Public Health Informatics, Computational, and Operations Research (PHICOR), Graduate School of Public Health and Health Policy, City University of New York, New York City, New York.
Public Health Informatics, Computational, and Operations Research (PHICOR), Graduate School of Public Health and Health Policy, City University of New York, New York City, New York.
Am J Prev Med. 2021 Mar;60(3):360-368. doi: 10.1016/j.amepre.2020.10.022. Epub 2021 Jan 27.
With norovirus vaccine candidates currently under development, now is the time to identify the vaccine characteristics and implementation thresholds at which vaccination becomes cost effective and cost saving in a community setting.
In 2020, a norovirus transmission, clinical, and economics computational simulation model representing different U.S. population segments was developed to simulate the spread of norovirus and the potential impact of vaccinating children aged <5 years and older adults (aged ≥65 years).
Compared with no vaccination, vaccinating preschool-aged children averted 8%-72% of symptomatic norovirus cases in a community, whereas vaccinating older adults averted 2%-29% of symptomatic cases (varying with vaccine efficacy [25%-75%] and vaccination coverage [10%-80%]). Vaccination with a 25% vaccine efficacy was cost effective (incremental cost-effectiveness ratio ≤$50,000 per quality-adjusted life year) when vaccination cost ≤$445 and cost saving at ≤$370 when vaccinating preschool-aged children and ≤$42 and ≤$30, respectively, when vaccinating older adults. With a 50% vaccine efficacy, vaccination was cost effective when it cost ≤$1,190 and cost saving at ≤$930 when vaccinating preschool-aged children and ≤$110 and ≤$64, respectively, when vaccinating older adults. These cost thresholds (cost effective and cost saving, respectively) further increased with a 75% vaccine efficacy to ≤$1,600 and ≤$1,300 for preschool-aged children and ≤$165 and ≤$100 for older adults.
This study outlines thresholds at which a norovirus vaccine would be cost effective and cost saving in the community when vaccinating children aged <5 years and older adults. Establishing these thresholds can help provide decision makers with targets to consider when developing and implementing a norovirus vaccine.
随着诺如病毒疫苗候选物的研发，现在是确定疫苗特征和实施阈值的时机，即在社区环境中，疫苗接种具有成本效益和节省成本。
在 2020 年，开发了一种诺如病毒传播、临床和经济学计算模拟模型，代表了不同的美国人群体，以模拟诺如病毒的传播以及为 5 岁以下儿童和≥65 岁的老年人接种疫苗的潜在影响。
与不接种疫苗相比，为学龄前儿童接种疫苗可避免社区中 8%-72%的有症状诺如病毒病例，而为老年人接种疫苗可避免 2%-29%的有症状病例（因疫苗效力[25%-75%]和接种率[10%-80%]而异）。当疫苗接种成本≤$445 时，接种疫苗的成本效益比（每增加一个质量调整生命年的增量成本效益比≤$50,000）为 25%的疫苗效力是有效的，当疫苗接种成本≤$370 时，接种疫苗具有成本效益，而当为学龄前儿童接种疫苗时，成本节省为≤$30，当为≥65 岁的老年人接种疫苗时，成本节省为≤$42。当疫苗效力为 50%时，当疫苗接种成本≤$1,190 且成本节省率≤$930 时，为学龄前儿童接种疫苗是有效的，当为≥65 岁的老年人接种疫苗时，成本节省率≤$110 且成本节省率≤$64。当疫苗效力为 75%时，这些成本阈值（分别为有效和节省成本）进一步提高至≤$1,600 和≤$1,300 用于为学龄前儿童接种疫苗，以及≤$165 和≤$100 用于为≥65 岁的老年人接种疫苗。
本研究概述了当为 5 岁以下儿童和≥65 岁的老年人接种疫苗时，在社区中诺如病毒疫苗具有成本效益和节省成本的阈值。确定这些阈值可以帮助决策者在制定和实施诺如病毒疫苗时提供目标。
