Zhang Xu-Sheng, Niyomsri Siwaporn, Mandal Sema, Mohammed Hamish, Mindlin Miranda, Dugbazah Bennet, Adjei Solomon, Owoseni Bukky, Charlett Andre, I'Anson Jessica, Sugars Elliot, Kliner Merav, Mannes Trish, Jewitt Ellie, Gilbert Lorna, Moazam Samihah, Dewsnap Claire, Phillips David, Amirthalingam Gayatri, Ramsay Mary E, Vickerman Peter, Walker Josephine G
Statistics, Modelling and Economics, Data, Analytics & Surveillance, UK Health Security Agency, London, UK.
Population Health Sciences, University of Bristol, Bristol, UK.
Lancet Reg Health Eur. 2025 Jul 1;55:101364. doi: 10.1016/j.lanepe.2025.101364. eCollection 2025 Aug.
In 2022, a global mpox outbreak occurred among gay and bisexual men who have sex with men (GBMSM). In England, the outbreak was controlled through reductions in sexual risk behaviour and vaccination of high-risk GBMSM. However, mpox continues to circulate, including an expanding outbreak in Africa. We evaluated the most cost-effective vaccination strategy to minimise future mpox outbreaks among GBMSM in England.
A mathematical model of mpox transmission among GBMSM was developed to estimate the costs per quality-adjusted-life-year (QALY) gained for different vaccination strategies starting in 2024 (10-year time-horizon; 3.5% discount rate; willingness-to-pay threshold £20,000/QALY). Reactive vaccination (only during outbreaks) and/or pre-emptive vaccination (continuous routine) strategies targeting high-risk GBMSM were compared to no vaccination. Baseline projections assumed importation of new mpox cases, and a vaccine effectiveness following 1/2 doses of 78%/89% for 5/10 years at £160/dose. Costs were estimated for case management, vaccination and public health responses during an outbreak.
All vaccination strategies reduced future outbreaks, gained QALYs and reduced costs compared to no vaccination. Continuous pre-emptive vaccination (daily rate 54 doses) with reactive vaccination (daily rate 81 doses) if there is an outbreak was most cost-effective, saving £8.8 million and gaining 108.6 QALYs over 10-years. Vaccination remains cost-effective if the vaccine costs less than £330/dose. Pre-emptive with reactive vaccination remains the preferred strategy across many sensitivity analyses, with just pre-emptive vaccination at a higher rate becoming the preferred strategy in some sensitivity analyses. Just reactive vaccination only becomes the preferred strategy when public health response costs are not included, and in this case the vaccine has to cost less than £110 per dose for vaccination to be cost-effective.
Vaccination of high-risk GBMSM is likely to be a cost-saving strategy for preventing future mpox outbreaks.
NIHR and Wellcome Trust.
2022年，男同性恋者和双性恋男性（GBMSM）群体中爆发了全球猴痘疫情。在英国，通过减少性风险行为以及为高风险的GBMSM群体接种疫苗，疫情得到了控制。然而，猴痘仍在传播，包括在非洲不断扩大的疫情。我们评估了最具成本效益的疫苗接种策略，以尽量减少英国GBMSM群体未来的猴痘疫情。
建立了GBMSM群体中猴痘传播的数学模型，以估计从2024年开始的不同疫苗接种策略每获得一个质量调整生命年（QALY）的成本（时间跨度为10年；贴现率为3.5%；支付意愿阈值为20,000英镑/QALY）。将针对高风险GBMSM群体的反应性疫苗接种（仅在疫情期间）和/或先发制性疫苗接种（持续常规接种）策略与不接种疫苗进行比较。基线预测假设会有新的猴痘病例输入，且接种1/2剂疫苗后的疫苗效力在5/10年内分别为78%/89%，每剂成本为160英镑。估计了疫情期间病例管理、疫苗接种和公共卫生应对措施的成本。
与不接种疫苗相比，所有疫苗接种策略都减少了未来的疫情，获得了QALY并降低了成本。持续先发制性疫苗接种（每日接种率54剂）并在出现疫情时采用反应性疫苗接种（每日接种率81剂）最具成本效益，在10年内节省了880万英镑并获得了108.6个QALY。如果疫苗成本低于每剂330英镑，疫苗接种仍具有成本效益。在许多敏感性分析中，先发制性与反应性疫苗接种仍是首选策略，在一些敏感性分析中，较高接种率的单纯先发制性疫苗接种成为首选策略。只有在不包括公共卫生应对成本的情况下，单纯反应性疫苗接种才成为首选策略，在这种情况下，疫苗每剂成本必须低于110英镑，疫苗接种才具有成本效益。
为高风险GBMSM群体接种疫苗可能是预防未来猴痘疫情的一项节省成本的策略。
英国国家卫生研究院（NIHR）和惠康信托基金会。
