H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, United States.
Department of Epidemiology of Microbial Diseases, Yale University, United States.
Vaccine. 2021 Apr 8;39(15):2133-2145. doi: 10.1016/j.vaccine.2021.02.066. Epub 2021 Mar 23.
Noroviruses are the leading cause of acute gastroenteritis in the United States and outbreaks frequently occur in daycare settings. Results of norovirus vaccine trials have been promising, however there are open questions as to whether vaccination of daycare children would be cost-effective. We investigated the incremental cost-effectiveness of a hypothetical norovirus vaccination for children in daycare settings compared to no vaccination.
We conducted a model-based cost-effectiveness analysis using a disease transmission model of children attending daycare. Vaccination with a 90% coverage rate in addition to the observed standard of care (exclusion of symptomatic children from daycare) was compared to the observed standard of care. The main outcomes measures were infections and deaths averted, quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratio (ICER). Cost-effectiveness was analyzed from a societal perspective, including medical costs to children as well as productivity losses of parents, over a two-year time horizon. Data sources included outbreak surveillance data and published literature.
A 50% efficacious norovirus vaccine averts 571.83 norovirus cases and 0.003 norovirus-related deaths per 10,000 children compared to the observed standard of care. A $200 norovirus vaccine that is 50% efficacious has a net cost increase of $178.10 per child and 0.025 more QALYs, resulting in an ICER of $7,028/QALY. Based on the probabilistic sensitivity analysis, we estimated that a $200 vaccination with 50% efficacy was 94.0% likely to be cost-effective at a willingness-to-pay of $100,000/QALY threshold and 95.3% likely at a $150,000/QALY threshold.
Due to the large disease burden associated with norovirus, it is likely that vaccinating children in daycares could be cost-effective, even with modest vaccine efficacy and a high per-child cost of vaccination. Norovirus vaccination of children in daycare has a cost-effectiveness ratio similar to other commonly recommended childhood vaccines.
诺如病毒是美国急性肠胃炎的主要病因，并且经常在日托场所爆发。诺如病毒疫苗试验的结果令人鼓舞，但是否为日托儿童接种疫苗具有成本效益仍存在一些疑问。我们调查了假设的日托环境中儿童接种诺如病毒疫苗相对于不接种疫苗的增量成本效益。
我们使用参加日托的儿童疾病传播模型进行了基于模型的成本效益分析。在观察到的标准护理（将症状性儿童排除在日托之外）之外，以 90%的覆盖率接种疫苗与观察到的标准护理进行了比较。主要结果衡量标准是预防感染和死亡，质量调整生命年（QALY），成本和增量成本效益比（ICER）。从社会角度考虑了成本效益，包括儿童的医疗费用和父母的生产力损失，为期两年。数据来源包括暴发监测数据和已发表的文献。
与观察到的标准护理相比，一种 50%有效的诺如病毒疫苗可预防每 10,000 名儿童发生 571.83 例诺如病毒病例和 0.003 例与诺如病毒相关的死亡。一种 50%有效的 200 美元的诺如病毒疫苗会使每个孩子的净成本增加 178.10 美元，并且 QALY 增加 0.025，从而使 ICER 达到 7,028/QALY。基于概率敏感性分析，我们估计，在 100,000 美元/QALY 的支付意愿阈值下，200 美元的疫苗接种率为 50%，其具有成本效益的可能性为 94.0%，在 150,000 美元/QALY 的支付意愿阈值下，其具有成本效益的可能性为 95.3%。
由于诺如病毒引起的疾病负担很大，因此即使疫苗的效力中等，每个孩子的疫苗接种成本较高，为日托儿童接种疫苗也可能具有成本效益。日托儿童接种诺如病毒疫苗的成本效益比与其他常见推荐的儿童疫苗相似。
