韩国儿童和老年人中四价流感疫苗与三价流感疫苗的成本效果比较。
Cost Effectiveness of Quadrivalent Influenza Vaccines Compared with Trivalent Influenza Vaccines in Young Children and Older Adults in Korea.
机构信息
Korea University Ansan Hospital, Ansan, Republic of Korea.
Division of Infectious Diseases, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
出版信息
Pharmacoeconomics. 2018 Dec;36(12):1475-1490. doi: 10.1007/s40273-018-0715-5.
INTRODUCTION
Trivalent influenza vaccines (TIVs) are currently reimbursed for subjects aged ≥ 65 years and children between 6 and 59 months of age under a national immunization program in South Korea. Quadrivalent influenza vaccines (QIVs) are expected to address the potential problem of influenza B-lineage mismatch for TIVs.
OBJECTIVE
The objective of this analysis was to compare the cost effectiveness of QIV versus TIV in children aged 6-59 months and older adults ≥ 65 years of age in South Korea.
METHODS
A 1-year static population model was employed to compare the costs and outcomes of a QIV vaccination program compared with TIV in children aged 6-59 months and older adults ≥ 65 years of age in South Korea. Influenza-related parameters (probabilities, health resource use, and costs) were derived from an analysis of the National Health Insurance System claims database between 2010 and 2013 under a broad and narrow set of International Classification of Diseases, Tenth Revision (ICD-10) codes used to identify influenza. Other inputs were extracted from published literature. Incremental cost-effectiveness ratios (2016 South Korean Won [KRW] per quality-adjusted life-year [QALY] gained) were estimated using a 'limited' societal perspective as per the Korean pharmacoeconomic guidelines. QALYs lost due to premature mortality were discounted at 5% annually.
RESULTS
For both age groups combined, under the narrow definition of influenza, QIV is expected to prevent nearly 16,000 (2923 in children and 13,011 in older adults) medically attended influenza cases, nearly 8000 (672 in children, 7048 in older adults) cases of complications, and over 230 (0 in children, 238 in older adults) deaths annually compared with TIV. The impact of using QIV versus TIV in this setting translates into savings of KRW 24 billion (KRW 0.6 billion in children, KRW 23.4 billion in older adults) in annual medical costs, and over 2100 (18 in children, 2084 in older adults) QALYs. Under the broad definition, the corresponding results are over 190,000 (50,697 in children, 140,644 in older adults) influenza cases, over 37,000 (12,623 in children, 24,526 in older adults) complications, 270 deaths (0 in children, 270 in older adults), KRW 94.22 billion (KRW 16 billion in children, KRW 78.2 billion in older adults), and over 3500 QALYs saved (316 in children, 3260 in older adults).
CONCLUSION
The use of QIV over TIV was estimated to not be cost effective in children 6-59 months of age, but cost saving in older adults, using the narrow definition of influenza; however, QIV use was cost saving in both age groups using the broad definition. QIV is expected to yield more benefits in older adults ≥ 65 years of age than in children aged 6-59 months due to higher influenza-related mortality and costs among the older adults. Further analyses considering the indirect effects of influenza vaccination in children are required.
简介
在韩国，三价流感疫苗（TIV）目前被纳入国家免疫计划，为年龄≥65 岁的人群和 6 至 59 个月大的儿童提供报销。四价流感疫苗（QIV）有望解决 TIV 中流感 B 谱系不匹配的潜在问题。
目的
本分析旨在比较 QIV 与 TIV 在韩国 6-59 个月儿童和≥65 岁老年人中的成本效益。
方法
采用为期 1 年的静态人群模型，比较了韩国 6-59 个月儿童和≥65 岁老年人中 QIV 接种计划与 TIV 的成本和结果。流感相关参数（概率、卫生资源利用和成本）源自对 2010 年至 2013 年国家健康保险系统索赔数据库的分析，使用广泛和狭义的国际疾病分类第十版（ICD-10）代码来识别流感。其他输入信息从已发表的文献中提取。根据韩国药物经济学指南，采用“有限”社会视角估算增量成本效益比（每获得一个质量调整生命年节省的 2016 韩元）。由于过早死亡而导致的 QALY 损失按每年 5%贴现。
结果
在狭义的流感定义下，对于两个年龄组，QIV 预计每年可预防近 16000 例（儿童 2923 例，老年人 13011 例）有医疗记录的流感病例，近 8000 例（儿童 672 例，老年人 7048 例）并发症病例，以及超过 230 例（儿童 0 例，老年人 238 例）死亡。与 TIV 相比，在这种情况下使用 QIV 而非 TIV 可节省每年 240 亿韩元（儿童 0.6 亿韩元，老年人 23.4 亿韩元）的医疗费用，并可获得超过 2100 个（儿童 18 个，老年人 2084 个）QALY。在广义的定义下，相应的结果是超过 190000 例（儿童 50697 例，老年人 140644 例）流感病例，超过 37000 例（儿童 12623 例，老年人 24526 例）并发症，270 例死亡（儿童 0 例，老年人 270 例），942.22 亿韩元（儿童 160 亿韩元，老年人 782 亿韩元），以及超过 3500 个 QALY 节省（儿童 316 个，老年人 3260 个）。
结论
在狭义的流感定义下，QIV 在 6-59 个月大的儿童中使用的成本效益不高，但在老年人中使用是节省成本的；然而，在广义的定义下，QIV 在两个年龄组中都是节省成本的。由于老年人的流感相关死亡率和费用较高，QIV 预计在≥65 岁的老年人中的获益大于 6-59 个月大的儿童。需要进一步分析考虑儿童流感疫苗接种的间接影响。
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