Xiong Xuechen, Huo Zhaohua, Chiang Valerie, Ye Jiaxi, Hong Yuh Dong, Yi Xingnan, Ng Carmen S, Li Philip H, Quan Jianchao
Department of Dermatology, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan.
Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
Asian Pac J Allergy Immunol. 2024 Sep 22. doi: 10.12932/AP-270524-1864.
Concerns about new COVID-19 vaccines played a key role in vaccine hesitancy and hampered population uptake. Hong Kong initiated a Vaccine Allergy Safety Track (VAS-Track) program to assess potential COVID-19 vaccine-associated allergies. A 'Hub-and-Spoke' model of predominately non-specialists supported by the allergist hub was established to meet overwhelming demand despite limited specialists.
To assess the cost-effectiveness of VAS-Track as a pre- and post-vaccination assessment service for individuals potentially at high risk of COVID-19 vaccine-related allergy.
An individual-level decision-analytical model was constructed using data from VAS-Track participants supplemented by published estimates. Analyses were from a health service provider perspective over 12 months. We calculated the incremental cost-effectiveness ratio (ICER) to estimate the cost per quality-adjusted life years (QALYs) gained. Willingness-to-pay threshold was based on local GDP per capita (US$ 49,590). Sensitivity analyses examined robustness of findings.
Cost-effectiveness varied widely across age groups. VAS-Track was cost-saving for older adults (dominant strategy for age ≥ 50) compared with standard practice across a range of sensitivity analyses. VAS-Track was not cost-effective for younger groups (age 18-49: ICER: US$ 410,914/QALY for pre-vaccination and US$ 213,786/QALY for post-vaccination assessments). Infection rate, cost of treating severe infection, and vaccination rate were most influential on cost-effectiveness estimates.
VAS-Track was cost-effective both as a pre- and post-vaccination assessment service for adults over 50. The 'Hub-and-Spoke' model using non-specialists with limited allergy specialist resources to provide vaccine allergy assessment services would provide high economic value compared with usual care for adults aged 50 and over.
对新型新冠疫苗的担忧在疫苗犹豫中起了关键作用，并阻碍了人群接种。香港启动了疫苗过敏安全追踪（VAS-Track）计划，以评估潜在的新冠疫苗相关过敏反应。尽管专科医生数量有限，但仍建立了以过敏专科医生为核心、主要由非专科医生组成的“轮辐式”模式，以满足大量需求。
评估VAS-Track作为针对可能有新冠疫苗相关过敏高风险个体的接种前和接种后评估服务的成本效益。
使用VAS-Track参与者的数据并辅以已发表的估计值构建了个体水平的决策分析模型。分析是从卫生服务提供者的角度进行的，为期12个月。我们计算了增量成本效益比（ICER），以估计每获得一个质量调整生命年（QALY）的成本。支付意愿阈值基于当地人均国内生产总值（49,590美元）。敏感性分析检验了研究结果的稳健性。
成本效益在不同年龄组中差异很大。在一系列敏感性分析中，与标准做法相比，VAS-Track对老年人具有成本节约效果（年龄≥50岁为优势策略）。VAS-Track对较年轻群体不具有成本效益（18-49岁：接种前评估的ICER为410,914美元/QALY，接种后评估的ICER为213,786美元/QALY）。感染率、治疗严重感染的成本和疫苗接种率对成本效益估计影响最大。
VAS-Track作为50岁以上成年人接种前和接种后评估服务均具有成本效益。与50岁及以上成年人的常规护理相比，利用过敏专科医生资源有限的非专科医生的“轮辐式”模式提供疫苗过敏评估服务将具有很高的经济价值。
