大规模儿童流感疫苗接种对英格兰和威尔士现有流感疫苗接种计划的影响：一项建模与成本效益分析。
Effect of mass paediatric influenza vaccination on existing influenza vaccination programmes in England and Wales: a modelling and cost-effectiveness analysis.
作者信息
Hodgson David, Baguelin Marc, van Leeuwen Edwin, Panovska-Griffiths Jasmina, Ramsay Mary, Pebody Richard, Atkins Katherine E
机构信息
Centre for Mathematics, Physics and Engineering in the Life Sciences and Experimental Biology, University College London, London, UK.
Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Respiratory Diseases Department, Public Health England, London, UK.
出版信息
Lancet Public Health. 2017 Feb;2(2):e74-e81. doi: 10.1016/S2468-2667(16)30044-5.
BACKGROUND
In 2013 England and Wales began to fund a live attenuated influenza vaccine programme for individuals aged 2-16 years. Mathematical modelling predicts substantial beneficial herd effects for the entire population as a result of reduced influenza transmission. With a decreased influenza-associated disease burden, existing immunisation programmes might be less cost-effective. The aim of this study was to assess the epidemiological effect and cost-effectiveness of the existing elderly and risk group vaccination programme under the new policy of mass paediatric vaccination in England.
METHODS
For this cost-effectiveness analysis, we used a transmission model of seasonal influenza calibrated to 14 seasons of weekly consultation and virology data in England and Wales. We combined this model with an economic evaluation to calculate the incremental cost-effectiveness ratios, measured in cost per quality-adjusted life-years (QALY) gained.
FINDINGS
Our results suggest that well timed administration of paediatric vaccination would reduce the number of low-risk elderly influenza cases to a greater extent than would vaccination of the low-risk elderly themselves if the elderly uptake is achieved more slowly. Although high-risk vaccination remains cost-effective, substantial uncertainty exists as to whether low-risk elderly vaccination remains cost-effective, driven by the choice of cost-effectiveness threshold. Under base case assumptions and a cost-effectiveness threshold of £15 000 per QALY, the low-risk elderly seasonal vaccination programme will cease to be cost-effective with a mean incremental cost-effectiveness ratio of £22 000 per QALY and a probability of cost-effectiveness of 20%. However, under a £30 000 per QALY threshold, the programme will remain cost-effective with 83% probability.
INTERPRETATION
With the likely move to decreased cost-effectiveness thresholds, reassessment of existing risk group-based vaccine programme cost-effectiveness in the presence of the paediatric vaccination programme is needed.
FUNDING
National Institute for Health Research, the Medical Research Council.
背景
2013年，英格兰和威尔士开始为2至16岁的人群资助一项减毒活流感疫苗计划。数学模型预测，由于流感传播减少，这将给整个人口带来显著的有益群体效应。随着流感相关疾病负担的减轻，现有的免疫计划可能在成本效益方面降低。本研究的目的是评估在英格兰大规模儿童疫苗接种新政策下，现有老年人和风险群体疫苗接种计划的流行病学效果和成本效益。
方法
对于这项成本效益分析，我们使用了一个季节性流感传播模型，该模型根据英格兰和威尔士14个季节的每周会诊和病毒学数据进行了校准。我们将这个模型与经济评估相结合，以计算增量成本效益比，以每获得一个质量调整生命年（QALY）的成本来衡量。
结果
我们的结果表明，如果老年人接种疫苗的速度较慢，及时接种儿童疫苗比为低风险老年人自身接种疫苗能更大程度地减少低风险老年流感病例的数量。虽然高风险人群接种疫苗仍然具有成本效益，但低风险老年人接种疫苗是否仍具有成本效益存在很大不确定性，这取决于成本效益阈值的选择。在基本情况假设和每QALY 15000英镑的成本效益阈值下，低风险老年人季节性疫苗接种计划将不再具有成本效益，平均增量成本效益比为每QALY 22000英镑，成本效益概率为20%。然而，在每QALY 30000英镑的阈值下，该计划仍有83%的概率具有成本效益。
解读
随着成本效益阈值可能降低，在有儿童疫苗接种计划的情况下，需要重新评估现有的基于风险群体的疫苗计划的成本效益。
资金来源
英国国家卫生研究院、医学研究理事会。
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