Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea; Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.
Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea; Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.
Vaccine. 2021 Jan 3;39(1):147-157. doi: 10.1016/j.vaccine.2020.09.012.
This study evaluates the cost-effectiveness of maternal acellular pertussis (aP) immunization in low- and middle-income countries using a dynamic transmission model.
We developed a dynamic transmission model to simulate the impact of infant vaccination with whole-cell pertussis (wP) vaccine with and without maternal aP immunization. The model was calibrated to Brazilian surveillance data and then used to project health outcomes and costs under alternative strategies in Brazil, and, after adjusting model parameter values to reflect their conditions, in Nigeria and Bangladesh. The primary measure of cost-effectiveness is incremental cost (2014 USD) per disability-adjusted life-year (DALY).
The dynamic model shows that maternal aP immunization would be cost-effective in Brazil, a middle-income country, under the base-case assumptions, but would be very expensive at infant vaccination coverage in and above the threshold range necessary to eliminate the disease (90-95%). At 2007 infant coverage (DTP1 90%, DTP3 61% at 1 year of age), maternal immunization would cost < $4,000 per DALY averted. At high infant coverage, such as Brazil in 1996 (DTP1 94%, DTP3 74% at 1 year), cost/DALY increases to $1.27 million. When the model's time horizon was extended from 2030 to 2100, cost/DALY increased under both infant coverage levels, but more steeply with high coverage. The results were moderately sensitive to discount rate, maternal vaccine price, and maternal aP coverage and were robust using the 100 best-fitting parameter sets. Scenarios representing low-income countries showed that maternal aP immunization could be cost-saving in countries with low infant coverage, such as Nigeria, but very expensive in countries, such as Bangladesh, with high infant coverage.
A dynamic model, which captures the herd immunity benefits of pertussis vaccination, shows that, in low- and middle-income countries, maternal aP immunization is cost-effective when infant vaccination coverage is moderate, even cost-saving when it is low, but not cost-effective when coverage levels pass 90-95%.
本研究通过动态传播模型评估在低收入和中等收入国家中母亲非细胞百白破（aP）免疫接种的成本效益。
我们开发了一个动态传播模型，以模拟婴儿接种全细胞百日咳（wP）疫苗和有无母亲 aP 免疫接种的影响。该模型经过巴西监测数据校准，然后用于在巴西，以及在调整模型参数值以反映其条件后，在尼日利亚和孟加拉国预测替代策略下的健康结果和成本。成本效益的主要衡量标准是每残疾调整生命年（DALY）的增量成本（2014 年美元）。
动态模型表明，在巴西，一个中等收入国家，在基本假设下，母亲 aP 免疫接种在婴儿疫苗接种覆盖率处于或高于消除疾病所需的阈值范围内（90-95%）是具有成本效益的。在 2007 年婴儿覆盖率（DTP1 为 90%，DTP3 在 1 岁时为 61%）的情况下，母亲免疫接种的费用将低于每避免一个 DALY 的 4000 美元。在高婴儿覆盖率的情况下，例如 1996 年的巴西（DTP1 为 94%，DTP3 在 1 岁时为 74%），每 DALY 的成本增加到 127 万美元。当模型的时间范围从 2030 年延长到 2100 年时，在两种婴儿覆盖率水平下，每 DALY 的成本都增加了，但高覆盖率下的增加更为陡峭。结果对贴现率、母亲疫苗价格和母亲 aP 覆盖率的变化具有中度敏感性，并且使用 100 个最佳拟合参数集是稳健的。代表低收入国家的情景表明，在婴儿覆盖率较低的国家，例如尼日利亚，母亲 aP 免疫接种可以节省成本，但在婴儿覆盖率较高的国家，例如孟加拉国，成本非常高。
动态模型捕捉到百日咳疫苗接种的群体免疫效益，表明在低收入和中等收入国家中，当婴儿疫苗接种覆盖率适中时，母亲 aP 免疫接种具有成本效益，即使在覆盖率较低时也具有成本效益，但当覆盖率水平超过 90-95%时则不具有成本效益。
