Leino Tuija, Baum Ulrike, Scott Peter, Ollgren Jukka, Salo Heini
Department of Health Security, National Institute for Health and Welfare (THL), Mannerheimintie 166, Helsinki Finland, P.O. Box 30, FI-00271 Helsinki, Finland.
Department of Health Solutions, National Institute for Health and Welfare (THL), Mannerheimintie 166, Helsinki Finland, P.O. Box 30, FI-00271 Helsinki, Finland.
Vaccine. 2017 Oct 9;35(42):5611-5617. doi: 10.1016/j.vaccine.2017.08.052.
This study aimed to estimate the impact of the national rotavirus (RV) vaccination programme, starting 2009, on the total hospital-treated acute gastroenteritis (AGE) and severe RV disease burden in Finland during the first five years of the programme. This study also evaluated the costs saved in secondary healthcare by the RV vaccination programme.
The RV related outcome definitions were based on ICD10 diagnostic codes recorded in the Care Register for Health Care. Incidences of hospitalised and hospital outpatient cases of AGE (A00-A09, R11) and RVGE (A08.0) were compared prior (1999-2005) and after (2010-2014) the start of the programme among children less than five years of age.
The reduction in disease burden in 2014, when all children under five years of age have been eligible for RV vaccination, was 92.9% (95%CI: 91.0%-94.5%) in hospitalised RVGE and 68.5% (66.6%-70.3%) in the total hospitalised AGE among children less than five years of age. For the corresponding hospital outpatient cases, there was a reduction of 91.4% (82.4%-96.6%) in the RVGE incidence, but an increase of 6.3% (2.7%-9.9%) in the AGE incidence. The RV vaccination programme prevented 2206 secondary healthcare AGE cases costing €4.5 million annually. As the RV immunisation costs were €2.3 million, the total net savings just in secondary healthcare costs were €2.2 million, i.e. €33 per vaccinated child.
The RV vaccination programme clearly controlled the severe, hospital-treated forms of RVGE. The total disease burden is a more valuable end point than mere specifically diagnosed cases as laboratory confirmation practises usually change after vaccine introduction. The RV vaccination programme annually pays for itself at least two times over.
本研究旨在评估自2009年起实施的国家轮状病毒（RV）疫苗接种计划在该计划实施的头五年里对芬兰医院收治的急性胃肠炎（AGE）总数及严重RV疾病负担的影响。本研究还评估了RV疫苗接种计划在二级医疗保健中节省的成本。
RV相关结局定义基于医疗保健护理登记册中记录的ICD10诊断代码。比较了该计划开始前（1999 - 2005年）和开始后（2010 - 2014年）五岁以下儿童中AGE（A00 - A09，R11）和RVGE（A08.0）的住院病例和门诊病例的发病率。
到2014年，当所有五岁以下儿童都有资格接种RV疫苗时，五岁以下儿童中住院RVGE的疾病负担降低了92.9%（95%CI：91.0% - 94.5%），住院AGE总数降低了68.5%（66.6% - 70.3%）。对于相应的门诊病例，RVGE发病率降低了91.4%（82.4% - 96.6%），但AGE发病率增加了6.3%（2.7% - 9.9%）。RV疫苗接种计划预防了2206例二级医疗保健AGE病例，每年节省成本450万欧元。由于RV免疫接种成本为230万欧元，仅二级医疗保健成本的总净节省为220万欧元，即每接种一名儿童节省33欧元。
RV疫苗接种计划明显控制了严重的、需住院治疗的RVGE形式。总疾病负担是比单纯特定诊断病例更有价值的终点，因为疫苗引入后实验室确认做法通常会改变。RV疫苗接种计划每年至少能收回自身成本两倍以上。
