Zurn P, Danthine J P
Département d'économétrie et d'économie politique, Ecole des HEC, Lausanne.
Soz Praventivmed. 1998;43 Suppl 1:S61-4, S134-7. doi: 10.1007/BF02042178.
The aim of this study was to assess and compare the costs and epidemiological impact of different vaccination strategies against hepatitis B in Switzerland. A birth cohort of 85,000 individuals was followed over its lifetime using a decision tree analysis. Published data were used to simulate the risk of hepatitis B virus (HBV) infection in the cohort, the consecutive clinical outcomes and the associated costs. Five vaccination scenarios were assessed and compared to the baseline, defined as the high-risk group strategy without prenatal screening. These were: 1. systematic prenatal screening and vaccination of newborns at risk; 2. universal vaccination of infants; 3. universal vaccination of schoolchildren; 4. universal vaccination of infants and schoolchildren; 5. universal vaccination of infants, schoolchildren and adolescents. Results are presented using a 3% annual discounting rate. Systematic prenatal screening reduced the number of chronic infections by 11% and prevented 6 deaths per year. The cost per year of life saved was estimated to be 23,350 CHF. The four universal vaccination scenarios had a much larger impact on the number of chronic infections and deaths prevented (reduction of 68-78%). Costs per year of life saved for universal vaccination ranged from 8820 CHF (infant strategy) to 12,380 CHF (schoolchildren strategy). However, the vaccination of schoolchildren would be as cost-effective as the vaccination of infants using alternative assumptions (a lower compliance for infants compared to schoolchildren or the need for a booster later in the life for infants). The benefit-cost ratio ranged from 1.2 (systematic prenatal screening and vaccination of newborns at risk) to 2.9 (vaccination of infants). Universal vaccination against hepatitis B is more cost-effective than the current selective vaccination strategy of newborns.
本研究的目的是评估和比较瑞士不同乙肝疫苗接种策略的成本及流行病学影响。采用决策树分析方法，对85000名个体的出生队列进行了终生随访。利用已发表的数据模拟该队列中乙肝病毒（HBV）感染风险、后续临床结局及相关成本。评估了五种疫苗接种方案，并与基线方案（定义为无产前筛查的高危组策略）进行比较。这五种方案分别是：1. 对有风险的新生儿进行系统的产前筛查和疫苗接种；2. 对婴儿进行普遍疫苗接种；3. 对学童进行普遍疫苗接种；4. 对婴儿和学童进行普遍疫苗接种；5. 对婴儿、学童和青少年进行普遍疫苗接种。结果以每年3%的贴现率呈现。系统的产前筛查使慢性感染数量减少了11%，每年预防6例死亡。估计每挽救一年生命的成本为23350瑞士法郎。四种普遍疫苗接种方案对预防慢性感染和死亡数量的影响要大得多（减少68%-78%）。普遍疫苗接种每挽救一年生命的成本从8820瑞士法郎（婴儿方案）到12380瑞士法郎（学童方案）不等。然而，在采用其他假设条件下（婴儿的依从性低于学童或婴儿后期需要加强接种），对学童进行疫苗接种与对婴儿进行疫苗接种具有相同的成本效益。效益成本比从1.2（对有风险的新生儿进行系统的产前筛查和疫苗接种）到2.9（对婴儿进行疫苗接种）不等。乙肝普遍疫苗接种比目前针对新生儿的选择性疫苗接种策略更具成本效益。
