巴西 PHiD-CV 免疫计划的年度健康和成本影响预估。

Estimated Annual Health and Cost Impact of PHiD-CV Immunization Program in Brazil.

机构信息

From the GSK Vaccines, Buenos Aires, Argentina.

Instituto Nacional de Cardiología, Rio de Janeiro, Brazil.

出版信息

Pediatr Infect Dis J. 2019 Oct;38(10):e260-e265. doi: 10.1097/INF.0000000000002436.

DOI:10.1097/INF.0000000000002436

PMID:31568144

Abstract

BACKGROUND

Streptococcus pneumoniae causes invasive pneumococcal disease (IPD), community-acquired pneumonia (CAP) and acute otitis media (AOM). Two higher-valent pneumococcal conjugate vaccines (PCV) are available, pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) and 13-valent PCV (PCV-13). This study estimated the economic and health impact of PHiD-CV vaccination on pneumococcal disease burden in children <5 years of age in Brazil.

METHODS

The disease burden prior to the PHiD-CV vaccination program was estimated from literature and databases. The effect of PHiD-CV was estimated as a reduction of 70% for IPD, 26% for CAP and 40% for AOM, based on published studies. Residual IPD cases attributable to serotype 19A were estimated using surveillance data. PCV-13 effectiveness against 19A-IPD was set at 30%-70% higher than PHiD-CV. Vaccine prices were US$12.85/dose for PHiD-CV and US$14.50/dose for PCV-13.

RESULTS

PHiD-CV vaccination reduced IPD by 6359, CAP by 315,016 and AOM by 669,943 cases, with estimated cost savings of >US$84 million annually and US$211-22,232 per case averted depending on the outcome. Switching from PHiD-CV to PCV-13 would avoid only a few additional IPD cases at additional costs exceeding US$18 million per year (US$125,192-386,230 per IPD case averted).

CONCLUSIONS

The PHiD-CV vaccination program in Brazil has resulted in important reductions of pneumococcal disease and substantial cost savings. Instead of switching PCVs, expanding vaccine coverage or investing in other health care interventions would be a more efficient use of resources to improve the health of the population in Brazil.

摘要

背景

肺炎链球菌可导致侵袭性肺炎球菌病（IPD）、社区获得性肺炎（CAP）和急性中耳炎（AOM）。目前有两种更高价的肺炎球菌结合疫苗（PCV），即肺炎球菌非结合型流感嗜血杆菌蛋白 D 结合疫苗（PHiD-CV）和 13 价 PCV（PCV-13）。本研究旨在评估 PHiD-CV 疫苗接种对巴西 5 岁以下儿童肺炎球菌疾病负担的经济和健康影响。

方法

根据文献和数据库资料，估算 PHiD-CV 疫苗接种计划实施前的疾病负担。根据已发表的研究结果，将 PHiD-CV 对 IPD、CAP 和 AOM 的效果估计为分别减少 70%、26%和 40%。利用监测数据估计 19A 血清型相关 IPD 的剩余病例数。设定 PCV-13 对 19A-IPD 的有效性比 PHiD-CV 高 30%-70%。PHiD-CV 疫苗的价格为 12.85 美元/剂，PCV-13 的价格为 14.50 美元/剂。

结果

PHiD-CV 疫苗接种使 IPD 减少 6359 例、CAP 减少 315016 例、AOM 减少 669943 例，每年估计节省 8400 多万美元，每例病例避免成本节约 211-22232 美元，具体取决于结果。从 PHiD-CV 切换到 PCV-13 每年只能避免少数额外的 IPD 病例，但成本超过 1800 万美元（每例 IPD 病例避免的成本为 125192-386230 美元）。