Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
Vaccine. 2020 Apr 9;38(17):3387-3396. doi: 10.1016/j.vaccine.2020.01.057. Epub 2020 Feb 28.
In many countries, annual immunization with inactivated influenza vaccine (IIV) is recommended for children with medical risk conditions. Prior cost-effectiveness analyses found such immunization to be cost saving, but assumed effectiveness against non-severe influenza outcomes and a higher effectiveness against severe influenza outcomes than recent studies would suggest. However, recent vaccine studies do not indicate any reduction in community or outpatient disease episodes in IIV immunized individuals. We therefore evaluated cost-effectiveness of IIV immunization in children with medical risk conditions in the Netherlands, assuming that IIV reduces influenza-related hospitalization and death, but has no meaningful impact on non-severe health outcomes.
A health economic decision tree model was developed to evaluate health effects and costs of annual IIV immunization versus no immunization. Model inputs were based on our study on influenza-related primary care visits and other literature. Immunization was considered cost effective if associated costs were less than €20,000 per quality-adjusted life year (QALY) gained. Probabilistic sensitivity analyses were performed to assess robustness of results, and one-way sensitivity analyses and scenario analyses were done to assess the influence of individual parameters.
Annual IIV prevents an average of 1.59 influenza-related hospitalizations and 0.02 deaths per 1,000 children with medical risk conditions. This results in an expected QALY gain of 0.43 at incremental costs of €21,564 per 1,000 children, corresponding to an incremental cost-effectiveness ratio (ICER) of €50,297/QALY compared to no immunization. Under base case assumptions, immunization had a 5% probability of being cost effective. Results were most influenced by vaccine efficacy against fatal influenza, QALY loss due to death, and mortality rate.
If IIV only reduces severe disease outcomes, as current evidence suggests, annual immunization of medical risk children is unlikely to be cost effective. Results should however be interpreted with caution as cost-effectiveness is largely dependent on incidence and QALY losses for fatal influenza, for which evidence is scarce.
在许多国家，建议为患有医学风险疾病的儿童接种季节性流感灭活疫苗（IIV）。先前的成本效益分析发现，此类免疫接种具有成本效益，但假设其对非严重流感结果的有效性以及对严重流感结果的有效性均高于近期研究结果。然而，最近的疫苗研究并未表明接种 IIV 的个体在社区或门诊疾病病例中有所减少。因此，我们假设 IIV 可降低流感相关住院和死亡的风险，但对非严重健康结果没有明显影响，从而评估了荷兰患有医学风险疾病的儿童接种 IIV 的成本效益。
开发了一种健康经济学决策树模型，以评估每年接种 IIV 与不接种疫苗的健康效果和成本。模型输入基于我们对流感相关初级保健就诊的研究和其他文献。如果相关成本低于每获得 1 个质量调整生命年（QALY）20,000 欧元，则认为免疫接种具有成本效益。进行了概率敏感性分析以评估结果的稳健性，并进行了单因素敏感性分析和情景分析，以评估单个参数的影响。
每年接种 IIV 可预防每 1,000 名患有医学风险疾病的儿童平均发生 1.59 例与流感相关的住院治疗和 0.02 例死亡。这导致每 1,000 名儿童预期 QALY 增加 0.43，增量成本为 21,564 欧元，与不接种疫苗相比，增量成本效益比（ICER）为 50,297 欧元/QALY。在基本情况下，免疫接种有 5%的可能性具有成本效益。结果受疫苗对致命流感的疗效，死亡导致的 QALY 损失和死亡率的影响最大。
如果 IIV 仅能降低严重疾病的结果，正如当前的证据所表明的那样，那么为患有医学风险的儿童进行年度免疫接种不太可能具有成本效益。但是，由于致命流感的发病率和 QALY 损失的证据稀缺，成本效益在很大程度上取决于这些因素，因此结果应谨慎解释。
