Leng Trystan, Whittles Lilith K, Nikitin Dariya, White Peter J
MRC Centre for Global Infectious Disease Analysis and NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College London, London, UK.
Modelling and Economics Unit, UK Health Security Agency, London, UK.
NPJ Vaccines. 2025 Jun 21;10(1):128. doi: 10.1038/s41541-025-01159-0.
Vaccination for UK men who have sex with men (MSM) at increased gonorrhea risk has been advised, but not yet implemented. Effective targeting is essential for cost-effectiveness, but previously-examined approaches have disadvantages: Vaccination-on-Diagnosis has low coverage (limiting impact), and Vaccination-according-to-Risk requires asking about sexual behavior to identify at-risk individuals, which is not always feasible. We developed a transmission-dynamic model to evaluate novel strategies offering vaccination based on information readily available to clinicians (diagnostic/vaccination history, if the patient is seeking care due to partner notification). Offering vaccination to MSM who are notified partners of gonorrhea cases or were diagnosed themselves in the past 2 years averts 1.6x more cases and is more cost-effective than Vaccination-on-Diagnosis. If vaccination provides 20% protection for 1.5 years after primary vaccination and 3 years after revaccination then at £18/dose administered, all considered strategies have ≥50 and ≥90% probabilities of positive net monetary benefit compared with no vaccination with a quality-adjusted life year valued at £20,000 and £30,000 respectively, thus meeting the UK criteria for cost-effectiveness. All novel strategies considered achieve greater impact than Vaccination-on-Diagnosis without the feasibility issues of Vaccination-according-to-Risk.
已建议对感染淋病风险增加的英国男男性行为者（MSM）进行疫苗接种，但尚未实施。有效的目标定位对于成本效益至关重要，但先前研究的方法存在缺点：诊断时接种疫苗的覆盖率较低（限制了影响），而根据风险接种疫苗需要询问性行为以确定高危个体，这并不总是可行的。我们开发了一个传播动力学模型，以评估基于临床医生容易获得的信息（诊断/疫苗接种史，如果患者因性伴通知而寻求治疗）提供疫苗接种的新策略。对作为淋病病例性伴被通知或在过去2年内自己被诊断的男男性行为者提供疫苗接种，可避免的病例数是诊断时接种疫苗的1.6倍，且比诊断时接种疫苗更具成本效益。如果初次接种疫苗后1.5年和再次接种疫苗后3年疫苗提供20%的保护，那么在每剂接种费用为18英镑的情况下，与不接种疫苗相比，所有考虑的策略分别以20,000英镑和30,000英镑的质量调整生命年估值，具有≥50%和≥90%的正净货币效益概率，从而符合英国的成本效益标准。所有考虑的新策略都比诊断时接种疫苗产生更大的影响，且不存在根据风险接种疫苗的可行性问题。
