不同免疫程序接种2剂麻疹-流行性腮腺炎-风疹联合减毒活疫苗的卫生经济学评价

何寒青; 张兵; 严睿; 李倩; 符剑; 唐学雯; 周洋; 邓璇; 谢淑云

Abstract

何寒青,张兵,严睿,李倩,符剑,唐学雯,周洋,邓璇,谢淑云.不同免疫程序接种2剂麻疹-流行性腮腺炎-风疹联合减毒活疫苗的卫生经济学评价[J].Chinese journal of Epidemiology,2016,37(8):1121-1126

不同免疫程序接种2剂麻疹-流行性腮腺炎-风疹联合减毒活疫苗的卫生经济学评价

Economic evaluation on different two-dose-vaccination-strategies related to Measles, Mumps and Rubella Combined Attenuated Live Vaccine

Received:January 30, 2016

DOI：10.3760/cma.j.issn.0254-6450.2016.08.014

KeyWord: 卫生经济学免疫程序麻疹-流行性腮腺炎-风疹联合减毒活疫苗

English Key Word: Health economic Immunization program Measles, Mumps and Rubella Combined Attenuated Live Vaccine

FundProject:2016年浙江省医药卫生一般研究计划科研项目（2016KYB059）；2015年浙江省预防医学会软课题计划（2015YF01）

Author Name	Affiliation	E-mail
He Hanqing	Expanded Program Immunization Department of Zhejiang Provincial Center for Diseases Control and Prevention, Hangzhou 310051, China
Zhang Bing	Expanded Program Immunization Department of Zhejiang Provincial Center for Diseases Control and Prevention, Hangzhou 310051, China
Yan Rui	Expanded Program Immunization Department of Zhejiang Provincial Center for Diseases Control and Prevention, Hangzhou 310051, China
Li Qian	Expanded Program Immunization Department of Zhejiang Provincial Center for Diseases Control and Prevention, Hangzhou 310051, China
Fu Jian	Expanded Program Immunization Department of Zhejiang Provincial Center for Diseases Control and Prevention, Hangzhou 310051, China
Tang Xuewen	Expanded Program Immunization Department of Zhejiang Provincial Center for Diseases Control and Prevention, Hangzhou 310051, China
Zhou Yang	Expanded Program Immunization Department of Zhejiang Provincial Center for Diseases Control and Prevention, Hangzhou 310051, China
Deng Xuan	Expanded Program Immunization Department of Zhejiang Provincial Center for Diseases Control and Prevention, Hangzhou 310051, China
Xie Shuyun	Expanded Program Immunization Department of Zhejiang Provincial Center for Diseases Control and Prevention, Hangzhou 310051, China	shyxie@cdc.zj.cn

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Abstract:

目的比较不同免疫程序接种2剂麻疹-流行性腮腺炎-风疹联合减毒活疫苗（MMR）的卫生经济学评价指标差异。方法对浙江省假定的70万出生队列人群随访一个生命周期（75年），采用增量成本效果比（ICER）、增量成本效益比（ICBR）和增量净收益（INB）方法，在设定条件下比较当前国家免疫规划中MMR接种策略（策略1）、调整为8和18月龄均接种MMR（策略2）以及额外再增加4岁组接种MMR（策略3）。调整研究设定的主要参数，利用敏感性分析评价研究结果的稳定性。结果与策略1相比，策略2和3的ICER（元/例）分别为2 012.51：1和4 238.72：1，ICBR分别为1：3.14和1：1.58，INB分别为2 127.78万元和927.65万元。分析接种率、疫苗保护效果、发病风险、疾病成本、疫苗价格和接种成本等指标敏感性，其卫生经济学评价结果一致，各指标变化幅度<20%。结论在国家免疫规划的基础上，改用8月龄接种MMR比4岁组增加1剂MMR的策略更具卫生经济学意义。

English Abstract:

Objective To evaluate the economic effect of Measles, Mumps and Rubella Combined Attenuated Live Vaccine (MMR) under different two-dose vaccination programs. Methods A hypothetical birth cohort of 750 000 infants over their lifetime, was followed up from birth through death in Zhejiang province. The current MMR vaccination strategie would include three different ones:1) Childlern were vaccinated with Measles-Rubella Combined Attenuated Live Vaccine and MMR, respectively at the age of 8 months and 18 months. 2) Children receive MMR at 8 months and 18 months, 3) Strategy 1 plus an additional vaccination of MMR at 4 years of age. Incremental cost-effectiveness ratio (ICER), incremental cost-benefit ratio (ICBR) and incremental net benefit (INB) were applied to calculate the health economic difference for Strategy 2 and Strategy 3 as compared to Strategy 1. Univariate sensitivity analysis was used to assess the robustness of results with main parameters, including the rate of immunization coverage, effectiveness of the vaccines, incidence and burdens of the related diseases, cost of vaccines and the vaccination program itself. Results ICER, ICBR and INB for Strategy 2 and Strategy 3 appeared as 2 012.51:1 RMB Yuan per case and 4 238.72:1 RMB Yuan per case, 1:3.14 and 1:1.58, 21 277 800 RMB Yuan and 9 276 500 RMB Yuan, respectively. Only slight changes (<20%) were found under the univariate sensitivity analysis, with varied values on main parameters. Conclusion Based on the current national immunization program, infants vaccinated with MMR at 8 months of age, generated more health economic effects than the Strategy 3.

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