Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Samuels Building, Sydney, NSW 2052, Australia.
Vaccine. 2019 Sep 20;37(40):5979-5985. doi: 10.1016/j.vaccine.2019.08.028. Epub 2019 Aug 28.
Influenza causes a significant burden among Australian adults aged 50-64, however, vaccine coverage rates remain suboptimal. The National Immunisation Program (NIP) currently funds influenza vaccinations in this age group only for those at high risk of influenza complications.
The main aim of this study was to determine whether a strategy of expanding the government-funded vaccination program to all adults 50-64 in preventing influenza-related hospitalisations will be cost beneficial to the government.
A cost-benefit analysis from a governmental perspective was performed using parameters informed by publicly available databases and published literature. Costs included cost of vaccinations and general practitioner consultation while benefits included the savings from averted respiratory and acute myocardial infarction (AMI) hospitalisations.
In the base-case scenario, the proposed policy would prevent 314 influenza/pneumonia, 388 other respiratory and 1482 AMI hospitalisations in a year. The government would save $8.03 million with an incremental benefit-cost ratio of 1.40. Most savings were due to averted AMI hospitalisations. In alternative scenarios cost savings ranged from saving of $31.4 million to additional cost to the government of $15.4 million, with sensitive variation in vaccine administration practices (through general practitioner or pharmacists) and vaccine effectiveness estimates.
Extension of the NIP to include adults 50-64 years of age is likely to be cost beneficial to the government, although this finding is sensitive to vaccine administration cost, which varies if provided through general practitioners or pharmacists; and to variation in vaccine effectiveness. An increased role of pharmacists in immunisation programs would likely result in cost savings in an expanded adult immunisation program.
流感给澳大利亚 50-64 岁成年人带来了巨大负担,但疫苗接种率仍不理想。国家免疫计划(NIP)目前只为高流感并发症风险的该年龄段人群提供流感疫苗接种。
本研究的主要目的是确定扩大政府资助的疫苗接种计划,为所有 50-64 岁成年人接种疫苗,以预防流感相关住院治疗,是否对政府具有成本效益。
从政府角度出发,采用公共数据库和已发表文献提供的参数进行成本效益分析。成本包括疫苗接种和全科医生咨询的费用,而效益包括避免呼吸道和急性心肌梗死(AMI)住院的节省。
在基本情况下,拟议政策将预防一年 314 例流感/肺炎、388 例其他呼吸道和 1482 例 AMI 住院治疗。政府将节省 803 万美元,增量效益成本比为 1.40。大部分节省归因于避免 AMI 住院治疗。在替代方案中,节省范围从节省 3140 万美元到政府额外支出 1.54 亿美元不等,疫苗接种管理实践(通过全科医生或药剂师)和疫苗有效性估计存在敏感变化。
将 NIP 扩大到包括 50-64 岁成年人可能对政府具有成本效益,但这一发现对疫苗接种管理成本敏感,疫苗接种管理成本如果通过全科医生或药剂师提供则会有所不同,并且对疫苗有效性的变化也敏感。在扩大成人免疫计划中,药剂师在免疫计划中发挥更大作用可能会导致成本节省。