a Department of National Immunization Program , Chinese Center for Disease Control and Prevention , Beijing , China.
Hum Vaccin Immunother. 2018 Jan 2;14(1):36-44. doi: 10.1080/21645515.2017.1385687. Epub 2017 Nov 27.
The aims of this study were to estimate the cost-effectiveness of the Haemophilus influenzae type b (Hib) vaccine for the prevention of childhood pneumonia, meningitis and other vaccine-preventable diseases in mainland China from a societal perspective and to provide information about the addition of the Hib vaccine to Chinese immunization programs.
A decision tree and the Markov model were used to estimate the costs and effectiveness of the Hib vaccine versus no Hib vaccine for a birth cohort of 100,000 children in 2016. The disease burden was estimated from the literature, statistical yearbooks and field surveys. Vaccine costs were calculated from government reports and the United Nations International Children's Emergency Fund (UNICEF) website. The WHO cost-effectiveness thresholds were used to evaluate the Hib vaccine intervention. A one-way sensitivity analysis and probabilistic sensitivity analysis were performed to evaluate the parameter uncertainties.
Within the hypothetical cohort, under a vaccination coverage of 90%, the Hib vaccine could reduce 91.4% of Hib pneumonia and 88.3% of Hib meningitis; the Hib vaccine could also prevent 25 deaths, 24 meningitis sequelae cases and 9 hearing loss cases caused by Hib infection. From a societal perspective, the incremental cost-effectiveness ratio (ICER) of the Hib vaccine compared with no vaccination was US$ 13,640.1 at the market price, which was less than 3 times the GDP per capita of China in 2016. The ICER of the Hib vaccine was US$ -59,122.9 at the UNICEF price, indicating a cost savings. The largest portion of the uncertainty in the result was caused by the annual incidence of all-cause pneumonia, proportion of pneumonia caused by Hi, vaccine costs per dose, annual incidence of Hib meningitis and costs per episode of meningitis. The models were robust considering parameter uncertainties.
The Hib vaccine is a cost-effective intervention among children in mainland China. The cost of Hib vaccine should be reduced, and it should be introduced into Chinese immunization programs.
本研究旨在从社会角度评估乙型流感嗜血杆菌（Hib）疫苗预防中国大陆儿童肺炎、脑膜炎和其他疫苗可预防疾病的成本效益，并为 Hib 疫苗纳入中国免疫规划提供信息。
采用决策树和马尔可夫模型，估计 2016 年 10 万名儿童出生队列中 Hib 疫苗与无 Hib 疫苗相比的成本和效果。疾病负担来自文献、统计年鉴和现场调查。疫苗成本根据政府报告和联合国儿童基金会（UNICEF）网站计算。采用世界卫生组织（WHO）成本效益阈值评估 Hib 疫苗干预措施。进行单因素敏感性分析和概率敏感性分析，以评估参数不确定性。
在假设队列中，接种率为 90%时，Hib 疫苗可降低 91.4%的 Hib 肺炎和 88.3%的 Hib 脑膜炎；还可预防 Hib 感染引起的 25 例死亡、24 例脑膜炎后遗症和 9 例听力损失。从社会角度看，Hib 疫苗与不接种疫苗相比，增量成本效益比（ICER）为市场价格的 13640.1 美元，低于 2016 年中国人均国内生产总值的 3 倍。按儿基会价格计算，Hib 疫苗的 ICER 为-59122.9 美元，表明节省成本。结果的不确定性主要来自全因肺炎的年发病率、Hi 引起肺炎的比例、每剂疫苗的成本、Hib 脑膜炎的年发病率和脑膜炎每例的成本。考虑到参数不确定性，模型具有稳健性。
Hib 疫苗是中国大陆儿童的一种具有成本效益的干预措施。应降低 Hib 疫苗的价格，并将其纳入中国免疫规划。
