Yang J, Yan H, Feng L Z, Yu H J
School of Public Health/Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China.
Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
Zhonghua Yu Fang Yi Xue Za Zhi. 2019 Oct 6;53(10):1000-1006. doi: 10.3760/cma.j.issn.0253-9624.2019.10.009.
To evaluate the cost-effectiveness of potential government fully-funded influenza vaccination for diabetics in our country. From the societal perspective, a decision tree model was developed to compare outcomes (including impact on the influenza-related outpatient consultation, hospitalization and excess mortality, and quality-adjusted life years (QALY), as well as incremental cost-effectiveness ratio (ICER)) of a national fully-funded vaccination programme in the population with diabetes and status quo (i.e., vaccinated with out-of-pocket payment, with a uptake rate of zero), using the published data with regarding to influenza related ILI (influenza-like illness) consultation rate, hospitalization rate and excess mortality rate, health-related quality of life and economic burden, diabetes prevalence, population size, health seeking behaviour, vaccine uptake rate, vaccine efficacy/effectiveness, etc. A time horizon of 1 year was used in the present analysis, and all costs were expressed in CNY in 2016 using the consumer price index. All results are presented in ((25), (75)). In the scenario of 40% vaccination coverage in the population with diabetes, government fully-funded vaccination programme was estimated to cost 1.71 (1.67, 1.75) billions CNY, and expected to prevent 110 000 (81 000, 143 000) influenza-related ILI consultations, 36 000 (28 000, 44 000) influenza-related SARI hospitalizations and 12 000 (9 000, 16 000) influenza-related deaths due to respiratory and cardiovascular diseases. A total of 108 000 (82 000, 142 000) QALY were estimated to be gained. The ICER was 10 088 (7 365, 14 046) CNY per QALY gained. The probability of cost-effectiveness of the fully-funded vaccination programme was 99.1% at a threshold of 53 680 CNY per QALY gained (GDP per capita in 2016). Government fully-funded influenza vaccination in population with diabetes is cost-effective, and thus is recommended as the key strategy of diabetes prevention and control.
评估我国政府为糖尿病患者提供全额资助流感疫苗接种的成本效益。从社会角度出发，构建了一个决策树模型，以比较全国全额资助疫苗接种计划在糖尿病患者群体中的结果（包括对流感相关门诊咨询、住院治疗和超额死亡率的影响，以及质量调整生命年（QALY））和现状（即自费接种，接种率为零），使用已发表的有关流感相关流感样疾病（ILI）咨询率、住院率和超额死亡率、健康相关生活质量和经济负担、糖尿病患病率、人口规模、就医行为、疫苗接种率、疫苗效力/效果等数据。本分析采用1年的时间范围，所有成本均使用消费价格指数以2016年人民币表示。所有结果均以（（25），（75））呈现。在糖尿病患者群体疫苗接种覆盖率为40%的情况下，政府全额资助疫苗接种计划估计成本为17.1（16.7，17.5）亿元人民币，预计可预防110000（81000，143000）例流感相关ILI咨询、36000（28000，44000）例流感相关严重急性呼吸感染（SARI）住院治疗以及12000（9000，16000）例因呼吸道和心血管疾病导致的流感相关死亡。估计总共可获得108000（82000，142000）个QALY。每获得一个QALY的增量成本效益比（ICER）为10088（7365，14046）元人民币。在每获得一个QALY的阈值为53680元人民币（2016年人均国内生产总值）时，全额资助疫苗接种计划具有成本效益的概率为99.1%。政府为糖尿病患者提供全额资助的流感疫苗接种具有成本效益，因此建议将其作为糖尿病预防和控制的关键策略。
