基于净增效益值流感疫苗成本效益系统评价与meta分析

Incremental net benefit value-based cost-effectiveness of mass vaccination of influenza vaccine: a systematic review and meta-analysis

目的基于最新提出的成本效益指标净增效益值(INB)比较评价预防接种四价流感疫苗(QIV)与三价流感疫苗(TIV)的成本效益。方法检索中国知网数据库、万方数据知识服务平台、 PubMed数据库和Web of science数据库,收集1998年1月1日—2018年8月7日公开发表的关于QIV与TIV成本效益比较的相关文献,应用Stata/SE 12.0软件进行meta分析,估计总增量净效益(TINB)。结果最终纳入5篇英文文献,累计研究对象96 727 891人;meta分析结果显示,QIV与TIV比较,合并的TINB为308(95%CI=303～313);在剔除权重系数较小的1个研究后合并的TINB为307(95%CI=302～313),剔除前后研究的合并效益值比较接近,纳入的文献结果较为可靠。发表偏倚结果显示本研究所纳入文献可能存在发表偏倚,但因纳入的文献较少,发表偏倚的检验仍需作进一步研究。结论接种QIV与TIV相比更具有成本效益。

Objective To analyze the cost-effectiveness of mass vaccination of quadrivalent influenza vaccine(QIV compared with that of trivalent influenza vaccine(TIV) using incremental net benefit(INB) method newly developed.Methods We searched four databases(PubMed, Web of science, Chinese National Knowledge Infrastructure [CNKI], and Wanfang Data Knowledge Service Platform) for literatures on cost-effectiveness analysis of quadrivalent influenza vaccine versus trivalent influenza vaccine published from January 1998 to August 7 th, 2018. We then conducted a meta-analysis using Stata/SE version 12.0 to estimate total incremental net benefit(TINB) of the QIV and TIV vaccination in targeted population. Results Totally 5 researches involving 96 727 891 participants were included in this study. The meta-analysis resulted in a combined TINB value of 308(95% confidence interval [95% CI]: 303 – 313) for all the QIV and TIV vaccinations under the assessment. After subtracting a research with small coefficient,the TINB of the researches was 307(95% CI: 302 – 313) and very similar to that before the subgroup analysis, suggesting that a reliable result of the study.Publication bias may be resulted from the study due to the limitation in the number of literatures included in the study.Conclusion The mass vaccination of quadrivalent influenza vaccine is more cost-effective compared with that of trivalent influenza vaccine.