Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA.
Legacy Medical Group-Mount Hood Women's Health, Gresham, OR, USA.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):5244-5252. doi: 10.1080/14767058.2021.1876654. Epub 2021 Jan 21.
To assess the cost-effectiveness of influenza vaccination for all pregnant patients in the United States.
We designed a cost-effectiveness model to compare outcomes and costs in pregnant patients who received the inactivated, trivalent influenza vaccine to those who did not. We used a theoretical cohort of 4 million patients, the number of individuals giving birth in the United States per year. We assumed that H1N1 and A or B type influenza were of equal incidence based on seasonal variation from the past ten years. Our outcomes include acquiring H1N1, acquiring A or B type influenza, maternal death, stillbirth, infant death, preterm birth, and cerebral palsy in addition to cost and quality-adjusted life years (QALYs). Probabilities were derived from the literature and QALYs generated at a discount rate of 3%. Sensitivity analyses were performed to assess the robustness of our model.
In our theoretical cohort of 4 million pregnant patients, the influenza vaccination strategy was associated with 1632 fewer stillbirths (24,332 in the vaccine strategy vs. 25,964 in the no vaccine strategy), 120 fewer maternal deaths (284 vs. 404), 340 fewer infant deaths (5608 vs. 5948), 32,856 fewer preterm births (403,896 vs. 436,752), and 641 fewer cases of moderate cerebral palsy (12,388 vs. 13,029). Additionally, the vaccination strategy corresponded to savings of $3.7 billion ($63.3 billion vs. $67.0 billion) and increased QALYs of 81,696 (226,852,076 vs 226,770,380). Therefore, it was considered a dominant strategy. Univariate sensitivity analysis demonstrated that the vaccine is cost saving until vaccine cost passes $900, far above the current cost of $12.16. In addition, we used sensitivity analysis to vary seasonal proportions of H1N1 to A or B type influenza. The vaccine was cost saving and increased QALYs for any proportion of H1N1 to A or B type influenza including when H1N1 was absent.
We demonstrate that in a cohort of 4 million patients, the influenza vaccine may save $3.7 billion per year, improve maternal and infant outcomes, and reduce morbidity and mortality. Our study provides further evidence that providers should strongly recommend that pregnant patients receive their annual influenza vaccine.
评估在美国为所有孕妇接种流感疫苗的成本效益。
我们设计了一个成本效益模型，比较了接受灭活、三价流感疫苗和未接种疫苗的孕妇的结果和成本。我们使用了一个 400 万患者的理论队列，这是美国每年分娩的人数。我们假设基于过去十年的季节性变化，H1N1 和 A 或 B 型流感的发病率相等。我们的结果包括感染 H1N1、感染 A 或 B 型流感、产妇死亡、死胎、婴儿死亡、早产和脑瘫，以及成本和质量调整生命年（QALY）。概率来自文献，QALY 以 3%的贴现率生成。进行了敏感性分析以评估我们模型的稳健性。
在我们的 400 万孕妇理论队列中，流感疫苗接种策略与 1632 例死胎减少相关（疫苗策略 24332 例，无疫苗策略 25964 例），120 例产妇死亡减少（疫苗策略 284 例，无疫苗策略 404 例），340 例婴儿死亡减少（疫苗策略 5608 例，无疫苗策略 5948 例），32856 例早产减少（疫苗策略 403896 例，无疫苗策略 436752 例），641 例中度脑瘫减少（疫苗策略 12388 例，无疫苗策略 13029 例）。此外，疫苗接种策略还节省了 37 亿美元（疫苗策略 633 亿美元，无疫苗策略 670 亿美元），并增加了 81696 个 QALY（疫苗策略 226852076 个，无疫苗策略 226770380 个）。因此，它被认为是一种主导策略。单变量敏感性分析表明，在疫苗成本超过 900 美元之前，疫苗是节省成本的，远远高于目前 12.16 美元的成本。此外，我们使用敏感性分析来改变 H1N1 与 A 或 B 型流感的季节性比例。对于 H1N1 与 A 或 B 型流感的任何比例，疫苗都是节省成本并增加 QALY 的，包括 H1N1 不存在的情况。
我们证明，在一个 400 万患者的队列中，流感疫苗每年可能节省 37 亿美元，改善母婴结局，并降低发病率和死亡率。我们的研究进一步证明，提供者应强烈建议孕妇接种流感疫苗。
