Technische Universtät Berlin, Department of Health Care Management, Berlin, Germany.
University of Canberra, Faculty of Education, Canberra, Australia.
Vaccine. 2018 Jul 16;36(30):4404-4424. doi: 10.1016/j.vaccine.2018.05.120. Epub 2018 Jun 12.
Vibrio cholera is a major contributor of diarrheal illness that causes significant morbidity and mortality globally. While there is literature on the health economics of diarrheal illnesses more generally, few studies have quantified the cost-of-illness and cost-effectiveness of cholera-specific prevention and control interventions. The present systematic review provides a comprehensive overview of the literature specific to cholera as it pertains to key health economic measures.
A systematic review was performed with no date restrictions up through February 2017 in PubMed, Econlit, Embase, Web of Science, and Cochrane Review to identify relevant health economics of cholera literature. After removing duplicates, a total of 1993 studies were screened and coded independently by two reviewers, resulting in 22 relevant studies. Data on population, methods, and results (cost-of-illness and cost-effectiveness of vaccination) were compared by country/region. All costs were adjusted to 2017 USD for comparability.
Costs per cholera case were found to be rather low: <$100 per case in most settings, even when costs incurred by patients/families and lost productivity are considered. When wider socioeconomic costs are included, estimated costs are >$1000/case. There is adequate evidence to support the economic value of vaccination for the prevention and control of cholera when vaccination is targeted at high-incidence populations and/or areas with high case fatality rates due to cholera. When herd immunity is considered, vaccination also becomes a cost-effective option for the general population and is comparable in cost-effectiveness to other routine immunizations.
Cholera vaccination is a viable short-to-medium term option, especially as the upfront costs of building water, sanitation, and hygiene (WASH) infrastructure are considerably higher for countries that face a significant burden of cholera. While WASH may be the more cost-effective solution in the long-term when implemented properly, cholera vaccination can still be a feasible, cost-effective strategy.
霍乱弧菌是导致全球大量发病和死亡的主要腹泻病病原体。虽然一般腹泻病的卫生经济学文献较多，但定量分析霍乱具体防控干预措施成本效益的研究甚少。本系统综述提供了与霍乱相关的文献综述，全面概述了与关键卫生经济学指标相关的文献。
对截至 2017 年 2 月在 PubMed、Econlit、Embase、Web of Science 和 Cochrane 综述中发表的相关文献进行了系统检索，无时间限制，以确定有关霍乱卫生经济学的文献。剔除重复文献后，由两名评审员独立筛选和编码，共筛选出 1993 项研究，其中 22 项研究与本综述相关。按国家/地区比较了人口、方法和结果（疫苗接种的成本效益）的数据。所有成本均按 2017 年美元进行了调整，以实现可比性。
霍乱病例的单位成本相对较低：在大多数情况下，即使考虑到患者/家庭的成本和生产力损失，每例病例的成本也低于 100 美元。当纳入更广泛的社会经济成本时，估计成本超过 1000 美元/例。有充分的证据支持针对高发人群和/或因霍乱病死率高的地区开展的霍乱疫苗接种，以预防和控制霍乱的经济价值。当考虑群体免疫时，疫苗接种对普通人群来说也是一种具有成本效益的选择，其成本效益与其他常规免疫接种相当。
霍乱疫苗接种是一种可行的短期至中期选择，尤其是对于那些面临重大霍乱负担的国家，建设水、环境卫生和个人卫生（WASH）基础设施的前期成本要高得多。虽然从长期来看，WASH 可能是更具成本效益的解决方案，但霍乱疫苗接种仍然是一种可行的、具有成本效益的策略。
