Lieu T A, Finkler L J, Sorel M E, Black S B, Shinefield H R
Division of Research, Permanente Medical Group, Oakland, CA 94611, USA.
Pediatrics. 1995 May;95(5):632-8.
To evaluate the cost-effectiveness of presumptive vaccination versus serological testing of school-age children (6 to 12 years) and adolescents (13 to 17 years) with a negative or uncertain history of varicella.
Decision analysis model based on published and unpublished probabilities and costs.
Hypothetical cohorts of 10,000 school-age children and 10,000 adolescents.
Number of chicken pox cases prevented and cost per chicken pox case prevented.
For school-age children, presumptively vaccinating would prevent 95% of the predicted chicken pox cases, would result in net savings when long-term and work loss costs were included, and would have a similar cost per case prevented as routinely testing before vaccination. For adolescents, presumptively vaccinating would be the most effective policy, and would prevent 99% of the projected chicken pox cases. A policy of routinely testing before vaccination would be the least effective policy for adolescents, preventing 81% of the predicted cases. However, even when long-term and work loss costs were taken into account, presumptively vaccinating adolescents had a relatively high cost of $329 per chicken pox case prevented and extremely high incremental costs per chicken pox case prevented compared with policies that involved serological testing. Results for school-age children were sensitive to the probability of previously having had chicken pox given a negative or uncertain history, to the rate of adherence to follow-up visits, and to vaccine price and test price. Results for adolescents were sensitive only to the rate of adherence to the first follow-up visit.
Presumptively vaccinating all patients with a negative or uncertain history of varicella is projected to be a relatively cost-effective policy for school-age children but not for adolescents. However, further empirical studies of the accuracy of a negative or uncertain history of chicken pox in these age groups are needed.
评估对水痘病史阴性或不确定的学龄儿童（6至12岁）和青少年（13至17岁）进行推定接种疫苗与血清学检测的成本效益。
基于已发表和未发表的概率及成本的决策分析模型。
10000名学龄儿童和10000名青少年的假设队列。
预防的水痘病例数及预防每例水痘病例的成本。
对于学龄儿童，推定接种疫苗可预防95%的预测水痘病例，若将长期和工作损失成本计算在内会带来净节省，且预防每例病例的成本与接种疫苗前常规检测相近。对于青少年，推定接种疫苗是最有效的策略，可预防99%的预计水痘病例。接种疫苗前常规检测的策略对青少年最无效，只能预防81%的预测病例。然而，即便将长期和工作损失成本考虑在内，推定接种疫苗预防每例水痘病例的成本相对较高，为329美元，与涉及血清学检测的策略相比，预防每例水痘病例的增量成本极高。学龄儿童的结果对水痘病史阴性或不确定时既往患过水痘的概率、随访依从率、疫苗价格和检测价格敏感。青少年的结果仅对首次随访的依从率敏感。
对所有水痘病史阴性或不确定的患者进行推定接种疫苗，预计对学龄儿童是一种相对具有成本效益的策略，但对青少年并非如此。然而，需要对这些年龄组中水痘病史阴性或不确定的准确性进行进一步的实证研究。
