Instituto de Evaluación Tecnológica en Salud, Bogotá DC, Colombia.
Instituto de Evaluación Tecnológica en Salud, Bogotá DC, Colombia; Universidad Nacional de Colombia, Bogotá DC, Colombia.
Value Health Reg Issues. 2022 Sep;31:101-110. doi: 10.1016/j.vhri.2022.04.004. Epub 2022 May 26.
Our study compares two national COVID-19 vaccination plan strategies-high-risk prioritization and no prioritization-and estimates their cost-effectiveness compared with no vaccination, to generate possible recommendations for future vaccination plans.
We developed a Markov discrete-time, compartmental, deterministic model stratified by Colombian departments, healthcare workers, comorbidities, and age groups and calibrated to seroprevalence, cases, and deaths. The model simulates three scenarios: no vaccination, no prioritization of vaccination, and prioritization of high-risk population. The study presents the perspective of the health system of Colombia, including the direct health costs financed by the government and the direct health outcomes related to the infection. We measured symptomatic cases, deaths, and costs for each of the three scenarios from the start of the vaccination rollout to February 20, 2023.
Both for the base-case and across multiple sensitivity analyses, the high-risk prioritization proves to be the most cost-effective of the considered strategies. An increment of US$255 million results in an incremental cost-effectiveness ratio of US$3339 per disability-adjusted life-year avoided. The simulations show that prioritization of high-risk population reduces symptomatic cases by 3.4% and deaths by 20.1% compared with no vaccination. The no-prioritization strategy is still cost-effective, with an incremental cost-effectiveness ratio of US$5223.66, but the sensitivity analysis the show potential risks of losing cost-effectiveness under the cost-effectiveness threshold (one gross domestic product per averted disability-adjusted life-year).
The high-risk prioritization strategy is consistently more cost-effective than the no-prioritization strategy across multiple scenarios. High-risk prioritization is the recommended strategy in low-resource settings to reduce the burden of disease.
本研究比较了两种国家 COVID-19 疫苗接种计划策略——高危人群优先和无优先，并估计与不接种疫苗相比其成本效益，为未来的疫苗接种计划提供可能的建议。
我们开发了一个马尔可夫离散时间、分区、确定性模型，按哥伦比亚各部门、卫生保健工作者、合并症和年龄组分层，并根据血清流行率、病例和死亡情况进行校准。该模型模拟了三种情况：不接种疫苗、不优先接种疫苗和优先接种高危人群。该研究从疫苗接种开始到 2023 年 2 月 20 日，从哥伦比亚卫生系统的角度展示了直接卫生成本（由政府资助）和与感染相关的直接卫生结果。我们衡量了三种情况下的有症状病例、死亡人数和成本。
无论是基本情况还是多次敏感性分析，高危人群优先接种都被证明是最具成本效益的策略之一。增量 2.55 亿美元，增量成本效益比为每避免一个残疾调整生命年 3339 美元。模拟表明，与不接种疫苗相比，高危人群优先接种可减少 3.4%的有症状病例和 20.1%的死亡人数。不优先接种疫苗仍然具有成本效益，增量成本效益比为 5223.66 美元，但敏感性分析表明，在成本效益阈值（每避免一个残疾调整生命年 1 个国内生产总值）下，可能存在失去成本效益的风险。
在多种情况下，高危人群优先接种策略始终比不优先接种策略更具成本效益。在资源有限的环境中，高危人群优先接种是减少疾病负担的推荐策略。
