美国儿童常规水痘疫苗接种计划的成本效益

Cost-effectiveness of a routine varicella vaccination program for US children.

作者信息

Lieu T A, Cochi S L, Black S B, Halloran M E, Shinefield H R, Holmes S J, Wharton M, Washington A E

机构信息

Department of Pediatrics, University of California, San Francisco.

出版信息

JAMA. 1994 Feb 2;271(5):375-81.

PMID:8283587

Abstract

OBJECTIVE

To evaluate the economic consequences of a routine varicella vaccination program that targets healthy children.

METHODS

Decision analysis was used to compare the costs, outcomes, and cost-effectiveness of a routine vaccination program with no intervention. Clinical outcomes were based on a mathematical model of vaccine efficacy that relied on published and unpublished data and on expert opinion. Medical utilization rates and costs were collected from multiple sources, including the Kaiser Permanente Medical Care Program and the California Hospital Discharge Database.

RESULTS

A routine varicella vaccination program for healthy children would prevent 94% of all potential cases of chickenpox, provided the vaccination coverage rate is 97% at school entry. It would cost approximately $162 million annually if one dose of vaccine per child were recommended at a cost of $35 per dose. From the societal perspective, which includes work-loss costs as well as medical costs, the program would save more than $5 for every dollar invested in vaccination. However, from the health care payer's perspective (medical costs only), the program would cost approximately $2 per chickenpox case prevented, or $2500 per life-year saved. The medical cost of disease prevention was sensitive to the vaccination coverage rate and vaccine price but was relatively insensitive to assumptions about vaccine efficacy within plausible ranges. An additional program for catch-up vaccination of 12-year-olds would have high incremental costs if the vaccination coverage rate of children of preschool age were 97%, but would result in net savings at a coverage rate of 50%.

CONCLUSIONS

A routine varicella vaccination program for healthy children would result in net savings from the societal perspective, which includes work-loss costs as well as medical costs. Compared with other prevention programs, it would also be relatively cost-effective from the health care payer's perspective.

摘要

目的

评估针对健康儿童的常规水痘疫苗接种计划的经济影响。

方法

采用决策分析方法，比较常规疫苗接种计划与不采取干预措施的成本、结果及成本效益。临床结果基于一个疫苗效力数学模型，该模型依赖已发表和未发表的数据以及专家意见。医疗利用率和成本从多个来源收集，包括凯撒医疗保健计划和加利福尼亚医院出院数据库。

结果

若健康儿童常规水痘疫苗接种计划在入学时的接种覆盖率为97%，则可预防94%的所有潜在水痘病例。若建议每名儿童接种一剂疫苗，每剂成本为35美元，那么每年成本约为1.62亿美元。从社会角度来看，包括工作损失成本和医疗成本，该计划每投入1美元用于疫苗接种可节省超过5美元。然而，从医疗保健支付方的角度（仅医疗成本）来看，该计划预防每例水痘病例的成本约为2美元，或每挽救一个生命年的成本为2500美元。疾病预防的医疗成本对接种覆盖率和疫苗价格敏感，但在合理范围内对疫苗效力假设相对不敏感。如果学龄前儿童的接种覆盖率为97%，针对12岁儿童的补种计划将有较高的增量成本，但接种覆盖率为50%时将实现净节省。