Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Unit of PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, the Netherlands; Department of Science and the Environment, Roskilde University, Roskilde, Denmark.
Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Vaccine. 2019 Sep 10;37(38):5698-5707. doi: 10.1016/j.vaccine.2019.07.097. Epub 2019 Aug 13.
Health economic evaluations are often required before implementing a vaccination programme. Such evaluations rarely consider the historical context of a vaccination programme. We review the financial history of vaccination programmes in the Netherlands, and compare these to demographic and macroeconomic developments as well as avoided mortality burden.
Previously uncatalogued historical expenditures on the Dutch National Immunisation Programme (NIP) and influenza vaccination were obtained from official reports. Costs were adjusted for inflation using Consumer Price Indices and expressed in Euro of 2016. Estimates on mortality burden averted were obtained from previous research and used to calculate the ratio of expenses to averted mortality burden for vaccinations against diphtheria, tetanus, pertussis, polio, measles, mumps and rubella for birth cohorts 1953-1992.
Developments towards a uniform government funded NIP started early 1950s with vaccinations against diphtheria, pertussis and tetanus, culminating in its official launch in 1957 together with polio vaccinations. Since the 1980s, expenditure increased nearly five-fold mostly due to the addition of new vaccines, while spending on already implemented vaccinations tended to decline. Overall, expenditure increased from € 5 million in 1957 to € 93 million in 2014. Relative to total healthcare expenditure, the NIP contributed little, ranging between 0.05% and 0.14%. Spending on influenza vaccination increased from € 37 million in 1996 to € 52 million in 2014, while relative to total healthcare expenditure it decreased from 0.069% to 0.055%. In 2014, 0.15% of healthcare expenditure and € 533 per birth was spent on vaccination programmes. Overall, for birth cohorts 1953-1992, € 5.4 thousand (95% confidence interval: 4.0-7.3) was expended per year-of-life-lost averted.
The actual costs per year-of-life gained are more favorable than estimated here since averted medical costs were not included. Although expenditure on vaccination programmes increased substantially, the contribution to overall healthcare expenditure remained small.
在实施疫苗接种计划之前，通常需要进行健康经济评估。此类评估很少考虑疫苗接种计划的历史背景。我们回顾了荷兰疫苗接种计划的财务历史，并将其与人口统计学和宏观经济发展以及避免的死亡负担进行了比较。
从官方报告中获取了先前未编目的荷兰国家免疫计划（NIP）和流感疫苗接种的历史支出。使用消费者价格指数调整了成本以使其与 2016 年的欧元挂钩。从先前的研究中获得了避免的死亡负担估计值，并用于计算 1953-1992 年出生队列的白喉、破伤风、百日咳、脊髓灰质炎、麻疹、腮腺炎和风疹疫苗接种的费用与避免的死亡负担的比例。
1950 年代初，政府资助的 NIP 朝着统一的方向发展，开始接种白喉、百日咳和破伤风疫苗，最终于 1957 年与脊髓灰质炎疫苗接种一起正式启动。自 1980 年代以来，支出增加了近五倍，主要是由于新疫苗的加入，而已经实施的疫苗接种支出趋于下降。总体而言，支出从 1957 年的 500 万欧元增加到 2014 年的 9300 万欧元。相对于总医疗保健支出，NIP 的贡献很小，范围在 0.05%到 0.14%之间。自 1996 年以来，流感疫苗接种的支出从 3700 万欧元增加到 2014 年的 5200 万欧元，而相对于总医疗保健支出，它从 0.069%下降到 0.055%。2014 年，0.15%的医疗保健支出和 533 欧元用于疫苗接种计划。总体而言，对于 1953-1992 年出生的队列，每年每损失一个生命年花费 5400 欧元（95%置信区间：4000-7300）。
由于未包括避免的医疗费用，因此实际获得的每一年生命的成本更为有利。尽管疫苗接种计划的支出大幅增加，但对总体医疗保健支出的贡献仍然很小。
