Department of Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
Pfizer Inc. New York, NY, United States of America.
PLoS One. 2018 Jul 25;13(7):e0201245. doi: 10.1371/journal.pone.0201245. eCollection 2018.
The burden of pneumococcal disease in China is high, and a 13-valent pneumococcal conjugate vaccine (PCV13) recently received regulatory approval and is available to Chinese infants. PCV13 protects against the most prevalent serotypes causing invasive pneumococcal disease (IPD) in China, but will not provide full societal benefits until made broadly available through a national immunization program (NIP).
To estimate clinical and economic benefits of introducing PCV13 into a NIP in China using local cost estimates and accounting for variability in vaccine uptake and indirect (herd protection) effects.
We developed a population model to estimate the effect of PCV13 introduction in China. Modeled health states included meningitis, bacteremia, pneumonia (PNE), acute otitis media, death and sequelae, and no disease. Direct healthcare costs and disease incidence data for IPD and PNE were derived from the China Health Insurance and Research Association database; all other parameters were derived from published literature. We estimated total disease cases and associated costs, quality-adjusted life years (QALYs), and deaths for three scenarios from a Chinese Payer Perspective: (1) direct effects only, (2) direct+indirect effects for IPD only, and (3) direct+indirect effects for IPD and inpatient PNE.
Scenario (1) resulted in 370.3 thousand QALYs gained and 12.8 thousand deaths avoided versus no vaccination. In scenarios (2) and (3), the PCV13 NIP gained 383.2 thousand and 3,580 thousand QALYs, and avoided 13.1 thousand and 147.5 thousand deaths versus no vaccination, respectively. In all three scenarios, the vaccination cost was offset by cost reductions from prevented disease yielding net costs of ¥29,362.32 million, ¥29,334.29 million, and ¥13,524.72 million, respectively. All resulting incremental cost-effectiveness ratios fell below a 2x China GDP cost-effectiveness threshold across a range of potential vaccine prices.
Initiation of a PCV13 NIP in China incurs large upfront costs but is good value for money, and is likely to prevent substantial cases of disease among children and non-vaccinated individuals.
在中国，肺炎球菌疾病负担很高，一种 13 价肺炎球菌结合疫苗（PCV13）最近获得监管批准，可用于中国婴儿。PCV13 可预防在中国引起侵袭性肺炎球菌病（IPD）的最常见血清型，但在通过国家免疫规划（NIP）广泛提供之前，不会带来全面的社会效益。
使用当地成本估算并考虑疫苗接种率和间接（群体保护）效应的变异性，估算在中国引入 PCV13 纳入 NIP 的临床和经济效益。
我们开发了一个人群模型来估计中国引入 PCV13 的效果。建模的健康状态包括脑膜炎、菌血症、肺炎（PNE）、急性中耳炎、死亡和后遗症以及无疾病。IPD 和 PNE 的直接医疗保健成本和疾病发生率数据来自中国健康保险与研究协会数据库；所有其他参数均来自已发表的文献。我们从中国支付者的角度估计了三种方案的总疾病病例和相关成本、质量调整生命年（QALY）以及死亡人数：（1）仅直接影响，（2）仅 IPD 的直接+间接影响，以及（3）IPD 和住院 PNE 的直接+间接影响。
与不接种疫苗相比，方案（1）导致 370.3 千 QALY 增加和 12.8 千例死亡避免。在方案（2）和（3）中，PCV13 NIP 分别获得 383.2 千和 3580 千 QALY，并分别避免 13.1 千和 147.5 千例死亡。在所有三种情况下，疫苗接种成本都被预防疾病的成本降低所抵消，产生净成本分别为 29362329 万元、29334299 万元和 135247299 万元。在潜在疫苗价格范围内，所有增量成本效益比均低于中国 GDP 成本效益阈值的 2 倍。
在中国启动 PCV13 NIP 会产生大量前期成本，但物有所值，并且很可能会预防儿童和未接种人群的大量疾病。
