Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark; Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serums Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
Nordic Cochrane Centre, Rigshospitalet, Blegdamsvej 9, DK- 2100 Copenhagen Ø, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200 København N, Denmark.
Vaccine. 2017 Dec 14;35(49 Pt B):6828-6841. doi: 10.1016/j.vaccine.2017.10.024. Epub 2017 Nov 13.
The objectives of this review were to identify vaccine economic evaluations that include herd immunity and describe the methodological approaches used.
We used Kim and Goldie's search strategy from a systematic review (1976-2007) of modelling approaches used in vaccine economic evaluations and additionally searched PubMed/MEDLINE and Embase for 2007-2015. Studies were classified according to modelling approach used. Methods for estimating herd immunity effects were described, in particular for the static models.
We identified 625 economic evaluations of vaccines against human-transmissible diseases from 1976 to 2015. Of these, 172 (28%) included herd immunity. While 4% of studies included herd immunity in 2001, 53% of those published in 2015 did this. Pneumococcal, human papilloma and rotavirus vaccines represented the majority of studies (63%) considering herd immunity. Ninety-five of the 172 studies utilised a static model, 59 applied a dynamic model, eight a hybrid model and ten did not clearly state which method was used. Relatively crude methods and assumptions were used in the majority of the static model studies.
The proportion of economic evaluations using a dynamic model has increased in recent years. However, 55% of the included studies used a static model for estimating herd immunity. Values from a static model can only be considered reliable if high quality surveillance data are incorporated into the analysis. Without this, the results are questionable and they should only be included in sensitivity analysis.
本研究旨在识别包含群体免疫的疫苗经济学评价，并描述所采用的方法学方法。
我们采用 Kim 和 Goldie 于系统评价（1976-2007 年）中所使用的建模方法的检索策略，并额外检索了 2007-2015 年的 PubMed/MEDLINE 和 Embase 数据库。根据所使用的建模方法对研究进行分类。尤其对静态模型，对群体免疫效应的估计方法进行了描述。
我们共识别了 1976 年至 2015 年针对人类传染性疾病的 625 项疫苗经济学评价。其中，172 项（28%）包含群体免疫。2001 年，仅有 4%的研究包含群体免疫，而 2015 年发表的研究中，这一比例为 53%。考虑群体免疫的研究中，肺炎球菌、人乳头瘤病毒和轮状病毒疫苗占大多数（63%）。172 项研究中有 95 项使用了静态模型，59 项使用了动态模型，8 项使用了混合模型，10 项未明确说明使用了哪种方法。在大多数静态模型研究中，使用了相对粗略的方法和假设。
近年来，使用动态模型的经济学评价比例有所增加。然而，55%的纳入研究使用静态模型来估计群体免疫。只有当高质量的监测数据纳入分析时，静态模型的结果才被认为是可靠的。如果没有这些数据，结果是值得怀疑的，并且应该只将其纳入敏感性分析。
