School of population health, Faculty of Medicine, UNSW, Sydney, Australia.
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia.
Clin Infect Dis. 2021 Oct 20;73(8):1424-1430. doi: 10.1093/cid/ciab442.
Following the introduction of rotavirus immunization in 2006 in the United States, there were substantial declines in the domestic rotavirus disease burden. In this study, we assess the value for money achieved by the program in the decade following vaccine introduction.
We applied an age-specific, static, multicohort compartmental model to examine the impact and cost-effectiveness of the US rotavirus immunization program in children <5 years of age using healthcare utilization data from 2001 to 2015 inclusive. We calculated the incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained from both a healthcare system and societal perspective.
Declines in healthcare use associated with the rotavirus and acute gastroenteritis occurred from 2006 and continued to grow before stabilizing from 2010 through 2011. From 2011 to 2015, an estimated annual average of approximately 118 000 hospitalizations, 86 000 emergency department presentations, and 460 000 outpatient and physician office visits were prevented. From a societal perspective during this same period, the program was estimated to be cost saving in the base case model and in >90% of probabilistic sensitivity analysis simulations and from a healthcare system perspective >98% of simulations found an ICER below $100 000 per QALY gained.
After the program stabilized, we found the rotavirus immunization in the United States was likely to have been cost saving to society. The greater than expected healthcare and productivity savings reflect the success of the rotavirus immunization program in the United States.
2006 年美国引入轮状病毒疫苗后，国内轮状病毒疾病负担大幅下降。在这项研究中，我们评估了疫苗接种计划实施十年后所取得的经济效益。
我们应用了一种特定于年龄的静态多队列隔室模型，使用 2001 年至 2015 年的医疗保健利用数据，从医疗保健系统和社会角度评估了美国轮状病毒免疫计划对<5 岁儿童的影响和成本效益。我们计算了每获得一个质量调整生命年（QALY）的增量成本效益比（ICER）。
自 2006 年以来，与轮状病毒和急性肠胃炎相关的医疗保健使用下降，并在 2010 年至 2011 年期间持续增长，然后趋于稳定。2011 年至 2015 年，估计每年平均可预防约 11.8 万例住院治疗、8.6 万例急诊就诊和 46 万例门诊和医生办公室就诊。在同一时期，从社会角度来看，在基本模型和超过 90%的概率敏感性分析模拟中，该计划被估计为成本节约，从医疗保健系统的角度来看，超过 98%的模拟发现每获得一个 QALY 的 ICER低于 100000 美元。
在该计划稳定之后，我们发现美国的轮状病毒免疫接种可能对社会具有成本效益。超出预期的医疗保健和生产力节约反映了美国轮状病毒免疫计划的成功。
