School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, Guangdong, China.
Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, Guangdong, China.
Vaccine. 2021 Apr 15;39(16):2237-2245. doi: 10.1016/j.vaccine.2021.03.041. Epub 2021 Mar 20.
To assess the cost-effectiveness of dual influenza and pneumococcal vaccination for the elderly in Shenzhen, China.
A Markov state-transition model with a weekly cycle was developed to compare the outcomes of dual influenza and pneumococcal vaccination for the prevention of influenza and pneumococcal infections compared with no vaccination among 70-74 years old people in Shenzhen over 5 years. The model allowed seasonal variation of influenza activity. We calculated the incremental cost-effectiveness ratio (ICER) with costs and quality-adjusted life years (QALYs) discounted at 5% annually from the societal perspective. The impact of parameter uncertainty on the results was examined using one-way and probabilistic sensitivity analyses (PSA).
In the base case, dual vaccination prevented 5042 influenza infections, 26 IPD cases, 3 disabilities, 34 deaths, and cost US$7.1 per person while resulting in a net gain of 0.0026 QALYs compared with no vaccination. Using once the Chinese gross domestic product per capita in 2019 (US$10,289) as the willingness-to-pay threshold, dual vaccination was cost-effective with an ICER of US$2699 per QALY gained. One-way sensitivity analyses showed that the ICER was relatively sensitive to changes in influenza attack rates and influenza vaccine effectiveness. Based on the results of PSA with 1000 Monte Carlo simulations, receiving both vaccines was cost-effective in 100% of the repetitions.
The current study provides evidence that dual influenza and pneumococcal vaccination is a cost-effective disease prevention strategy for the elderly in Shenzhen, China.
评估在中国深圳为老年人进行流感和肺炎球菌联合疫苗接种的成本效益。
采用每周循环的马尔可夫状态转移模型，比较了在中国深圳为 70-74 岁老年人接种流感和肺炎球菌联合疫苗与不接种疫苗预防流感和肺炎球菌感染的结果，模型允许流感活动的季节性变化。我们从社会角度计算了增量成本效益比（ICER），成本和质量调整生命年（QALY）以每年 5%贴现。使用单因素敏感性分析（Sensitivity Analysis）和概率敏感性分析（PSA）来检查参数不确定性对结果的影响。
在基础情况下，联合疫苗接种预防了 5042 例流感感染、26 例侵袭性肺炎球菌病（IPD）病例、3 例残疾、34 例死亡，且每人花费 7.1 美元，与不接种疫苗相比，净获得 0.0026 个 QALY。在中国 2019 年人均国内生产总值（GDP）（10289 美元）作为支付意愿阈值，接种两种疫苗的增量成本效益比为每获得一个 QALY 需花费 2699 美元。单因素敏感性分析表明，ICER 对流感发病率和流感疫苗有效性的变化相对敏感。基于 PSA 的 1000 次蒙特卡罗模拟结果，两种疫苗均接种在 100%的重复中是具有成本效益的。
本研究提供了证据表明，在中国深圳，流感和肺炎球菌联合疫苗接种是一种针对老年人的具有成本效益的疾病预防策略。
