A、C、W-135 和 Y 群脑膜炎球菌多糖结合疫苗在澳大利亚青少年中的成本效益分析。
Cost-effectiveness of meningococcal polysaccharide serogroups A, C, W-135 and Y conjugate vaccine in Australian adolescents.
机构信息
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
出版信息
Vaccine. 2019 Aug 14;37(35):5009-5015. doi: 10.1016/j.vaccine.2019.07.008. Epub 2019 Jul 10.
OBJECTIVES
The incidence of invasive meningitis disease (IMD) is increasing in Australia. A conjugate vaccine of meningococcal polysaccharide serogroups A, C, W and Y (MenACWY) is currently indicated for infants aged 12 months on the Australian National Immunisation Program. This study sought to determine the cost-effectiveness of a broader MenACWY vaccination program for Australians aged 15 to 19 years.
METHODS
A Markov model was constructed to simulate the incidence and consequences of IMD in Australians aged 0-84 years, with follow up until age 85 years. The model comprised four health states: 'Alive with no previous IMD', 'Alive, post IMD without long-term complications', 'Alive, post IMD with long-term complications' and 'Dead'. Decision analysis compared the clinical consequences and costs of a vaccination program versus no vaccination from the perspective of the Australian health care system. Age-specific incidence of IMD and fatality rates were derived from Australian surveillance data. Vaccine coverage, vaccine efficacy and herd immunity were based on published data. The total cost for MenACWY vaccination was AU$56 per dose. Costs and health outcomes were discounted by 5% per annum (in the base-case analysis).
RESULTS
Compared to no vaccination, a MenACWY vaccination program targeted at Australians aged 15-19 years was expected to prevent 1664 IMD cases in the Australian population aged 0-84 years followed up until age 85 years. The program would lead to 1131 life years (LYs) and 2058 quality adjusted life years (QALYs) gained at a total cost of AU$115 million (all discounted values). These equated to incremental cost-effectiveness ratios of AU$101,649 per LY gained and AU$55,857 per QALY gained. A probabilistic sensitivity analysis demonstrated a likelihood of cost-effectiveness of 34.6%, assuming a willingness to pay threshold of AU$50,000 per QALY gained.
CONCLUSION
The likelihood of this program being cost-effective under a willingness to pay threshold AU$50,000 per QALY gained is 35%.
目的
侵袭性脑膜炎疾病（IMD）在澳大利亚的发病率正在上升。目前，一种脑膜炎球菌多糖血清群 A、C、W 和 Y 的结合疫苗（MenACWY）已被列入澳大利亚国家免疫计划，用于 12 个月大的婴儿。本研究旨在确定对 15 至 19 岁澳大利亚人进行更广泛的 MenACWY 疫苗接种计划的成本效益。
方法
构建了一个马尔可夫模型来模拟澳大利亚 0-84 岁人群中 IMD 的发病率和后果，并随访至 85 岁。该模型包括四个健康状态：“无既往 IMD 存活”、“无长期并发症的 IMD 存活”、“有长期并发症的 IMD 存活”和“死亡”。决策分析从澳大利亚医疗保健系统的角度比较了接种疫苗与不接种疫苗的临床后果和成本。IMD 的年龄特异性发病率和死亡率率来自澳大利亚监测数据。疫苗覆盖率、疫苗效力和群体免疫基于已发表的数据。MenACWY 疫苗接种的总费用为每剂 56 澳元。在基本分析中，成本和健康结果按每年 5%贴现。
结果
与不接种疫苗相比，针对 15-19 岁澳大利亚人的 MenACWY 疫苗接种计划预计将预防澳大利亚 0-84 岁人群中 1664 例 IMD 病例，随访至 85 岁。该计划将导致 1131 个生命年（LYs）和 2058 个质量调整生命年（QALYs）获得，总成本为 1.15 亿澳元（所有贴现价值）。这相当于每获得一个 LY 的增量成本效益比为 101649 澳元，每获得一个 QALY 的增量成本效益比为 55857 澳元。概率敏感性分析表明，在愿意支付 50000 澳元/QALY 的阈值下，该计划具有 34.6%的成本效益可能性。
结论
在愿意支付 50000 澳元/QALY 的阈值下，该计划具有 35%的成本效益可能性。
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