Levin & Morgan LLC, Bethesda, Maryland, USA
Self-employed, Phoenix, Arizona, USA.
BMJ Glob Health. 2023 Jul;8(7). doi: 10.1136/bmjgh-2022-011526.
Since 2000, the incidence of measles and rubella has declined as measles-rubella (MR) vaccine coverage increased due to intensified routine immunisation (RI) and supplementary immunisation activities (SIAs). The World Health Assembly commissioned a feasibility assessment of eliminating measles and rubella. The objective of this paper is to present the findings of cost-effectiveness analysis (CEA) of ramping up MR vaccination with a goal of eliminating transmission in every country.
We used projections of impact of routine and SIAs during 2018-2047 for four scenarios of ramping up MR vaccination. These were combined with economic parameters to estimate costs and disability-adjusted life years averted under each scenario. Data from the literature were used for estimating the cost of increasing routine coverage, timing of SIAs and introduction of rubella vaccine in countries.
The CEA showed that all three scenarios with ramping up coverage above the current trend were more cost-effective in most countries than the 2018 trend for both measles and rubella. When the measles and rubella scenarios were compared with each other, the most cost-effective scenario was likely to be the most accelerated one. Even though this scenario is costlier, it averts more cases and deaths and substantially reduces the cost of treatment.
The Intensified Investment scenario is likely the most cost-effective of the vaccination scenarios evaluated for reaching both measles and rubella disease elimination. Some data gaps on costs of increasing coverage were identified and future efforts should focus on filling these gaps.
自 2000 年以来，由于强化常规免疫（RI）和补充免疫活动（SIAs），麻疹-风疹（MR）疫苗覆盖率的提高导致麻疹和风疹的发病率下降。世界卫生大会委托对消除麻疹和风疹进行可行性评估。本文的目的是介绍提高 MR 疫苗接种率的成本效益分析（CEA）的结果，目标是在每个国家消除传播。
我们使用 2018-2047 年期间常规和 SIA 对四种提高 MR 疫苗接种率的情景的影响预测。这些预测与经济参数相结合，以估计每种情景下的成本和避免的残疾调整生命年。使用文献中的数据来估算提高常规覆盖率、SIA 时间安排和在各国引入风疹疫苗的成本。
成本效益分析表明，在大多数国家，所有三种提高覆盖率的情景都比 2018 年麻疹和风疹的趋势更具成本效益。当将麻疹和风疹情景进行比较时，最具成本效益的情景可能是最加速的情景。尽管该情景成本更高，但它可避免更多病例和死亡，并大大降低治疗成本。
强化投资情景可能是评估的疫苗接种情景中最具成本效益的情景，可同时达到消除麻疹和风疹的目标。确定了一些关于提高覆盖率成本的资料空白，未来的工作应重点填补这些空白。
