Cafiero-Fonseca Elizabeth T, Stawasz Andrew, Johnson Sydney T, Sato Reiko, Bloom David E
Data for Decisions, LLC, Waltham, Massachusetts, United States of America.
Performance Analysis and Improvement, Massachusetts General Hospital/Massachusetts General Physicians Organization, Boston, Massachusetts, United States of America.
PLoS One. 2017 Oct 31;12(10):e0186903. doi: 10.1371/journal.pone.0186903. eCollection 2017.
Pneumococcal disease causes substantial morbidity and mortality, including among adults. Adult pneumococcal vaccines help to prevent these burdens, but they are underused. Accounting for the full benefits of adult pneumococcal vaccination may promote more rational resource allocation decisions with respect to adult pneumococcal vaccines.
Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review to assess the extent to which the literature has empirically captured (e.g., through measurement or modeling) the full benefits of adult pneumococcal vaccination.
We systematically searched PubMed and Embase to identify studies published between January 1, 2010 and April 10, 2016 that examine adult pneumococcal vaccination. We included articles if they captured any health or economic benefit of an adult pneumococcal vaccine administered to adults age ≥ 50 or ≥ 18 in risk groups. Finally, we summarized the literature by categorizing the types of benefits captured, the perspective taken, and the strength of the evidence presented. Our protocol is number 42016038335 in the PROSPERO International prospective register of systematic reviews.
We identified 5,857 papers and included 150 studies for analysis. While most capture health gains and healthcare cost savings, far fewer studies consider additional benefit categories, such as productivity gains. However, the studies with a broader approach still exhibit significant limitations; for example, many present only abstracts, while others offer no new measurements. Studies that examine the 13-valent pneumococcal conjugate vaccine focus more on broad economic benefits, but still have limitations.
This review highlights the need for more robust empirical accounting of the full benefits of adult pneumococcal vaccination. Literature outside this realm indicates that these broad benefits may be substantial. Failing to investigate the full benefits may lead society to undervalue vaccines' contributions and therefore underinvest in their development and adoption.
肺炎球菌疾病会导致严重的发病和死亡情况，包括在成年人中。成人肺炎球菌疫苗有助于预防这些负担，但使用不足。考虑成人肺炎球菌疫苗接种的全部益处可能会促进在成人肺炎球菌疫苗方面做出更合理的资源分配决策。
我们使用系统评价和荟萃分析的首选报告项目（PRISMA）指南进行了一项系统评价，以评估文献在多大程度上通过实证（如通过测量或建模）捕捉到了成人肺炎球菌疫苗接种的全部益处。
我们系统检索了PubMed和Embase，以识别2010年1月1日至2016年4月10日期间发表的研究成人肺炎球菌疫苗接种的研究。如果文章捕捉到了接种给年龄≥50岁或处于风险组的≥18岁成年人的成人肺炎球菌疫苗的任何健康或经济效益，我们就将其纳入。最后，我们通过对所捕捉到的益处类型、所采用的视角以及所呈现证据的强度进行分类来总结文献。我们的方案在国际系统评价前瞻性注册库PROSPERO中的编号为42016038335。
我们识别出5857篇论文，并纳入150项研究进行分析。虽然大多数研究捕捉到了健康收益和医疗成本节省，但考虑额外益处类别的研究要少得多，如生产力提高。然而，采用更广泛方法的研究仍然存在显著局限性；例如，许多研究只给出了摘要，而其他研究没有提供新的测量数据。研究13价肺炎球菌结合疫苗的研究更多地关注广泛的经济效益，但仍然存在局限性。
本综述强调需要对成人肺炎球菌疫苗接种的全部益处进行更有力的实证核算。该领域之外的文献表明这些广泛的益处可能很大。未能研究全部益处可能会导致社会低估疫苗的贡献，从而在疫苗的研发和应用方面投资不足。
