TB Modelling Group, TB Centre, and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
Sanofi Pasteur, Singapore, Singapore.
Nat Commun. 2022 Feb 1;13(1):602. doi: 10.1038/s41467-022-28234-7.
The M72/AS01 tuberculosis vaccine showed 50% (95%CI: 2-74%) efficacy in a phase 2B trial in preventing active pulmonary tuberculosis disease, but potential cost-effectiveness of adolescent immunisation is unknown. We estimated the impact and cost-effectiveness of six scenarios of routine adolescent M72/AS01-like vaccination in South Africa and India. All scenarios suggested an M72/AS01-like vaccine would be highly (94-100%) cost-effective in South Africa compared to a cost-effectiveness threshold of $2480/disability-adjusted life-year (DALY) averted. For India, a prevention of disease vaccine, effective irrespective of recipient's M. tuberculosis infection status at time of administration, was also highly likely (92-100%) cost-effective at a threshold of $264/DALY averted; however, a prevention of disease vaccine, effective only if the recipient was already infected, had 0-6% probability of cost-effectiveness. In both settings, vaccinating 50% of 18 year-olds was similarly cost-effective to vaccinating 80% of 15 year-olds, and more cost-effective than vaccinating 80% of 10 year-olds. Vaccine trials should include adolescents to ensure vaccines can be delivered to this efficient-to-target population.
M72/AS01 结核疫苗在一项预防活动性肺结核疾病的 2B 期试验中显示出 50%（95%CI：2-74%）的疗效，但青少年免疫接种的潜在成本效益尚不清楚。我们评估了南非和印度常规青少年 M72/AS01 样疫苗接种的六种方案的影响和成本效益。所有方案均表明，与避免每残疾调整生命年（DALY）成本 2480 美元的成本效益阈值相比，南非的 M72/AS01 样疫苗非常具有成本效益（94-100%）。对于印度，一种无论接种者在接种时的结核分枝杆菌感染状态如何都能有效预防疾病的疫苗，在避免每 DALY 成本 264 美元的阈值下，也极有可能具有成本效益（92-100%）；然而，一种仅在接种者已感染时才有效的预防疾病疫苗，其成本效益的可能性为 0-6%。在这两种情况下，50%的 18 岁青少年接种疫苗与 80%的 15 岁青少年接种疫苗同样具有成本效益，并且比 80%的 10 岁青少年接种疫苗更具成本效益。疫苗试验应包括青少年，以确保可以将疫苗提供给这一高效目标人群。
