Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599.
State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
Proc Natl Acad Sci U S A. 2021 Mar 30;118(13). doi: 10.1073/pnas.2004933118.
Antimicrobial resistance (AMR) poses a serious threat to global public health. However, vaccinations have been largely undervalued as a method to hinder AMR progression. This study examined the AMR impact of increasing pneumococcal conjugate vaccine (PCV) coverage in China. China has one of the world's highest rates of antibiotic use and low PCV coverage. We developed an agent-based DREAMR (Dynamic Representation of the Economics of AMR) model to examine the health and economic benefits of slowing AMR against commonly used antibiotics. We simulated PCV coverage, pneumococcal infections, antibiotic use, and AMR accumulation. Four antibiotics to treat pneumococcal diseases (penicillin, amoxicillin, third-generation cephalosporins, and meropenem) were modeled with antibiotic utilization, pharmacokinetics, and pharmacodynamics factored into predicting AMR accumulation. Three PCV coverage scenarios were simulated over 5 y: 1) status quo with no change in coverage, 2) scaled coverage increase to 99% in 5 y, and 3) accelerated coverage increase to 85% over 2 y followed by 3 y to reach 99% coverage. Compared to the status quo, we found that AMR against penicillin, amoxicillin, and third-generation cephalosporins was significantly reduced by 6.6%, 10.9%, and 9.8% in the scaled scenario and by 10.5%, 17.0%, and 15.4% in the accelerated scenario. Cumulative costs due to AMR, including direct and indirect costs to patients and caretakers, were reduced by $371 million in the scaled and $586 million in the accelerated scenarios compared to the status quo. AMR-reducing benefits of vaccines are essential to quantify in order to drive appropriate investment.
抗菌药物耐药性（AMR）对全球公共卫生构成严重威胁。然而，疫苗接种作为一种阻止 AMR 进展的方法在很大程度上被低估了。本研究考察了提高中国肺炎球菌结合疫苗（PCV）覆盖率对抗 AMR 的影响。中国是世界上抗生素使用量最高和 PCV 覆盖率最低的国家之一。我们开发了一个基于代理的 DREAMR（AMR 经济学的动态表示）模型，以研究减缓 AMR 对常用抗生素的健康和经济效益。我们模拟了 PCV 覆盖率、肺炎球菌感染、抗生素使用和 AMR 积累。我们用抗生素利用、药代动力学和药效学来模拟治疗肺炎球菌疾病的四种抗生素（青霉素、阿莫西林、第三代头孢菌素和美罗培南），以预测 AMR 积累。我们模拟了三种 PCV 覆盖率方案，持续 5 年：1）现状，即覆盖率不变，2）在 5 年内将覆盖率提高到 99%，3）在 2 年内将覆盖率提高到 85%，然后再用 3 年时间达到 99%的覆盖率。与现状相比，我们发现，在逐步提高覆盖率的方案中，青霉素、阿莫西林和第三代头孢菌素的 AMR 分别显著降低了 6.6%、10.9%和 9.8%，在加速提高覆盖率的方案中，青霉素、阿莫西林和第三代头孢菌素的 AMR 分别显著降低了 10.5%、17.0%和 15.4%。与现状相比，在逐步提高覆盖率的方案中，累积的 AMR 相关成本（包括患者和看护者的直接和间接成本）减少了 3.71 亿美元，在加速提高覆盖率的方案中减少了 5.86 亿美元。为了推动适当的投资，量化疫苗的减少 AMR 效益至关重要。
