Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Vaccine. 2018 May 11;36(20):2896-2901. doi: 10.1016/j.vaccine.2017.09.023. Epub 2017 Sep 14.
BACKGROUND: Vaccination Program for US-bound Refugees (VPR) currently provides one or two doses of some age-specific Advisory Committee on Immunization Practices (ACIP)-recommended vaccines to US-bound refugees prior to departure. METHODS: We quantified and compared the full vaccination costs for refugees using two scenarios: (1) the baseline of no VPR and (2) the current situation with VPR. Under the first scenario, refugees would be fully vaccinated after arrival in the United States. For the second scenario, refugees would receive one or two doses of selected vaccines before departure and complete the recommended vaccination schedule after arrival in the United States. We evaluated costs for the full vaccination schedule and for the subset of vaccines provided by VPR by four age-stratified groups; all costs were reported in 2015 US dollars. We performed one-way and probabilistic sensitivity analyses and break-even analyses to evaluate the robustness of results. RESULTS: Vaccination costs with the VPR scenario were lower than costs of the scenario without the VPR for refugees in all examined age groups. Net cost savings per person associated with the VPR were ranged from $225.93 with estimated Refugee Medical Assistance (RMA) or Medicaid payments for domestic costs to $498.42 with estimated private sector payments. Limiting the analyses to only the vaccines included in VPR, the average costs per person were 56% less for the VPR scenario with RMA/Medicaid payments. Net cost savings with the VPR scenario were sensitive to inputs for vaccination costs, domestic vaccine coverage rates, and revaccination rates, but the VPR scenario was cost savings across a range of plausible parameter estimates. CONCLUSIONS: VPR is a cost-saving program that would also reduce the risk of refugees arriving while infected with a vaccine preventable disease.
背景:美国入境难民免疫接种计划(VPR)目前在难民出发前,根据免疫实践咨询委员会(ACIP)的建议,为其提供一种或两种特定年龄组的疫苗。
方法:我们通过两种方案来量化和比较难民的完全免疫接种成本:(1)没有 VPR 的基线方案,(2)目前有 VPR 的情况。在第一种方案下,难民抵达美国后将接受全面疫苗接种。对于第二种方案,难民将在出发前接种一到两剂选定的疫苗,并在抵达美国后完成建议的疫苗接种计划。我们通过四个年龄分层组评估了全面接种计划和 VPR 提供的疫苗亚组的成本;所有成本均以 2015 年美元计。我们进行了单因素和概率敏感性分析以及盈亏平衡分析,以评估结果的稳健性。
结果:对于所有研究年龄组的难民,VPR 方案的接种成本均低于没有 VPR 方案的成本。VPR 相关的人均净成本节省从估计的难民医疗援助(RMA)或医疗保险支付的国内费用 225.93 美元到估计的私营部门支付的 498.42 美元不等。将分析仅限于 VPR 中包含的疫苗,RMA/Medicaid 支付的 VPR 方案的人均成本降低了 56%。VPR 方案的净成本节省对疫苗接种成本、国内疫苗覆盖率和复种率等投入敏感,但 VPR 方案在一系列合理的参数估计范围内仍具有成本节省优势。
结论:VPR 是一个具有成本效益的计划,它还将降低难民入境时感染疫苗可预防疾病的风险。
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