Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand.
International Health Policy Program (IHPP), Ministry of Public Health, Nonthaburi 11000, Thailand.
Int J Environ Res Public Health. 2020 Feb 14;17(4):1247. doi: 10.3390/ijerph17041247.
Influenza outbreaks in Thai prisons were increasing in number every year and to address this, the Thai Ministry of Public Health (MOPH) initiated a policy to promote vaccination for prisoners. The objective of this study was to assess the cost effectiveness and budget impact of the influenza vaccination policy for prisoners in Thailand. The study obtained data from the Division of Epidemiology, Department of Disease Control (DDC), MOPH. Deterministic system dynamic modelling was exercised to estimate the financial implication of the vaccination programme in comparison with routine outbreak control. The incremental cost-effectiveness ratio (ICER) was calculated via a DDC perspective. The reproductive number was estimated at 1.4. A total of 143 prisons across the country (375,763 prisoners) were analysed. In non-vaccination circumstances, the total healthcare cost amounted to 174.8 million Baht (US$ 5.6 million). Should all prisoners be vaccinated, the total healthcare cost would reduce to 90.9 million Baht (US$ 2.9 million), and 46.8 million Baht (US$ 1.5 million) of this is related to the vaccination. The ICER of vaccination (compared with routine outbreak control) varied between 39,738.0 to 61,688.3 Baht per disability-adjusted life year (DALY) averted (US$ 1281.9-1989.9). Should the vaccination cover 30% of the prisoners, the ICER would be equal to 46,866.8 Baht (US$ 1511.8) per DALY averted with the budget burden amounted to Baht (US$ 4.8 million). The vaccination programme would become more cost-effective if the routine outbreak control was intensified. In summary, the vaccination programme was a cost-effective measure to halt influenza outbreak amongst prisoners. Further primary studies that aim to assess the actual impact of the programme are recommended.
泰国监狱中的流感疫情每年都在增加，为了解决这个问题，泰国公共卫生部（MOPH）启动了一项为囚犯接种疫苗的政策。本研究的目的是评估泰国囚犯流感疫苗接种政策的成本效益和预算影响。该研究从疾病控制部（DDC）流行病学司获取数据。确定性系统动力学模型用于估计与常规暴发控制相比，疫苗接种计划的财务影响。通过 DDC 视角计算增量成本效益比（ICER）。繁殖数估计为 1.4。全国共有 143 所监狱（375763 名囚犯）进行了分析。在不接种疫苗的情况下，医疗保健总成本为 1.748 亿泰铢（560 万美元）。如果所有囚犯都接种疫苗，医疗保健总成本将降至 9090 万泰铢（2900 万美元），其中 4680 万泰铢（1500 万美元）与疫苗接种有关。疫苗接种（与常规暴发控制相比）的 ICER 范围在每残疾调整生命年（DALY）避免 39738.0-61688.3 泰铢（1281.9-1989.9 美元）之间（DALY 避免），预算负担为 46866.8 泰铢（1511.8 美元）。如果疫苗接种覆盖率为 30%，则 DALY 避免的 ICER 将为 46866.8 泰铢（1511.8 美元），预算负担为 4800 万泰铢（1511.8 美元）。如果加强常规暴发控制，疫苗接种计划将更具成本效益。总之，疫苗接种计划是阻止囚犯中流感爆发的一项具有成本效益的措施。建议进行进一步的初级研究，以评估该计划的实际影响。
