Shepard D S, Walsh J A, Kleinau E, Stansfield S, Bhalotra S
Institute for Health Policy, Heller School, Brandeis University, Waltham, MA 02254-9110, USA.
Vaccine. 1995;13(8):707-14. doi: 10.1016/0264-410x(94)00063-s.
To help the Children's Vaccine Initiative (CVI) achieve its goal of new and improved children's vaccines, we developed and applied a cost-effectiveness model to set priorities for vaccine development. The model measures the health benefits in additional Quality-Adjusted Life Years (QALYs) gained by the combined birth cohorts of all developing countries over an assumed useful life of a proposed vaccine (generally 10 years). It measures costs as the net cost of developing, procuring, and administering the vaccine to the same population and time frame compared to the status quo (the current vaccine, if any). It weights each dollar of in-kind allocation of the existing health infrastructure less heavily than a dollar cash outlay to purchase new vaccine to reflect severe constraints on foreign exchange and non-personnel costs. It expresses cost-effectiveness as the net cost per QALY. The model was applied to 13 candidate vaccines selected by the CVI for initial analysis on the basis of their near-term feasibility. The five most cost-effective improvements, each of which could generate a QALY inexpensively (below $25 per QALY), were an early-administration or an early two-dose measles vaccine, slow release tetanus toxoid (for women), improved typhoid vaccine, and hepatitis B combined with diphtheria-tetanus-pertussis vaccine.
为帮助儿童疫苗倡议组织（CVI）实现研发新型改良儿童疫苗的目标，我们开发并应用了一种成本效益模型，以确定疫苗研发的优先顺序。该模型衡量的是在假定的某种拟议疫苗使用寿命（通常为10年）内，所有发展中国家联合出生队列通过接种该疫苗所获得的额外质量调整生命年（QALY）中的健康效益。它将成本衡量为与现状（现有疫苗，如果有的话）相比，在相同人群和时间范围内研发、采购及接种该疫苗的净成本。对于现有卫生基础设施的实物分配，每1美元的权重低于用于购买新疫苗的1美元现金支出，以反映外汇和非人员成本方面的严重限制。它将成本效益表示为每QALY的净成本。该模型应用于CVI根据近期可行性选出的13种候选疫苗进行初步分析。五种最具成本效益的改进措施，每一种都能以较低成本（每QALY低于25美元）产生一个QALY，分别是早期接种或早期两剂次麻疹疫苗、缓释破伤风类毒素（针对女性）、改良伤寒疫苗，以及乙肝与白喉 - 破伤风 - 百日咳联合疫苗。
