Edmunds W J
Department of Biological Sciences, University of Warwick, Coventry.
Commun Dis Public Health. 1998 Dec;1(4):221-8.
There is still no consensus on which hepatitis B virus (HBV) immunisation option should be adopted in the United Kingdom (UK). This review considers why three recent UK studies on the subject reached different conclusions, and whether they provide sufficient information to base an informed decision on cost-effectiveness grounds. The studies differed in methodology, particularly in the models used to estimate the effectiveness of the competing programmes. This led the authors to draw very different conclusions as to the relative cost-effectiveness of universal infant and selective immunisation, probably because the study that favoured infant immunisation omitted an allowance for the indirect protection afforded to others by immunisation of a proportion of the population. This would lead to the underestimation of the relative effectiveness of a programme targeted at high-risk individuals. Selective vaccination is probably more cost-effective than mass immunisation, but universal immunisation may still be considered a cost-effective option (in addition to selective immunisation) if future health benefits are not discounted (i.e., given a lower value than present ones). If future health benefits are discounted then mass infant immunisation is almost certainly not cost-effective. If selective immunisation is to be adopted, then the current (selective) strategy should be properly implemented, as it appears to have had little impact on HBV infection and disease.
在英国应采用哪种乙肝病毒（HBV）免疫方案仍未达成共识。本综述探讨了为何英国近期三项关于该主题的研究得出了不同结论，以及它们是否提供了足够信息，以便基于成本效益依据做出明智决策。这些研究在方法上存在差异，特别是在用于估计竞争方案有效性的模型方面。这导致作者们对普遍婴儿免疫和选择性免疫的相对成本效益得出了截然不同的结论，可能是因为支持婴儿免疫的研究未考虑到部分人群免疫给其他人带来的间接保护。这将导致低估针对高危个体的方案的相对有效性。选择性疫苗接种可能比大规模免疫更具成本效益，但如果不考虑未来健康益处的贴现（即赋予其比当前更低的价值），普遍免疫仍可能被视为一种具有成本效益的选择（除了选择性免疫之外）。如果考虑未来健康益处的贴现，那么大规模婴儿免疫几乎肯定不具有成本效益。如果要采用选择性免疫，那么当前的（选择性）策略应得到妥善实施，因为它似乎对HBV感染和疾病影响甚微。
