北京市老年人肺炎多糖疫苗接种成本效益分析

Cost-benefit analysis of 23-valent pneumococcal polysaccharide vaccine in elderly population in Beijing

目的评价23价肺炎球菌多糖疫苗在北京市老年人群中接种的效果和成本效益。方法采用历史性队列研究,选择2005-2008年接种过23价肺炎球菌多糖疫苗的老年人116人作为接种组,选择同期未接种疫苗的老年人116人为未接种组,进行1∶1配对,通过问卷调查回顾性收集2组基本情况和相关疾病患病及其医疗花费情况,采用卫生经济学方法进行成本效益分析。结果接种组和未接种组老年人群2005-2008年肺炎及其相关疾病发病密度分别为9.17/百人年和48.42/百人年,疫苗保护率为81.10%,接种与未接种疫苗发生肺炎及其相关疾病的相对危险度(RR)为0.19,95%CI=0.10～0.34;接种总成本24 418元,通过接种疫苗减少的医疗支出及相关总费用为458435.32元,效益成本比值(BCR)为6.49;效益成本比值随疫苗价格和发病情况改变而波动。结论北京市老年人群接种肺炎球菌多糖疫苗具有较好的成本效益,可有效预防老年人群肺炎及其相关疾病的发生。

Objective To evaluate the efficacy and compare the decrease of related medical care cost of 23-valent pneumococcal polysaccharide vaccine in pneumococcal infection diseases prevention among the elderly people in Beijing.Methods A historic cohort study was conducted.We selected 116 elderly people who vaccined pneumococcal polysaccharide vaccine during the period of 2005-2008 in Beijing as the vaccined group,and 116 elderly people who did not have vaccine during the same period in the same community as the unvaccined group.The subjects were matched on age,gender,health condition,and income level.Also,we collected baseline informationon,incidence of related pneumonia diseases and medical care costs with a questionnaire.Chi-square test,U test and nonparametric test were adopted in the analysis.ResultsThe incidence density of pneumococcal infection diseases and related pneumonia diseases in the vaccine group and unvaccine group was 9.17/100 person year and 48.42/100 person year,respectively.The protective rate was 81.10% and relative risk（RR） was 0.19,（95% confidence interval 0.10-0.34）.The total health economic analysis indicated the cost was 24 418 RMB yuan and the total savings was 458 435.32 RMB yuan.The benefit cost ratio（BCR） was 6.49.BCR was sensitive to the cost of vaccine and the incidence of pneumococcal diseases.Conclusion The pneumococcal polysaccharide vaccine has an efficacy and good cost-benefit for prevention of pneumococcal infection diseases and related pneumonia diseases in the elderly population in Beijing.