水痘疫苗不同免疫策略的卫生经济学评价

Economic evaluation of different chickenpox vaccination strategies

目的:比较水痘疫苗不同免疫策略的成本和效益。方法:通过问卷调查的形式获取浙江省因罹患水痘导致的直接和间接经济负担;结合浙江省水痘流行特征数据,应用Matlab软件建立浙江省水痘传播动力学模型,预测从2017年开始后续40年(2017—2056年)采用水痘疫苗不同免疫策略(不接种疫苗、接种一剂、接种两剂)时水痘病例发生情况;以不接种疫苗策略为对照,计算效益成本比,并对设定的主要参数进行敏感性分析。结果:完成浙江省105例水痘病例调查,人均直接和间接经济负担分别为506. 84元和1045. 39元,合计1552. 23元。40年间,接种一剂疫苗累计发生709. 08万例水痘病例,比不接种疫苗(1759. 89万例)减少了59. 71%;疫苗接种费用总投入为23. 66亿元,所获得的总收益为337. 41亿元,效益成本比为14. 26∶1。若接种两剂疫苗,40年累计发生272. 49万例水痘病例,比不接种疫苗减少了84. 52%;总投入和总收益分别为44. 95亿元和443. 09亿元,效益成本比为9. 86∶1。敏感性分析结果显示,无论接种一剂还是接种两剂,疫苗价格均最为敏感,其次为无疫苗状态下的水痘发病率。结论:浙江省将水痘疫苗纳入免疫规划符合经济性原则,建议将接种一剂甚至两剂全程纳入免疫规划。

Objective: To evaluate the cost/benefit of different vaccination strategies related to chickenpox vaccine. Methods: The direct economic cost and indirect economic cost caused by chickenpox were obtained through questionnaire survey. The epidemic characteristics of chickenpox in Zhejiang province were studied by literature review. Dynamic model was set up by Matlab software based on the parameters of chickenpox,to predict the incidence trends of chickenpox with different immunization strategies( no vaccination,1-dose vaccination,2-dose vaccination) in future 40 years( 2017-2056). A cost-benefit analysis was conducted,and the sensitivities of the main parameters were analyzed. Results: Through the questionnaire survey of 105 cases,the direct and indirect economic cost per case was 506. 84 Yuan and 1045. 39 Yuan respectively,with the total of 1552. 23 Yuan. During the prediction period( 40 years),there would be 7. 0908 million cases in strategy 2,which was 59. 71% less than strategy 1( 17. 5989 million cases). Total vaccination costs in strategy 2 were 2. 366 billion Yuan,with a total economic gain of 33. 741 billion Yuan and benefit/cost ratio( BCR) of 14. 26∶ 1. If strategy 3 was adopted,2. 7249 million chickenpox cases would occur,with a decrease of 84. 52% compared with strategy 1. Total vaccination costs in strategy 3 was 4. 495 billion Yuan,with a total economic gain of 44. 309 billion Yuan and BCR of 9. 86 ∶ 1. Analysis showed that the vaccine price was the most sensitive variable, followed by the incidence of chickenpox in the absence of vaccine.Conclusions: In Zhejiang province,one-dose strategy and two-dose strategy were both cost effective. It is suggested that the chickenpox vaccination should be included in the immunization program in Zhejiang province.