Mangtani P, Hall A J, Normand C E
Department of Epidemiology and Population Studies, London School of Hygiene and Tropical Medicines.
J Epidemiol Community Health. 1995 Jun;49(3):238-44. doi: 10.1136/jech.49.3.238.
To assess the cost effectiveness of adding universal hepatitis B vaccination in infancy or pre-adolescence to a policy of selective vaccination of at risk groups.
Costs of a selective policy and additional costs of universal vaccination policies were estimated from costs of vaccine delivery and published data on target populations. Additional years of life gained were calculated for each policy by applying life tables to estimates of mortality attributable to hepatitis B.
England and Wales.
Compared with no vaccination, vaccination in infancy was the most cost effective followed by vaccination in preadolescence. Selective vaccination was the least effective (cost per year of life gained 2568 pounds, 2824 pounds, and 8564 pounds respectively). Adding vaccination in infancy or at pre-adolescence to a selective policy cost 1537 pounds or 1658 pounds per year of life gained. Discounting years gained in the future at 6% per annum, however, made pre-adolescent vaccination more cost effective than infant or selective vaccination (51,817 pounds, 94,821 pounds, and 124,779 pounds per discounted year of life gained). Adding pre-adolescent vaccination to a selective policy cost 32,125 pounds per discounted year of life gained and infant vaccination, 77,085 pounds.
Universal vaccination against hepatitis B was more cost effective than selective vaccination in a low prevalence country. Discounting future health gain, however, made universal infant vaccination lest cost effective than universal pre-adolescent vaccination. If future health gained is as important as present gain the addition of universal vaccination to a selective policy is equivalent to the cost per quality adjusted year of life from renal transplantation or breast cancer screening.
评估在针对高危人群的选择性疫苗接种政策基础上，于婴儿期或青春期前增加普遍乙肝疫苗接种的成本效益。
从疫苗接种成本和已公布的目标人群数据估算选择性政策的成本以及普遍疫苗接种政策的额外成本。通过将生命表应用于乙肝所致死亡率的估计值，计算每种政策额外获得的生命年数。
英格兰和威尔士。
与不接种疫苗相比，婴儿期接种疫苗成本效益最高，其次是青春期前接种疫苗。选择性接种疫苗效果最差（每获得一年生命的成本分别为2568英镑、2824英镑和8564英镑）。在选择性政策基础上增加婴儿期或青春期前接种疫苗，每获得一年生命的成本为1537英镑或1658英镑。然而，按每年6%对未来获得的生命年进行贴现后，青春期前接种疫苗比婴儿期或选择性接种疫苗更具成本效益（每贴现一年生命获得的成本分别为51817英镑、94821英镑和124779英镑）。在选择性政策基础上增加青春期前接种疫苗，每贴现一年生命获得的成本为32125英镑，增加婴儿期接种疫苗为77085英镑。
在乙肝低流行国家，普遍接种乙肝疫苗比选择性接种疫苗更具成本效益。然而，对未来健康收益进行贴现后，普遍婴儿期接种疫苗的成本效益低于普遍青春期前接种疫苗。如果未来健康收益与当前收益同样重要，那么在选择性政策基础上增加普遍接种疫苗的成本相当于肾移植或乳腺癌筛查每质量调整生命年的成本。
