of vaccination on reduction of incidence of pneumococcal diseases and mortality of children ≤7 years. Outcomes are presented in terms of disease cases averted, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio.
Under baseline assumptions, PPV-23 is currently the only cost-effective option, whereas PCV-13 showed the greatest impact on pneumococcal disease burden, reducing invasive pneumococcal diseases by 31.3%, pneumonia by 15.3% and gaining 73.8 QALYs (10,000 individuals at discount rate of 3%). Incremental cost-effectiveness ratios of PCV-13 and PCV-7 are US$29,460/QALY and US$104,094/QALY, respectively, showing no cost-effectiveness based on the World Health Organization recommended willingness-to-pay threshold. On the other hand, the incremental cost-effectiveness ratios of PCVs were most sensitive to vaccination costs; if it reduces 4.7% and 32.2% for PCV-7 and PCV-13, respectively, the vaccination will be cost-effective.
To scale up current vaccination strategies and achieve potential health benefits, the replacement of PCV-7 with PCV-13 should be considered. As well, PCV's costs need to be reduced by increasing public subsidies and providing financial support to poor families.
在中国，每年约有70万5岁以下儿童被诊断患有肺炎，其中3万人死于该疾病。尽管中国有7价肺炎球菌结合疫苗（PCV - 7）和23价肺炎球菌多糖疫苗（PPV - 23），但费用需由消费者承担，导致PCV - 7的接种覆盖率较低。我们旨在开展一项模拟研究，以评估PCV - 7、13价肺炎球菌结合疫苗（PCV - 13）和PPV - 23在中国预防儿童肺炎及其他疫苗可预防疾病方面的成本效益和健康效益。
使用马尔可夫模拟模型进行经济评估。包括人口统计学、流行病学数据、疫苗成本和效力等参数均取自先前的研究。对10万名新生儿的假设队列（重点关注7岁及以下的肺炎球菌疾病）进行随访，直至死亡或年满100岁。该模型纳入了疫苗接种对降低肺炎球菌疾病发病率和7岁及以下儿童死亡率的影响。结果以避免的疾病病例数、质量调整生命年（QALY）和增量成本效益比来呈现。
在基线假设下，PPV - 23目前是唯一具有成本效益的选择，而PCV - 13对肺炎球菌疾病负担的影响最大，可将侵袭性肺炎球菌疾病减少31.3%，肺炎减少15.3%，并获得73.8个QALY（贴现率为3%时，10000人）。PCV - 13和PCV - 7的增量成本效益比分别为29460美元/QALY和104094美元/QALY，根据世界卫生组织推荐的支付意愿阈值，显示不具有成本效益。另一方面，PCV的增量成本效益比对疫苗接种成本最为敏感；如果PCV - 7和PCV - 13的接种成本分别降低4.7%和32.2%，则疫苗接种将具有成本效益。
为扩大当前的疫苗接种策略并实现潜在的健康效益，应考虑用PCV - 13替代PCV - 7。此外，需要通过增加公共补贴和为贫困家庭提供财政支持来降低PCV的成本。
