Du Min, Qin Chenyuan, Liu Min, Liu Jue
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing 100191, China.
Institute for Global Health and Development, Peking University, No. 5, Yiheyuan Road, Haidian District, Beijing 100871, China.
Vaccines (Basel). 2023 May 7;11(5):957. doi: 10.3390/vaccines11050957.
Due to significant economic burden and disability from ischaemic stroke and the relationship between ischaemic stroke and SARS-CoV-2 infection, we aimed to explore the cost-effectiveness of the two-dose inactivated COVID-19 vaccination program in reducing the economic burden of ischaemic stroke after SARS-CoV-2 infection. We constructed a decision-analytic Markov model to compare the two-dose inactivated COVID-19 vaccination strategy to the no vaccination strategy using cohort simulation. We calculated incremental cost-effectiveness ratios (ICERs) to evaluate the cost-effectiveness and used number of the ischaemic stroke cases after SARS-CoV-2 infection and quality-adjusted life-years (QALYs) to assess effects. Both one-way deterministic sensitivity analysis and probabilistic sensitivity analysis were performed to assess the robustness of the results. We found that the two-dose inactivated vaccination strategy reduced ischaemic stroke cases after SARS-CoV-2 infection by 80.89% (127/157) with a USD 1.09 million as vaccination program cost, saved USD 3675.69 million as direct health care costs and gained 26.56 million QALYs compared with no vaccination strategy among 100,000 COVID-19 patients (ICER < 0 per QALY gained). ICERs remained robust in sensitivity analysis. The proportion of older patients and the proportion of two-dose inactivated vaccination among older people were the critical factors that affected ICER. This study suggests the importance of COVID-19 vaccination is not only in preventing the spread of infectious diseases, but also in considering its long-term value in reducing the economic burden of non-communicable diseases such as ischaemic stroke after SARS-CoV-2 infection.
由于缺血性中风造成的巨大经济负担和残疾，以及缺血性中风与SARS-CoV-2感染之间的关系，我们旨在探讨两剂次新型冠状病毒灭活疫苗接种计划在减轻SARS-CoV-2感染后缺血性中风经济负担方面的成本效益。我们构建了一个决策分析马尔可夫模型，通过队列模拟将两剂次新型冠状病毒灭活疫苗接种策略与未接种疫苗策略进行比较。我们计算了增量成本效益比（ICER）以评估成本效益，并使用SARS-CoV-2感染后缺血性中风病例数和质量调整生命年（QALY）来评估效果。进行了单向确定性敏感性分析和概率敏感性分析以评估结果的稳健性。我们发现，在10万名新型冠状病毒肺炎患者中，与未接种疫苗策略相比，两剂次灭活疫苗接种策略使SARS-CoV-2感染后缺血性中风病例减少了80.89%（127/157），疫苗接种计划成本为109万美元，节省了3.67569亿美元的直接医疗保健成本，并获得了2656万个QALY（每获得一个QALY的ICER < 0）。ICER在敏感性分析中保持稳健。老年患者比例和老年人中两剂次灭活疫苗接种比例是影响ICER的关键因素。本研究表明，新型冠状病毒疫苗接种的重要性不仅在于预防传染病传播，还在于考虑其在减轻SARS-CoV-2感染后缺血性中风等非传染性疾病经济负担方面的长期价值。
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