Cookson S T, Stamboulian D, Demonte J, Quero L, Martinez de Arquiza C, Aleman A, Lepetic A, Levine M M
Center for Vaccine Development, University of Maryland School of Medicine, Baltimore 21201, USA.
Int J Epidemiol. 1997 Feb;26(1):212-9. doi: 10.1093/ije/26.1.212.
Cholera spread to Latin America in 1991; subsequently, cholera vaccination was considered as an interim intervention until long-term solutions involving improved water supplies and sanitation could be introduced. Three successive summer cholera outbreaks in northern Argentina and the licensing of the new single-dose oral cholera vaccine, CVD 103-HgR, raised questions of the cost and benefit of using this new vaccine.
This study explored the potential benefits to the Argentine Ministry of Health of treatment costs averted, versus the costs of vaccination with CVD 103-HgR in the relatively confined population of northern Argentina affected by the cholera outbreaks. Water supplies and sanitation in this area are poor but a credible infrastructure for vaccine delivery exists.
In our cost-benefit model of a 3-year period (1992-1994) with an annual incidence of 2.5 case-patients per 1000 population and assumptions of vaccine efficacy of 75% and coverage of 75%, vaccination of targeted high risk groups would prevent 1265 cases.
Assuming a cost of US$602 per treated case and of US$1.50 per dose of vaccine, the total discounted savings from use of vaccine in the targeted groups would be US$132,100. The projected savings would be altered less by vaccine coverage (range 75-90%) or efficacy (60-85%) changes than by disease incidence changes. Our analysis underestimated the true costs of cholera in Argentina because we included only medical expenditures; Indirect losses to trade and tourism had the greatest economic impact. However, vaccination with CVD 103-HgR was still cost-beneficial in the base case.
霍乱于1991年蔓延至拉丁美洲；随后，霍乱疫苗接种被视为一种临时干预措施，直至能够引入涉及改善供水和卫生设施的长期解决方案。阿根廷北部连续三个夏季发生霍乱疫情，以及新型单剂量口服霍乱疫苗CVD 103-HgR获得许可，引发了关于使用这种新疫苗的成本效益问题。
本研究探讨了在阿根廷北部受霍乱疫情影响的相对有限人群中，避免治疗成本对阿根廷卫生部的潜在益处，与使用CVD 103-HgR进行疫苗接种的成本进行对比。该地区供水和卫生条件较差，但存在可靠的疫苗接种基础设施。
在我们为期3年（1992 - 1994年）的成本效益模型中，假设年发病率为每1000人口2.5例患者，疫苗效力为75%，覆盖率为75%，对目标高危人群进行疫苗接种可预防1265例病例。
假设每例治疗病例成本为602美元，每剂疫苗成本为1.50美元，在目标人群中使用疫苗的总贴现节省额将为132,100美元。与疾病发病率变化相比，疫苗覆盖率（75% - 90%范围）或效力（60% - 85%）变化对预计节省额的影响较小。我们的分析低估了阿根廷霍乱的实际成本，因为我们仅纳入了医疗支出；贸易和旅游业的间接损失产生了最大的经济影响。然而，在基本情况下，使用CVD 103-HgR进行疫苗接种仍具有成本效益。
