Dilokthornsakul Piyameth, Lan Le My, Thakkinstian Ammarin, Hutubessy Raymond, Lambach Philipp, Chaiyakunapruk Nathorn
Center for Medical and Health Technology Assessment (CM-HTA), Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
EClinicalMedicine. 2022 Apr 21;47:101410. doi: 10.1016/j.eclinm.2022.101410. eCollection 2022 May.
A number of cost-effectiveness analysis of influenza vaccination have been conducted to estimate value of influenza vaccines in elderly and health workers (HWs). This study aims to summarize cost-effectiveness evidence by pooling the incremental net monetary benefit (INMB) of influenza vaccination.
A systematic review was performed in electronic databases from their inceptions to February 2022. Cost-effectiveness studies reporting quality-adjusted life year (QALY), or life year (LY) of influenza vaccination were included. Stratified meta-analyses by population, perspective, country income-level, and herd-effect were performed to pool INMB across studies. The protocol was registered at PROSPERO (CRD42021246746).
A total of 21 studies were included. Eighteen studies were conducted in elderly, two studies were conducted in HWs, and one study was conducted in both elderly and HWs. According to pre-specified analyses, studies for elderly in high-income economies (countries) (HIEs) and upper-middle income economies (UMIEs) without herd effect could be pooled. For HIEs under a societal perspective, the perspective which identify all relevant costs occurred in the society including direct medical cost, direct non-medical cost and indirect cost, pooled INMB was $217·38 (206·23, 228·53, I =28.2%), while that for healthcare provider/payer perspective was $0·20 (-11,908·67, 11,909·07, I = 0.0%). For societal perspective in UMIEs, pooled INMB was $28·39 (-190·65, 133·87, I = 92.8%). The findings were robust across a series of sensitivity analyses for HIEs. Studies in HWs indicated that influenza vaccination was cost-effective compared to no vaccination or current practice.
Influenza vaccination might be cost-effective for HWs and elderly in HIEs under a societal perspective with relatively small variations among included studies, while there remains limited evidence for healthcare provider/payer perspective or other level of incomes. Further evidence is warranted.
This study was funded by a grant of Immunization, Vaccine and Biologicals department of the World Health Organization. The authors would like to acknowledge the contributions of the US CDC which provided financial support to the development and publication of this report. Grant number US CDC, WHO IVR (U50CK000431).
已开展多项流感疫苗接种的成本效益分析，以评估流感疫苗在老年人和医护人员中的价值。本研究旨在通过汇总流感疫苗接种的增量净货币效益（INMB）来总结成本效益证据。
对电子数据库从建立至2022年2月进行系统评价。纳入报告流感疫苗接种质量调整生命年（QALY）或生命年（LY）的成本效益研究。按人群、视角、国家收入水平和群体效应进行分层荟萃分析，以汇总各研究的INMB。该方案已在国际前瞻性系统评价注册库（PROSPERO）注册（注册号CRD42021246746）。
共纳入21项研究。18项研究针对老年人开展，2项研究针对医护人员开展，1项研究同时针对老年人和医护人员开展。根据预先设定的分析，可汇总高收入经济体（国家）（HIEs）和中高收入经济体（UMIEs）中无群体效应的老年人研究。对于HIEs社会视角（该视角识别社会中发生的所有相关成本，包括直接医疗成本、直接非医疗成本和间接成本），汇总的INMB为217.38美元（206.23，228.53，I=28.2%），而对于医疗服务提供者/支付方视角，INMB为0.20美元（-11908.67，11909.07，I=0.0%）。对于UMIEs的社会视角，汇总的INMB为28.39美元（-190.65，133.87，I=92.8%）。在针对HIEs的一系列敏感性分析中，研究结果均稳健。针对医护人员的研究表明，与不接种疫苗或现行做法相比，流感疫苗接种具有成本效益。
在社会视角下，流感疫苗接种对HIEs中的医护人员和老年人可能具有成本效益，纳入研究之间的差异相对较小，而对于医疗服务提供者/支付方视角或其他收入水平，证据仍然有限。需要进一步的证据。
本研究由世界卫生组织免疫、疫苗和生物制品部门的一项赠款资助。作者感谢美国疾病控制与预防中心（US CDC）的贡献，其为本报告的编写和发表提供了资金支持。资助编号：US CDC，WHO IVR（U50CK000431）。
