Nikitin Dariya, Whittles Lilith K, Imai-Eaton Jeffrey W, White Peter J
Medical Research Council Centre for Global Infectious Disease Analysis and National Institute for Health and Care Research Health Protection Research Unit in Modelling and Health Economics, Imperial College London, London, United Kingdom.
Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America.
J Infect Dis. 2025 Feb 4;231(1):71-83. doi: 10.1093/infdis/jiae123.
Observational evidence suggests the 4CMenB meningococcal vaccine may partially protect against gonorrhea, with 1 dose being two-thirds as protective as 2 doses. We examined the cost-effectiveness of vaccinating men who have sex with men (MSM) in England, with 1- or 2-dose primary vaccination.
Integrated transmission-dynamic health-economic modeling explored the effects of targeting strategy, first- and second-dose uptake levels, and duration of vaccine protection, using observational estimates of vaccine protection.
Vaccination with 1 or 2 primary doses is always cost-saving, irrespective of uptake, although vaccine sentiment is an important determinant of impact and cost-effectiveness. The most impactful and cost-effective targeting is offering "vaccination according to risk" (VaR), to all patients with gonorrhea plus those reporting high numbers of sexual partners. If VaR is not feasible to implement then the more restrictive strategy of "vaccination on diagnosis" (VoD) with gonorrhea is cost-effective, but much less impactful. Under conservative assumptions, VaR (2-dose) saves £7.62M (95% credible interval [CrI], 1.15-17.52) and gains 81.41 (95% CrI, 28.67-164.23) quality-adjusted life-years (QALYs) over 10 years; VoD (2-dose) saves £3.40M (95% CrI, .48-7.71) and gains 41.26 (95% CrI, 17.52-78.25) QALYs versus no vaccination. Optimistic versus pessimistic vaccine-sentiment assumptions increase net benefits by approximately 30% (VoD) or approximately 60% (VaR).
At UK costs, targeted 4CMenB vaccination of MSM gains QALYs and is cost-saving at any uptake level. Promoting uptake maximizes benefits and is an important role for behavioral science.
观察性证据表明，4CMenB脑膜炎球菌疫苗可能对淋病有部分保护作用，1剂疫苗的保护效果是2剂的三分之二。我们研究了在英国对男男性行为者（MSM）进行1剂或2剂初次疫苗接种的成本效益。
综合传播动力学健康经济模型利用疫苗保护的观察性估计值，探讨了靶向策略、首剂和第二剂接种水平以及疫苗保护持续时间的影响。
无论接种率如何，接种1剂或2剂初次疫苗始终具有成本效益，尽管疫苗接受度是影响和成本效益的重要决定因素。最具影响力和成本效益的靶向策略是向所有淋病患者以及报告有大量性伴侣的患者提供“按风险接种疫苗”（VaR）。如果实施VaR不可行，那么对淋病患者采用更严格的“确诊接种疫苗”（VoD）策略具有成本效益，但影响要小得多。在保守假设下，与不接种疫苗相比，VaR（2剂）在10年内节省762万英镑（95%可信区间[CrI]，115 - 1752），并获得81.41（95% CrI，28.67 - 164.23）个质量调整生命年（QALY）；VoD（2剂）节省340万英镑（95% CrI，48 - 771），并获得41.26（95% CrI，17.52 - 78.25）个QALY。乐观与悲观的疫苗接受度假设使净效益分别增加约30%（VoD）或约60%（VaR）。
按照英国的成本，对男男性行为者进行有针对性的4CMenB疫苗接种可获得质量调整生命年，且在任何接种水平下都具有成本效益。提高接种率可使效益最大化，这是行为科学的重要作用。
