Tucker A W, Haddix A C, Bresee J S, Holman R C, Parashar U D, Glass R I
Viral Gastroenteritis Section, Respiratory and Enteric Viruses Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
JAMA. 1998 May 6;279(17):1371-6. doi: 10.1001/jama.279.17.1371.
Rotavirus is the most common cause of severe diarrhea in children, and a live, oral vaccine may soon be licensed for prevention.
To estimate the economic impact of a national rotavirus immunization program in the United States.
Cost-effectiveness was analyzed from the perspectives of the health care system and society. A decision tree used estimates of disease burden, costs, vaccine coverage, efficacy, and price obtained from published and unpublished sources.
The proposed vaccine would be administered to infants at ages 2, 4, and 6 months as part of the routine schedule of childhood immunizations.
Total costs, outcomes prevented, and incremental cost-effectiveness.
A routine, universal rotavirus immunization program would prevent 1.08 million cases of diarrhea, avoiding 34000 hospitalizations, 95000 emergency department visits, and 227000 physician visits in the first 5 years of life. At $20 per dose, the program would cost $289 million and realize a net loss of $107 million to the health care system-$103 per case prevented. The program would provide a net savings of $296 million to society. Threshold analysis identified a break-even price per dose of $9 for the health care system and $51 for the societal perspective. Greater disease burden and greater vaccine efficacy and lower vaccine price increased cost-effectiveness.
A US rotavirus immunization program would be cost-effective from the perspectives of society and the health care system, although the cost of the immunization program would not be fully offset by the reduction in health care cost of rotavirus diarrhea unless the price fell to $9 per dose.
轮状病毒是导致儿童严重腹泻的最常见病因，一种口服活疫苗可能很快获批用于预防。
评估在美国实施全国轮状病毒免疫计划的经济影响。
从医疗保健系统和社会角度分析成本效益。决策树使用了从已发表和未发表来源获得的疾病负担、成本、疫苗覆盖率、效力和价格估计值。
拟议的疫苗将作为儿童常规免疫计划的一部分，在婴儿2、4和6月龄时接种。
总成本、预防的结局以及增量成本效益。
一项常规的、普及的轮状病毒免疫计划在儿童生命的前5年将预防108万例腹泻，避免34000例住院、95000次急诊就诊和227000次门诊就诊。每剂疫苗20美元时，该计划将花费2.89亿美元，医疗保健系统净亏损1.07亿美元，即每预防一例损失103美元。该计划将为社会节省2.96亿美元。阈值分析确定，从医疗保健系统角度看，每剂疫苗的盈亏平衡价格为9美元，从社会角度看为51美元。更大的疾病负担、更高的疫苗效力和更低的疫苗价格可提高成本效益。
从社会和医疗保健系统角度看，美国的轮状病毒免疫计划具有成本效益，尽管除非疫苗价格降至每剂9美元，否则免疫计划的成本不会被轮状病毒腹泻医疗保健成本的降低完全抵消。
