Azzari C, Baldo V, Giuffrida S, Gani R, O'Brien E, Alimenti C, Daniels V J, Wolfson L J
Department of Health Sciences, University of Florence and Meyer Children's University Hospital, Florence 50139, Italy.
Hygiene and Public Health Unit Department of Cardiac Thoracic Vascular Sciences and Public Health University of Padua, Padua 35100, Italy.
Clinicoecon Outcomes Res. 2020 Jun 8;12:273-283. doi: 10.2147/CEOR.S229685. eCollection 2020.
In 2017, varicella vaccination became mandatory for all children in Italy, based on a two-dose schedule administered at 12-15 months of age and 5 to 6 years of age. Varicella vaccines are available in different formulations (as a single vaccine or as a combination vaccine together with measles, mumps, and rubella) and are made by multiple manufacturers with different effectiveness profiles. This study calculates the cost-effectiveness of a range of varicella vaccination strategies to identify the optimal strategy for Italy.
A dynamic transmission cost-effectiveness model was applied in Italy to simulate the long-term (50 years) costs and outcomes associated with different varicella vaccination strategies. Five vaccination strategies were evaluated using the model: two doses of two different combination Measles-Mumps-Rubella-Varicella vaccines (either Vaccine A (MSD) [denoted QQVa] or Vaccine B (GSK) [denoted QQVb]); a first dose of a single Varicella vaccine followed by a second dose of a combination vaccine (either Vaccine C (MSD) followed by Vaccine A [denoted MQVa] or Vaccine D (GSK) followed by Vaccine B [denoted MQVb]); or no vaccine at all (NV). The model was adapted for Italy using publicly available Italian data and expert opinion.
Over the 50-year time-horizon, in the absence of universal varicella vaccination, there would be 34.8 million varicella cases, 142 varicella-infection-related deaths, and €23 billion in societal costs. The cost per capita from a societal perspective ranged from €164.55 to €392.18 with NV being the most expensive and QQVa the least expensive. The most effective strategy was QQVa, which resulted in a 66% decrease in varicella cases and 30% reduction in varicella-related deaths compared to NV strategy. QQVa led to a net saving in societal cost around €13 billion compared to NV as the cost of vaccination was more than offset by the savings that resulted from the reduced burden of illness.
Varicella vaccination has a major impact on reducing varicella incidence, prevalence, and societal costs. This analysis supports the policy for universal varicella vaccination in Italy as the NV strategy was the most expensive and resulted in the poorest outcomes. QQVa offers the greatest benefits at the lowest cost and should be considered as a potential priority strategy for Italian population.
2017年，意大利规定所有儿童必须接种水痘疫苗，接种程序为两剂，分别在12至15个月龄和5至6岁时接种。水痘疫苗有不同的剂型（单苗或与麻疹、腮腺炎和风疹组成的联合疫苗），由多家制造商生产，效果各异。本研究计算了一系列水痘疫苗接种策略的成本效益，以确定意大利的最佳策略。
在意大利应用动态传播成本效益模型，模拟不同水痘疫苗接种策略的长期（50年）成本和结果。使用该模型评估了五种接种策略：两种不同的麻疹-腮腺炎-风疹-水痘联合疫苗各接种两剂（疫苗A（默克）[记为QQVa]或疫苗B（葛兰素史克）[记为QQVb]）；先接种一剂水痘单苗，再接种一剂联合疫苗（先接种疫苗C（默克）再接种疫苗A[记为MQVa]或先接种疫苗D（葛兰素史克）再接种疫苗B[记为MQVb]）；或完全不接种疫苗（NV）。该模型根据意大利公开数据和专家意见进行了调整。
在50年的时间跨度内，如果不进行普遍水痘疫苗接种，将有3480万例水痘病例、142例与水痘感染相关的死亡，社会成本达230亿欧元。从社会角度看，人均成本在164.55欧元至392.18欧元之间，NV策略成本最高，QQVa成本最低。最有效的策略是QQVa，与NV策略相比，水痘病例减少66%，水痘相关死亡减少30%。与NV策略相比，QQVa使社会成本净节省约130亿欧元，因为疫苗接种成本被疾病负担减轻带来的节省所抵消。
水痘疫苗接种对降低水痘发病率、患病率和社会成本有重大影响。该分析支持意大利普遍接种水痘疫苗的政策，因为NV策略成本最高且结果最差。QQVa以最低成本提供了最大效益，应被视为意大利人群潜在的优先策略。
