Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
China National Health Development Research Centre, Ministry of Health, Beijing, PR China; Peking University Health Science Center, No. 38 Xueyuan Rd., P.O. Box 218, Haidian District, Beijing 100191, PR China.
Vaccine. 2019 Dec 10;37(52):7547-7559. doi: 10.1016/j.vaccine.2019.09.084. Epub 2019 Oct 10.
To support vaccine decision-making we estimated from the societal perspective the potential health impact and costs averted through immunization with three vaccines - Haemophilus influenzae type b (Hib), pneumococcal conjugate vaccine (PCV) and rotavirus vaccine (RVV).
Based on variability in disease burden, strength of health system and economic status, we selected four states in India: Bihar, New Delhi, Maharashtra and Tamil Nadu. We used secondary data sources to estimate the number of under-5 deaths averted from Hib, pneumococcus and rotavirus in each state and back-calculated the total cases averted. We synthesized available data to estimate the disease burden, treatment cost, caretaker productivity loss and vaccine coverage in each state. A Delphi Survey and roundtable among Indian experts was conducted to reach consensus on model inputs.
By scaling up coverage of Hib, PCV and RVV, India could save over US$1 billion (uncertainty range: US$0.9-US$2.4 billion) in economic benefits and avert more than 90,000 needless child deaths each year. An estimated US$1 billion (US$0.9-US$2 billion) or 88% of the total amount of cost savings would be attributable to lost productivity due to premature pneumococcal death. Another US$112.8 million (US$105-297 million), or 10% of the total cost would be accounted by costs related to loss of productivity due to disability as a result of these diseases. Treatment costs of Hib, pneumococcal disease and rotavirus gastroenteritis, would account for US$8.4 million (US$4-12 million) or <1% of the total costs of these diseases. Finally, caretaker productivity loss from seeking care would represent US$1.5 million (US$ 1-4.9 million). Cost savings varied by vaccine, coverage scenarios and states.
Hib, PCV and RVV vaccine introduction in India can result in immediate benefits to the government and households in terms of savings.
为了支持疫苗决策，我们从社会角度估算了通过接种三种疫苗（乙型流感嗜血杆菌（Hib）、肺炎球菌结合疫苗（PCV）和轮状病毒疫苗（RVV））可避免的潜在健康影响和成本节约。
根据疾病负担、卫生系统实力和经济状况的差异，我们在印度选择了四个邦：比哈尔邦、新德里、马哈拉施特拉邦和泰米尔纳德邦。我们使用二手数据源估算了每个邦的 5 岁以下儿童因 Hib、肺炎球菌和轮状病毒而死亡的人数，并回溯计算了总病例数。我们综合了可用数据，估算了每个邦的疾病负担、治疗费用、看护者生产力损失和疫苗覆盖率。我们还进行了印度专家的德尔菲调查和小组讨论，以就模型输入达成共识。
通过扩大 Hib、PCV 和 RVV 的覆盖率，印度每年可节省超过 10 亿美元（不确定范围：9 亿至 24 亿美元）的经济效益，并避免 9 万多例不必要的儿童死亡。估计有 10 亿美元（9 亿至 20 亿美元）或总成本节约的 88%归因于因过早死于肺炎球菌而导致的生产力损失。另外的 1.128 亿美元（1.05 亿至 2.97 亿美元）或总成本的 10%归因于因这些疾病导致残疾而导致的生产力损失。Hib、肺炎球菌病和轮状病毒胃肠炎的治疗费用将占这些疾病总成本的 840 万美元（400 万至 1200 万美元）或<1%。最后，看护者因寻求治疗而导致的生产力损失为 150 万美元（100 万至 490 万美元）。成本节约因疫苗、覆盖范围和邦而异。
在印度引入 Hib、PCV 和 RVV 疫苗可以立即为政府和家庭带来节约方面的效益。
