Sribhutorn Apirak, Phrommintikul Arintaya, Wongcharoen Wanwarang, Chaikledkaew Usa, Eakanunkul Suntara, Sukonthasarn Apichard
Program in Clinical Epidemiology, Faculty of Medicine, Chiang Mai University, Thailand.
Department of Pharmacy Practice, School of Pharmaceutical Sciences, University of Phayao, Thailand.
J Geriatr Cardiol. 2018 Jun;15(6):413-421. doi: 10.11909/j.issn.1671-5411.2018.06.008.
Influenza vaccination has been clinically shown to reduce adverse cardiovascular outcomes in acute coronary syndrome (ACS) patients, but the economic perspectives can provide important data to make informed decisions. This study aimed to perform the economic evaluation of lifelong annual influenza vaccination for cardiovascular events and well-established pneumonia prevention.
Lifetime costs, life-expectancy, and quality-adjusted live years (QALYs) were estimated beyond one-year cycle length of a six-health states Markov model condition on whether a hospitalization for ACS, stroke, heart failure, pneumonia, no hospitalizations occurred, or death. The comparison of three age-groups of 40-49, 50-65, and > 65 years scenario was performed. Incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB) were presented as a societal perspective in 2016. The model robustness was determined by one-way and probabilistic sensitivity analyses.
The influenza vaccination was cost-effective in all age-groups, by dominant ICERs (lower cost with higher effectiveness) which was completely lower than acceptable willingness-to-pay threshold of Thailand [160,000 THB (4,466.8 USD) per QALYs], with a great incremental value of NMB. Especially, the 50-year-old-and-above scenario was shown as the most benefit at 129,092 THB (3,603.9 USD) for each patient.
The annually additional influenza vaccination to standard treatment in ACS was cost-effective in all age-groups, which should be considered in clinical practice and health-policy making process.
临床研究表明，流感疫苗接种可降低急性冠状动脉综合征（ACS）患者不良心血管事件的发生风险，但从经济学角度分析可为做出明智决策提供重要数据。本研究旨在对终身每年接种流感疫苗预防心血管事件和已明确的肺炎进行经济学评估。
采用六健康状态马尔可夫模型，以ACS、中风、心力衰竭、肺炎、无住院或死亡导致的住院情况为条件，估计超过一年周期长度的终身成本、预期寿命和质量调整生命年（QALY）。对40 - 49岁、50 - 65岁和> 65岁三个年龄组的情况进行比较。从社会角度呈现2016年的增量成本效益比（ICER）和净货币效益（NMB）。通过单向和概率敏感性分析确定模型的稳健性。
流感疫苗接种在所有年龄组中均具有成本效益，其ICER占优（成本更低且效果更好），完全低于泰国可接受的支付意愿阈值[每QALY 160,000泰铢（4,466.8美元）]，NMB具有很大的增量价值。特别是，50岁及以上年龄组的情况显示每名患者的效益最大，为129,092泰铢（3,603.9美元）。
在ACS标准治疗基础上每年额外接种流感疫苗在所有年龄组中均具有成本效益，在临床实践和卫生政策制定过程中应予以考虑。
