2016 - 2018年英格兰男男性行为者中甲肝疫情的传播动态及预防未来疫情的疫苗接种策略成本效益分析
Transmission dynamics of the 2016-18 outbreak of hepatitis A among men who have sex with men in England and cost-effectiveness analysis of vaccination strategies to prevent future outbreaks.
作者信息
Zhang Xu-Sheng, Ong Jason J, Macgregor Louis, Vilaplana Tatiana G, Heathcock Simone T, Mindlin Miranda, Weatherburn Peter, Hickson Ford, Edelstein Michael, Mandal Sema, Vickerman Peter
机构信息
Statistics, Modelling and Economics, Data, Analytics & Surveillance, UK Health Security Agency, UK.
University of Bristol, Bristol, UK.
出版信息
Lancet Reg Health Eur. 2022 Jun 17;19:100426. doi: 10.1016/j.lanepe.2022.100426. eCollection 2022 Aug.
BACKGROUND
Despite being vaccine-preventable, hepatitis A virus (HAV) outbreaks occur among men who have sex with men (MSM). We modelled the cost-effectiveness of vaccination strategies to prevent future outbreaks.
METHODS
A HAV transmission model was calibrated to HAV outbreak data for MSM in England over 2016-2018, producing estimates for the basic reproduction number (R) and immunity levels (seroprevalence) post-outbreak. For a hypothetical outbreak in 2023 (same R and evolving immunity), the cost-effectiveness of pre-emptive (vaccination between outbreaks among MSM attending sexual health services (SHS)) and reactive (vaccination during outbreak among MSM attending SHS and primary care) vaccination strategies were modelled. Effectiveness in quality-adjusted life-years (QALYs) and costs were estimated (2017 UK pounds) from a societal perspective (10-year time horizon; 3% discount rate). The incremental cost-effectiveness ratio (ICER) was estimated.
FINDINGS
R for the 2016-2018 outbreak was 3·19 (95% credibility interval (95%CrI) 2·87-3·46); seroprevalence among MSM increased to 70·4% (95%CrI 67·3-72·8%) post-outbreak. For our hypothetical HAV outbreak in 2023, pre-emptively vaccinating MSM over the preceding five-years was cost-saving (compared to no vaccination) if the yearly vaccine coverage rate among MSM attending SHS was <9·1%. Reactive vaccination was also cost-saving compared to no vaccination, but was dominated by pre-emptive vaccination if the yearly vaccination rate was >8%. If the pre-emptive yearly vaccination rate fell below this threshold, it became cost-saving to add reactive vaccination to pre-emptive vaccination.
INTERPRETATION
Although highly transmissible, existing immunity limited the recent HAV outbreak among MSM in England. Pre-emptive vaccination between outbreaks, with reactive vaccination if indicated, is the best strategy for limiting future HAV outbreaks.
FUNDING
NIHR.
背景
尽管甲型肝炎病毒（HAV）感染可通过疫苗预防，但男男性行为者（MSM）中仍会发生HAV疫情。我们对预防未来疫情的疫苗接种策略的成本效益进行了建模。
方法
根据2016 - 2018年英格兰MSM的HAV疫情数据校准了HAV传播模型，得出疫情后基本再生数（R）和免疫水平（血清阳性率）的估计值。对于2023年的假设疫情（相同的R和不断变化的免疫力），对先发制人（在性健康服务机构（SHS）就诊的MSM在疫情间隔期进行疫苗接种）和反应性（在SHS和初级保健机构就诊的MSM在疫情期间进行疫苗接种）疫苗接种策略的成本效益进行了建模。从社会角度（10年时间范围；3%贴现率）估计了质量调整生命年（QALYs）的有效性和成本（2017年英镑）。估计了增量成本效益比（ICER）。
研究结果
2016 - 2018年疫情的R为3.19（95%可信区间（95%CrI）2.87 - 3.46）；疫情后MSM中的血清阳性率升至70.4%（95%CrI 67.3 - 72.8%）。对于我们假设的2023年HAV疫情，如果在性健康服务机构就诊的MSM的年度疫苗接种覆盖率<9.1%，在过去五年中对MSM进行先发制人疫苗接种是节省成本的（与不接种疫苗相比）。与不接种疫苗相比，反应性疫苗接种也节省成本，但如果年度疫苗接种率>8%，则被先发制人疫苗接种所主导。如果先发制人年度疫苗接种率低于此阈值，在先发制人疫苗接种基础上增加反应性疫苗接种就会节省成本。
解读
尽管HAV传播性很强，但现有的免疫力限制了近期英格兰MSM中的HAV疫情。在疫情间隔期进行先发制人疫苗接种，并在必要时进行反应性疫苗接种，是限制未来HAV疫情的最佳策略。
资金来源
英国国家卫生研究院（NIHR）
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