Videnza Consultores, Lima, Peru.
Videnza Consultores, Calle Los Manzanos 296, San Isidro, Lima, Peru.
BMC Health Serv Res. 2024 Oct 10;24(1):1216. doi: 10.1186/s12913-024-11684-8.
Infant vaccination coverage rates in Peru have declined in recent years, exacerbated by the COVID-19 pandemic. Introduction of the fully-liquid diphtheria, tetanus, and acellular pertussis (DTaP)-inactivated polio vaccine (IPV)-hepatitis B (HB)-Haemophilus influenzae type B (Hib) hexavalent vaccine (DTaP-IPV-HB-Hib) in Peru's infant National Immunization Program may help improve coverage. We evaluated costs and healthcare outcomes, including coverage, of switching from a pentavalent vaccine containing whole-cell pertussis component (DTwP-HB-Hib) plus IPV/oral polio vaccine (IPV/OPV) to the hexavalent vaccine for the primary vaccination scheme (2, 4 and 6 months).
The analysis was performed over a 5-year period on a cohort of children born in Peru in 2020 (N = 494,595). Four scenarios were considered: the pentavalent plus IPV/OPV scheme (S1); replacing the pentavalent plus IPV/OPV scheme with the hexavalent scheme (S2); expanded delivery of the pentavalent plus IPV/OPV scheme (S3); expanded delivery of the hexavalent scheme (S4). Vaccine coverage and incidence of adverse reactions (ARs) were estimated using Monte Carlo simulations and previous estimates from the literature. Cases of vaccine-preventable diseases were estimated using a Markov model. Logistical and healthcare costs associated with these outcomes were estimated. Impact of key variables (including coverage rates, incidence of ARs and vaccine prices) on costs was evaluated in sensitivity analyses.
The overall cost from a public health payer perspective associated with the pentavalent plus IPV/OPV vaccine scheme (S1) was estimated at $56,719,350, increasing to $61,324,263 (+ 8.1%), $59,121,545 (+ 4.2%) and $64,872,734 (+ 14.4%) in scenarios S2, S3 and S4, respectively. Compared with the status quo (S1), coverage rates were estimated to increase by 3.1% points with expanded delivery alone, and by 9.4 and 14.3% points, if the hexavalent vaccine is deployed (S2 and S4, respectively). In both scenarios with the hexavalent vaccine (S2 and S4), pertussis cases would also be 5.7% and 8.7% lower, and AR rates would decrease by 32%. The cost per protected child would be reduced when the hexavalent vaccine scheme. Incidence of ARs was an important driver of cost variability in the sensitivity analysis.
Implementation of the hexavalent vaccine in Peru's National Immunization Program has a positive public health cost consequence.
近年来，秘鲁婴儿疫苗接种覆盖率有所下降，这一情况因 COVID-19 大流行而进一步恶化。秘鲁国家免疫计划引入全液体制备的白喉、破伤风和无细胞百日咳（DTaP）-灭活脊髓灰质炎（IPV）-乙型肝炎（HB）-流感嗜血杆菌（Hib）六价疫苗（DTaP-IPV-HB-Hib），可能有助于提高覆盖率。我们评估了切换到五价疫苗（包含全细胞百日咳成分的 DTwP-HB-Hib）加 IPV/口服脊髓灰质炎疫苗（IPV/OPV）和六价疫苗用于初级免疫接种方案（2、4 和 6 个月）的成本和医疗保健结果，包括覆盖范围。
本分析在 2020 年秘鲁出生的儿童队列（N=494595）上进行了 5 年的研究。考虑了以下四种情况：五价疫苗加 IPV/OPV 方案（S1）；用六价疫苗方案（S2）替代五价疫苗加 IPV/OPV 方案；扩大五价疫苗加 IPV/OPV 方案的供应（S3）；扩大六价疫苗方案的供应（S4）。使用蒙特卡罗模拟和文献中的先前估计值来估计疫苗覆盖率和不良反应（AR）发生率。使用马尔可夫模型估计疫苗可预防疾病的病例数。从后勤和医疗保健成本的角度评估了这些结果。在敏感性分析中评估了关键变量（包括覆盖率、不良反应发生率和疫苗价格）对成本的影响。
从公共卫生支付者的角度来看，五价疫苗加 IPV/OPV 疫苗方案（S1）的总成本估计为 5671.935 万美元，增加到 6132.4263 万美元（增加 8.1%）、5912.1545 万美元（增加 4.2%）和 6487.2734 万美元（增加 14.4%）在方案 S2、S3 和 S4 中。与现状（S1）相比，仅扩大供应预计可将覆盖率提高 3.1 个百分点，如果使用六价疫苗（S2 和 S4），覆盖率将分别提高 9.4 和 14.3 个百分点。在两种使用六价疫苗的方案中（S2 和 S4），百日咳病例也将分别降低 5.7%和 8.7%，不良反应率将降低 32%。实施六价疫苗方案将降低每个受保护儿童的成本。不良反应发生率是敏感性分析中成本变化的重要驱动因素。
在秘鲁国家免疫计划中实施六价疫苗具有积极的公共卫生成本效益。
