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[中国老年人群季节性流感疫苗的成本效益分析]

[Cost-effective analysis of seasonal influenza vaccine in elderly Chinese population].

作者信息

Chen C, Liu G E, Wang M J, Gao T F, Jia H P, Yang H, Feng L Z

机构信息

National School of Development, Peking University, Beijing 100871, China.

China Center for Health Economic Research, Peking University, Beijing 100871, China.

出版信息

Zhonghua Yu Fang Yi Xue Za Zhi. 2019 Oct 6;53(10):993-999. doi: 10.3760/cma.j.issn.0253-9624.2019.10.008.

Abstract

To evaluate the cost-effectiveness of seasonal influenza vaccination, compared to no vaccination, for the elderly aged ≥60 years old in China. A static life-time Markov model is conducted to simulate the Chinese elderly population aged ≥60 years old. Taking the health care system perspective, one-year analytic cycle length is used for each influenza season. The model was assumed to be repeated until the individual reaches 100 years old. Three interventions were evaluated, including no vaccination, annual trivalent influenza vaccination, and annual quadrivalent influenza vaccination. Using the threshold of 3 times GDP per capita per Quality-adjusted life year (QALY) (193 932/QALY), the incremental cost-effectiveness ratio (ICER) was calculated to compare the cost-effectiveness of every two interventions.Model inputs like data for costs and utilities were from studies on Chinese population if they were available. QALY was used to measure health utility. One-way sensitivity analysis and probabilistic sensitivity analysis were adopted to quantify the level of confidence of the model output. The total influenza associated costs of no vaccination would be 603 CNY per person, while the total costs of annual trivalent vaccination would be 1 027 CNY. Using trivalent vaccine would result in 0.007 QALY gained per person compared to no vaccination, with an increased cost of 424 CNY per person. The ICER of trivalent vaccination over no vaccination for all the elderly population in China would be 64 026 CNY per QALY gained, which was less than the threshold of 3 times GDP per capita. The total costs of annual quadrivalent vaccination would be 1 988 CNY. Using quadrivalent vaccine would result in 0.008 additional QALY gained per person compared to no vaccination, with an increased cost of 1 385 CNY per person. The ICER of quadrivalent vaccination over no vaccination would be 174 081 CNY per QALY gained, which was less than the threshold of 3 times GDP per capita. Vaccinating elderly population would improve health utilities at higher health care costs for the elderly. Using the threshold of 3 times GDP per capita per QALY (193 932/QALY), both trivalent and quadrivalent vaccination would be cost-effective compared to no vaccination in elderly Chinese population.

摘要

为评估在中国≥60岁老年人中,季节性流感疫苗接种与不接种相比的成本效益。构建了一个静态终身马尔可夫模型来模拟中国≥60岁的老年人群体。从医疗保健系统的角度出发,每个流感季节采用一年的分析周期长度。假设该模型重复运行直至个体年满100岁。评估了三种干预措施,包括不接种疫苗、每年接种三价流感疫苗和每年接种四价流感疫苗。使用人均国内生产总值的3倍/每质量调整生命年(QALY)(193932元/QALY)作为阈值,计算增量成本效益比(ICER),以比较每两种干预措施的成本效益。如果有来自中国人群研究的数据,则模型输入(如成本和效用数据)采用这些数据。采用QALY来衡量健康效用。采用单向敏感性分析和概率敏感性分析来量化模型输出的置信水平。不接种疫苗时,与流感相关的人均总成本为603元,而每年接种三价疫苗的总成本为1027元。与不接种疫苗相比,接种三价疫苗每人可获得0.007个QALY,人均成本增加424元。在中国所有老年人群体中,接种三价疫苗相对于不接种疫苗的ICER为每获得一个QALY 64026元,低于人均国内生产总值3倍的阈值。每年接种四价疫苗的总成本为1988元。与不接种疫苗相比,接种四价疫苗每人可额外获得0.008个QALY,人均成本增加1385元。接种四价疫苗相对于不接种疫苗的ICER为每获得一个QALY 174081元,低于人均国内生产总值3倍的阈值。为老年人接种疫苗会以更高的医疗保健成本改善健康效用。使用人均国内生产总值的3倍/每QALY(193932元/QALY)作为阈值,与不接种疫苗相比,在中国老年人群体中接种三价和四价疫苗均具有成本效益。

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