在法国，对青少年女孩进行巨细胞病毒（CMV）疫苗接种以预防孕妇感染的成本效益分析。

Cost-effectiveness of vaccination against cytomegalovirus (CMV) in adolescent girls to prevent infections in pregnant women living in France.

机构信息

INSERM, IAME, UMR 1137, UFR de Médecine, 75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France.

Department of Infectious Diseases, CIC Cochin-Pasteur, Cochin Broca Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; INSERM U 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; INSERM CIC 1417, Paris, France.

出版信息

Vaccine. 2018 Feb 28;36(10):1285-1296. doi: 10.1016/j.vaccine.2018.01.042. Epub 2018 Feb 1.

DOI:10.1016/j.vaccine.2018.01.042

PMID:29397227

Abstract

BACKGROUND

CMV infections are the most frequent congenital infections worldwide.

AIM

Assess the cost-effectiveness of vaccination strategies of adolescent girls vs. current practice (hygiene counseling) to prevent CMV seroconversions during pregnancy in France.

METHOD

A Markov decision-tree model simulated overtime the trajectory of a single fictive cohort of 390,000 adolescent women aged 14 years old, living in France. Impact of vaccination was explored until the end of their reproductive live 40 years later. STRATEGIES COMPARED: "S1: No vaccination" (current practice); "S2: Routine vaccination"; "S3: Screening and vaccination of the seronegative".

MODEL PARAMETERS

Seroconversion rate without vaccination (0.035%/pregnant woman-week); fetal transmission risk (41%). Vaccine vs. no vaccination: a 50% decrease in maternal seroconversions.

OUTCOMES

Quality-Adjusted Life-Years (QALYs) of the cohort-born babies; discounted costs; Incremental Cost-Effectiveness Ratio (ICER).

RESULTS

S2 was the most effective strategy (with 35,000 QALYs gained) and the most expensive (€211,533,000); S1 was the least effective and least costly (€75,423,000). ICERs of strategy S3 vs. S1, and S2 vs. S3 were 6,000€/QALY gained (95% uncertainty range [2700-13,300]) and 16,000€/QALY [negative ICER (S3 dominated by S2) - 94,000] gained, respectively; highly cost-effective because ICER < 1∗France's GPD/capita = €30,000.

SENSITIVITY ANALYSIS

If the seroprevalence was >62% (vs. 20% in the base case), S3 would become the most efficient strategy.

CONCLUSION

In France, systematic vaccination of adolescent girls was the most efficient strategy to prevent maternal seroconversions. If the population was less than 62% immune, systematic screening and vaccination of susceptibles would become the most cost-effective approach.

摘要

背景

CMV 感染是全球最常见的先天性感染。

目的

评估在法国，对少女进行疫苗接种策略与当前实践（卫生咨询）以预防妊娠期间 CMV 血清转化的成本效益。

方法

采用马尔可夫决策树模型，模拟了一个虚构的 39 万名 14 岁少女队列的随时间变化轨迹。直至 40 年后她们生殖生命结束时，对疫苗接种的影响进行了探索。比较了以下策略：“S1：不接种疫苗”（当前实践）；“S2：常规疫苗接种”；“S3：血清阴性者的筛查和疫苗接种”。

模型参数

未接种疫苗的血清转化率（0.035%/孕妇周）；胎儿传播风险（41%）。疫苗接种与不接种疫苗：母体血清转化率降低 50%。

结果

队列中婴儿的质量调整生命年（QALY）；贴现成本；增量成本效益比（ICER）。

S2 是最有效的策略（获得 35000 个 QALY），也是最昂贵的策略（21153.3 万欧元）；S1 是最无效和最便宜的策略（7542.3 万欧元）。S3 与 S1 相比，S2 与 S3 的 ICER 分别为 6000 欧元/QALY （95%置信区间[2700-13300]）和 16000 欧元/QALY（S3 优于 S2 的负 ICER-94000 欧元）；因为 ICER＜1*法国人均 GDP=30000 欧元，所以具有成本效益。