Oddone E Z, Cowper P A, Hamilton J D, Feussner J R
Division of General Internal Medicine, Duke University Medical Center, Durham, NC.
Health Serv Res. 1993 Apr;28(1):97-121.
Our objective was to assess the cost effectiveness of hepatitis B vaccine in predialysis patients.
Costs were calculated from estimated rates of health services use and unit costs of resource use. Efficacy data were based on probability estimates from the medical literature and included vaccination response rates, anticipated hepatitis B virus (HBV) infection rates, and outcomes from HBV.
Costs and effectiveness of HBV vaccination was modeled with a decision tree constructed to analyze three vaccination strategies for patients with renal insufficiency: vaccine given prior to dialysis, vaccine given at time of dialysis, and no vaccine. Sensitivity analyses were performed to assess the effect of varying important clinical and cost variables.
DATA COLLECTION/EXTRACTION METHODS: All analyses were based on efficacy and cost estimates derived from the medical literature. Analyses were conducted with the aid of SMLTREE software.
The number of patients requiring vaccination per case of HBV prevented was higher for dialysis patients (625 vaccinees/case prevented) than for predialysis patients (434 vaccinees/case prevented). The cost-effectiveness ratios were $25,313/case of HBV prevented for vaccination at the time of dialysis and $31,111 for the predialysis vaccine. When a higher HBV infection rate (based on clinical trial data) was substituted in the analysis, the cost effectiveness of a predialysis vaccination strategy improved to $856 per case prevented. Results were sensitive to the cost of the vaccine and the incidence of HBV infection in dialysis patients. For the predialysis strategy to become cost saving, the price of the vaccine would have to decrease from $114 to $1.50, or the incidence of infection would have to increase from 0.6 percent to 38 percent, holding all other variables constant.
Additional HBV infection can be prevented by immunizing predialysis patients, but the cost is high. Decisions concerning vaccination policy should be influenced by local prevalence of HBV infection.
我们的目的是评估乙肝疫苗在透析前患者中的成本效益。
成本根据卫生服务使用估计率和资源使用单位成本计算得出。疗效数据基于医学文献中的概率估计，包括疫苗接种反应率、预期乙肝病毒（HBV）感染率以及HBV相关结局。
采用决策树模型对乙肝疫苗接种的成本和效果进行建模，该决策树用于分析肾功能不全患者的三种疫苗接种策略：透析前接种疫苗、透析时接种疫苗以及不接种疫苗。进行敏感性分析以评估不同重要临床和成本变量的影响。
数据收集/提取方法：所有分析均基于从医学文献中得出的疗效和成本估计。分析借助SMLTREE软件进行。
每预防一例HBV感染所需接种疫苗的患者数量，透析患者（625名接种者/例感染预防）高于透析前患者（434名接种者/例感染预防）。透析时接种疫苗预防HBV感染的成本效益比为每例25,313美元，透析前接种疫苗的成本效益比为31,111美元。当分析中采用更高的HBV感染率（基于临床试验数据）时，透析前接种疫苗策略的成本效益提高至每例预防感染856美元。结果对疫苗成本和透析患者HBV感染发生率敏感。对于透析前接种策略要实现成本节约，疫苗价格需从114美元降至1.50美元，或者感染发生率需从0.6%增至38%，同时其他所有变量保持不变。
通过为透析前患者接种疫苗可预防额外的HBV感染，但成本较高。关于疫苗接种政策的决策应受当地HBV感染流行情况影响。
