Vaccination of risk groups in England using the 13 valent pneumococcal conjugate vaccine: economic analysis

被引:56
|
作者
Rozenbaum, Mark H. [1 ]
van Hoek, Albert Jan [2 ]
Fleming, Douglas [3 ]
Trotter, Caroline L. [4 ]
Miller, Elizabeth [2 ]
Edmunds, W. John [5 ]
机构
[1] Univ Groningen, Dept Pharm, Unit PharmacoEpidemiol & PharmacoEcon, NL-9713 AV Groningen, Netherlands
[2] Hlth Protect Agcy, Immunisat Hepatitis & Blood Safety Dept, London, England
[3] Royal Coll Gen Practitioners, Birmingham Res Unit, Birmingham, W Midlands, England
[4] Univ Bristol, Sch Social & Community Med, Bristol, Avon, England
[5] Univ London London Sch Hyg & Trop Med, Ctr Math Modelling Infect Dis, London WC1E 7HT, England
来源
BMJ-BRITISH MEDICAL JOURNAL | 2012年 / 345卷
基金
美国国家卫生研究院;
关键词
COMMUNITY-ACQUIRED PNEUMONIA; COST-EFFECTIVENESS; LIFE EXPECTANCY; ADULTS; DISEASE; HIV; GUIDELINES; UTILITIES; DIAGNOSIS; CARRIAGE;
D O I
10.1136/bmj.e6879
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective To estimate the cost effectiveness of vaccinating people with high risk conditions against invasive pneumococcal disease using the 13 valent pneumococcal conjugate vaccine. Design Economic evaluation using a cohort model from the perspective of healthcare providers. Setting England. Participants People aged 2 years and older at increased risk of invasive pneumococcal disease due to chronic kidney disease; splenic dysfunction; HIV infection; a compromised immune system; chronic heart, liver, or respiratory disease; or diabetes. Main outcome measures Costs, gains in life years and quality adjusted life years (QALYs), and incremental cost effectiveness ratios. Results Increasing indirect protection resulting from the vaccination programme of infants using the 13 valent pneumococcal conjugate vaccine means that the burden of disease preventable by targeting high risk groups will diminish in time. Under base case assumptions-that is, no overall impact on non bacteraemic pneumonia in high risk groups and assuming the high risk vaccination programme would be launched two to three years after the infant programme-the incremental cost effectiveness ratio was estimated to be more than 30 pound 000 ((sic)37 216; $48 210) per QALY gained for most risk groups. If, however, the vaccine does not offer protection against non-bacteraemic pneumococcal pneumonia or the vaccine was introduced concomitantly with the infant 13 valent pneumococcal conjugate vaccination programme then vaccinating high risk people would (more) likely be cost effective. Sensitivity analyses showed that the cost effectiveness was particularly sensitive to assumed herd benefits and vaccine efficacy estimates. Conclusion Under base case assumptions it is unlikely that a pneumococcal vaccination programme aimed at risk groups could be considered cost effective. Uncertainty could be substantially reduced by establishing the effectiveness of the 13 valent pneumococcal conjugate vaccine against non-bacteraemic pneumococcal pneumonia, particularly in at risk groups.
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页数:17
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