Shields Gemma E, Elvidge Jamie, Davies Linda M
Centre for Health Economics, University of Manchester, Manchester, UK.
BMJ Open. 2017 Jun 10;7(6):e014847. doi: 10.1136/bmjopen-2016-014847.
The Council of the European Union (EU) has recommended that action should be taken to increase influenza vaccination in the elderly population. The aims were to systematically review and critically appraise economic evaluations for influenza vaccination in the elderly population in the EU.
Electronic searches of the NHS Economic Evaluation, Health Technology Assessment, MEDLINE and Embase databases were run to identify full economic evaluations. Two levels of screening were used, with explicit inclusion criteria applied by two independent reviewers at each stage. Prespecified data extraction and critical appraisal were performed on identified studies. Results were summarised qualitatively.
Of the 326 search results, screening identified eight relevant studies. Results varied widely, with the incremental cost-effectiveness ratio ranging from being both more effective and cheaper than no intervention to costing €4 59 350 per life-year gained. Cost-effectiveness was most sensitive to variations in influenza strain, vaccination type and strategy, population and modelling characteristics.
Most studies suggest that vaccination is cost-effective (seven of eight studies identified at least one cost-effective scenario). All but one study used economic models to synthesise data from different sources. The results are uncertain due to the methods used and the relevance and robustness of the data used. Sensitivity analysis to explore these aspects was limited. Integrated, controlled prospective clinical and economic evaluations and surveillance data are needed to improve the evidence base. This would allow more advanced modelling techniques to characterise the epidemiology of influenza more accurately and improve the robustness of cost-effectiveness estimates.
欧盟理事会建议采取行动提高老年人群的流感疫苗接种率。目的是系统回顾并严格评估欧盟老年人群流感疫苗接种的经济学评价。
检索英国国家医疗服务体系经济学评价数据库、卫生技术评估数据库、MEDLINE数据库和Embase数据库，以识别完整的经济学评价。采用两级筛选，每个阶段由两名独立评审员应用明确的纳入标准。对纳入研究进行预先设定的数据提取和严格评价。结果进行定性总结。
326条检索结果中，筛选出8项相关研究。结果差异很大，增量成本效益比从比不干预更有效且成本更低到每获得一个生命年花费459350欧元不等。成本效益对流感毒株、疫苗接种类型和策略、人群及模型特征的变化最为敏感。
大多数研究表明接种疫苗具有成本效益（8项研究中有7项至少确定了一种具有成本效益的方案）。除一项研究外，所有研究均使用经济模型综合来自不同来源的数据。由于所采用的方法以及所用数据的相关性和稳健性，结果具有不确定性。探索这些方面的敏感性分析有限。需要综合的、对照的前瞻性临床和经济学评价以及监测数据来改善证据基础。这将使更先进的建模技术能够更准确地描述流感的流行病学特征，并提高成本效益估计的稳健性。
