增加流感疫苗接种率的干预措施成本：系统评价。
The Cost of Interventions to Increase Influenza Vaccination: A Systematic Review.
机构信息
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; Department of Epidemiology, UCLA Jonathan and Karin Fielding School of Public Health, University of California-Los Angeles, Los Angeles, California.
Evidence-based Synthesis Program, West Los Angeles VA Medical Center, Los Angeles, California; Rand Health, RAND Corporation, Santa Monica, California.
出版信息
Am J Prev Med. 2018 Feb;54(2):299-315. doi: 10.1016/j.amepre.2017.11.010. Epub 2018 Jan 18.
CONTEXT
Influenza vaccination rates remain below Healthy People 2020 goals. This project sought to systematically review economic evaluations of healthcare-based quality improvement interventions for improving influenza vaccination uptake among general populations and healthcare workers.
EVIDENCE ACQUISITION
The databases MEDLINE, Econlit, Centre for Reviews & Dissemination, Greylit, and Worldcat were searched in July 2016 for papers published from January 2004 to July 2016. Eligible studies evaluated efforts by bodies within the healthcare system to encourage influenza vaccination by means of an organizational or structural change. For each study, program costs per enrollee and per additional enrollee vaccinated were derived (excluding vaccine costs, standardized to 2017 U.S. dollars). Complete economic evaluations were examined when available.
EVIDENCE SYNTHESIS
Of 2,350 records, 18 articles were eligible and described 29 unique interventions. Most interventions improved vaccine uptake. Among 23 interventions in general populations, the median program cost was $3.27 (interquartile range, $0.82-$11.53) per enrollee and $50.78 (interquartile range, $27.85-$124.84) per additional enrollee vaccinated. Among ten complete economic evaluations in general populations, three studies reported net cost savings, four reported costs <$50,000 per quality-adjusted life year, and three reported costs <$60,000 per life saved. Among six interventions in healthcare workers, the median program cost was $8.09 (interquartile range, $5.03-$10.31) per worker enrolled and $125.24 (interquartile range, $96.06-$171.38) per additional worker vaccinated (there were no complete economic analyses).
CONCLUSIONS
Quality improvement interventions for influenza vaccination involve per-enrollee costs that are similar to the cost of the vaccine itself ($11.78-$36.08/dose). Based on limited available evidence in general populations, quality improvement interventions may be cost saving to cost effective for the health system.
背景
流感疫苗接种率仍低于“健康人民 2020 目标”。本项目旨在系统回顾基于医疗保健的质量改进干预措施的经济评估，以提高普通人群和卫生保健工作者的流感疫苗接种率。
证据获取
2016 年 7 月，检索了 MEDLINE、Econlit、中心评论与传播数据库、灰色文献数据库和 Worldcat 数据库，以获取 2004 年 1 月至 2016 年 7 月发表的论文。合格研究评估了医疗系统内各机构通过组织或结构变革鼓励流感疫苗接种的努力。对于每一项研究，都得出了每位参与者和每位额外参与者的接种计划成本（不包括疫苗成本，按 2017 年美元标准化）。在可用时，检查了完整的经济评估。
证据综合
在 2350 条记录中，有 18 篇文章符合条件，描述了 29 项独特的干预措施。大多数干预措施提高了疫苗接种率。在普通人群中的 23 项干预措施中，每位参与者的计划成本中位数为 3.27 美元（四分位距，0.82-11.53 美元），每位额外参与者的接种成本中位数为 50.78 美元（四分位距，27.85-124.84 美元）。在普通人群中的 10 项完整经济评估中，有 3 项研究报告了净成本节约，4 项研究报告了每质量调整生命年成本<50000 美元，3 项研究报告了每挽救生命成本<60000 美元。在卫生保健工作者中的 6 项干预措施中，每位参与者的计划成本中位数为 8.09 美元（四分位距，5.03-10.31 美元），每位额外参与者的接种成本中位数为 125.24 美元（四分位距，96.06-171.38 美元）（没有完整的经济分析）。
结论
流感疫苗接种的质量改进干预措施涉及的每位参与者成本与疫苗本身的成本相似（11.78-36.08 美元/剂）。基于普通人群中有限的可用证据，质量改进干预措施可能对卫生系统具有成本效益。
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