Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Respiratory Diseases Department, Public Health England, London, United Kingdom.
Respiratory Diseases Department, Public Health England, London, United Kingdom; MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, W2 1PG, United Kingdom; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
Vaccine. 2020 Jan 22;38(4):752-762. doi: 10.1016/j.vaccine.2019.11.001. Epub 2019 Nov 15.
In Japan, the current influenza vaccination programme is targeting older individuals. On the other hand, epidemics of influenza are likely to be mainly driven by children. In this study, we consider the most cost-effective target age group for a seasonal influenza vaccination programme in Japan.
We constructed a deterministic compartmental Susceptible-Exposed-Infectious-Recovered (SEIR) model with data from the 2012/13 to 2014/15 influenza seasons in Japan. Bayesian inference with Markov Chain Monte Carlo method was used for parameter estimation. Cost-effectiveness analyses were conducted from public health care payer's perspective.
A scenario targeting children under 15 was expected to reduce the number of cases 6,382,345 compared to the current strategy. A scenario targeting elderly population (age over 49 years) was expected to reduce the number of cases 693,206. The children targeted scenario demonstrated negative ICER (incremental cost-effectiveness ratio) value. On the other hand, elderly targeted scenario demonstrated higher ICER value than the willingness to pay (50,000 USD/QALY).
A vaccination programme which targets children under 15 is predicted to have much larger epidemiological impact than those targeting elderly.
在日本，目前的流感疫苗接种计划针对的是老年人。另一方面，流感的流行很可能主要由儿童驱动。在这项研究中，我们考虑了日本季节性流感疫苗接种计划的最具成本效益的目标年龄组。
我们使用日本 2012/13 至 2014/15 流感季节的数据构建了一个确定性的 SIR （易感-暴露-感染-恢复） compartmental 模型。贝叶斯推断与马尔可夫链蒙特卡罗方法用于参数估计。从公共医疗保健支付者的角度进行了成本效益分析。
与当前策略相比，针对 15 岁以下儿童的方案预计将减少 6382345 例病例。针对老年人群（49 岁以上）的方案预计将减少 693206 例病例。针对儿童的方案表现出负的增量成本效益比（ICER）值。另一方面，老年人群的方案的 ICER 值高于意愿支付（50000 美元/QALY）。
针对 15 岁以下儿童的疫苗接种计划预计将比针对老年人的计划产生更大的流行病学影响。
