Szucs T D, Smala A, Berger K, Windorfer A
Zentrum für Pharmakoökonomie, Universität Mailand.
Med Klin (Munich). 1998 Aug 15;93(8):468-77. doi: 10.1007/BF03042596.
In this cost-effectiveness study 4 different vaccination strategies against hepatitis B in children and adolescents are evaluated and compared with the situation without immunization.
Projections are made for the population of the today's adolescents underage 15 and the newborns of the next 30 years. The number of avoided hepatitis B virus (HBV) infections and the cases of disease as well as the costs associated with treatment and vaccination are determined. The course of incidence of the hepatitis B virus is observed for different age groups.
Compared to the situation without any vaccination against hepatitis B, a decrease of the remaining infections of at least 18,900 up to 46,600 could be expected during the next 30 years. The treatment costs for the remaining cases of disease could be reduced by 0.4 up to 1.6 billions DM. The remaining expenditures for treatment and vaccination would be limited to 2.3 up to 3.4 billions DM. The net costs of a vaccination are determined as about 14,200 up to 63,000 DM per avoided case of infection. Considering the commonly accepted number of unreported cases of hepatitis B as to be the 5- to 10 fold of the known incidence, all of the 4 compared vaccination strategies will be cost-effective and associated with net savings of about 5,900 up to 36,400 DM per avoided case of hepatitis B virus infection during 30 years. The epidemiological situation will be positive influenced by such a mass vaccination. The minimization of incidence is shown for the different age groups.
Considering these economical arguments, first the vaccination of all adolescents between age 11 to 15 and second the vaccination of all children/adolescents between age 0 to 15 are the preferable strategies. The immunization of all children/adolescents between age 0 to 15 is the most effective strategy from an epidemiological point of view.
在这项成本效益研究中，评估了4种针对儿童和青少年的不同乙肝疫苗接种策略，并与未进行免疫接种的情况进行了比较。
对当前15岁以下青少年人群以及未来30年的新生儿进行了预测。确定了避免的乙肝病毒（HBV）感染数量、疾病病例数以及与治疗和疫苗接种相关的成本。观察了不同年龄组乙肝病毒的发病率变化过程。
与未接种任何乙肝疫苗的情况相比，预计在未来30年内，剩余感染病例至少可减少18,900至46,600例。剩余疾病病例的治疗成本可降低0.4亿至16亿德国马克。治疗和疫苗接种的剩余支出将限制在23亿至34亿德国马克。每避免一例感染，疫苗接种的净成本约为14,200至63,000德国马克。考虑到普遍认为未报告的乙肝病例数是已知发病率的5至10倍，所有4种比较的疫苗接种策略都将具有成本效益，并且在30年内每避免一例乙肝病毒感染可节省约5,900至36,400德国马克。这种大规模疫苗接种将对流行病学情况产生积极影响。不同年龄组的发病率均呈现出最小化趋势。
考虑到这些经济因素，首先，对所有11至15岁的青少年进行疫苗接种，其次，对所有0至15岁的儿童/青少年进行疫苗接种是更可取的策略。从流行病学角度来看，对所有0至15岁的儿童/青少年进行免疫接种是最有效的策略。
