Lai Xiaozhen, Garcia Cristina, Wu Dan, Knoll Maria Deloria, Zhang Haijun, Xu Tingting, Jing Rize, Yin Zundong, Wahl Brian, Fang Hai
China Center for Health Development Studies, Peking University, Beijing, China.
Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China.
Lancet Reg Health West Pac. 2022 Dec 19;32:100666. doi: 10.1016/j.lanwpc.2022.100666. eCollection 2023 Mar.
Although 13-valent pneumococcal conjugate vaccine (PCV13) is available in China's private market, it has yet to be introduced into the National Immunization Programme (NIP) and is therefore not available to large parts of the population. This study aimed to estimate the cost-effectiveness of including PCV13 in China's NIP at national and provincial levels.
We adopted a decision-tree Markov model to estimate the cost-effectiveness of adding 3-dose PCV13 in the NIP compared to the in the private market from a societal perspective. The model hypothesized a birth cohort for five years after vaccine introduction. Treatment costs and vaccine program costs were calculated from Chinese Center for Disease Control and Prevention (CDC) and national insurance databases. Disease burden data, incidence rate ratios, and other parameters were derived from published and grey literature. Cases and deaths averted, quality-adjusted life years (QALYs) gained, and incremental cost-effectiveness ratios (ICERs) were estimated at the provincial, regional, and national levels. One-way, scenario and probabilistic sensitivity analyses were conducted to explore model uncertainty.
At the national level, introducing PCV13 in the NIP was predicted to prevent approximately 4807 pneumococcal deaths (66% reduction) and 1,057,650 pneumococcal cases (17% reduction) in the first five years of the 2019 birth cohort. Under the assumed base case price of US$ 25 per dose in the NIP, PCV13 in the NIP was cost-effective nationally with ICER of US$ 5.222 per QALY gained, and was cost-effective in 17 and cost-saving in 4 of the 31 provinces compared to the . One-way and scenario sensitivity analyses indicated robust results when varying all model parameters, and probabilistic sensitivity analysis showed a 98% probability of cost-effectiveness nationally.
Our findings highlight the cost-effectiveness of introducing PCV13 in China's NIP. Provincial results supported subnational introduction of PCV13, and priority should be given to less socioeconomically developed provinces. Since vaccination cost is the most influential model parameter, efforts to improve PCV affordability after pooled procurement will benefit public health in a cost-effective manner.
The Bill & Melinda Gates Foundation.
尽管13价肺炎球菌结合疫苗（PCV13）在中国的私人市场上已有供应，但尚未被纳入国家免疫规划（NIP），因此大部分人群无法接种。本研究旨在评估在国家和省级层面将PCV13纳入中国国家免疫规划的成本效益。
我们采用决策树马尔可夫模型，从社会角度评估在国家免疫规划中添加3剂PCV13与私人市场中的疫苗相比的成本效益。该模型假设了疫苗引入后五年的出生队列。治疗成本和疫苗项目成本来自中国疾病预防控制中心（CDC）和国家保险数据库。疾病负担数据、发病率比和其他参数来自已发表和灰色文献。在省级、区域和国家层面估计了避免的病例和死亡、获得的质量调整生命年（QALY）以及增量成本效益比（ICER）。进行了单向、情景和概率敏感性分析以探索模型的不确定性。
在国家层面，预计在2019年出生队列的前五年中，将PCV13纳入国家免疫规划可预防约4807例肺炎球菌死亡（减少66%）和1057650例肺炎球菌病例（减少17%）。在国家免疫规划中每剂假设基础价格为25美元的情况下，国家免疫规划中的PCV13在全国范围内具有成本效益，每获得一个QALY的ICER为5222美元，与私人市场中的疫苗相比，在31个省份中的17个省份具有成本效益，在4个省份具有成本节约效益。单向和情景敏感性分析表明，在改变所有模型参数时结果稳健，概率敏感性分析显示在全国范围内具有成本效益的概率为98%。
我们的研究结果突出了在中国国家免疫规划中引入PCV13的成本效益。省级结果支持在国家以下层面引入PCV13，应优先考虑社会经济欠发达省份。由于疫苗接种成本是最具影响力的模型参数，集中采购后努力提高PCV的可承受性将以具有成本效益的方式使公共卫生受益。
比尔及梅琳达·盖茨基金会。
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