中国糖尿病患者免费接种流感疫苗的成本效果分析

Cost-effectiveness of potential government fully-funded influenza vaccination in population with diabetes in China

目的分析我国为糖尿病患者提供免费流感疫苗接种的成本效果。方法基于我国流感发病、住院和死亡负担、流感患者健康相关生命质量和经济负担、糖尿病患病情况、人口学特征、人群就医行为、疫苗接种率、疫苗效力等公开发表数据,构建决策树模型,测量与当前自费接种相比,为糖尿病患者提供免费流感疫苗接种对流感相关发病、住院和超额死亡,以及质量调整寿命年(QALY)的影响;并从全社会角度估计免费接种策略的增量成本效果比(ICER)。分析时间框为1年,所有成本均采用居民消费指数调整到2016年的价值(人民币),结果数据均采用M(P25,P75)表示。结果为糖尿病患者提供免费流感疫苗接种,当接种率达到40%时,疫苗接种成本为17.1亿元(16.7亿元,17.5亿元)。与自费接种相比(假设接种率为0),流感相关流感样病例(ILI)门急诊例数减少11.0万(8.1万,14.3万),流感相关严重急性呼吸道感染住院例数减少3.6万(2.8万,4.4万),流感相关呼吸道和心血管疾病超额死亡例数减少1.2万(0.9万,1.6万),避免10.8万(8.2万,14.2万)QALY损失,ICER为10088元/QALY(7365元/QALY,14046元/QALY)。当支付意愿阈值采用我国2016年人均国内生产总值53680元时,为糖尿病患者提供免费流感疫苗接种具有成本效果的概率为99.1%。结论为糖尿病患者提供免费流感疫苗接种具有成本效果,建议将其作为糖尿病综合管理的重点。

Objective To evaluate the cost-effectiveness of potential government fully-funded influenza vaccination for diabetics in our country.Methods From the societal perspective,a decision tree model was developed to compare outcomes(including impact on the influenza-related outpatient consultation,hospitalization and excess mortality,and quality-adjusted life years(QALY),as well as incremental cost-effectiveness ratio(ICER))of a national fully-funded vaccination programme in the population with diabetes and status quo(i.e.,vaccinated with out-of-pocket payment,with a uptake rate of zero),using the published data with regarding to influenza related ILI(influenza-like illness)consultation rate,hospitalization rate and excess mortality rate,health-related quality of life and economic burden,diabetes prevalence,population size,health seeking behaviour,vaccine uptake rate,vaccine efficacy/effectiveness,etc.A time horizon of 1 year was used in the present analysis,and all costs were expressed in CNY in 2016 using the consumer price index.All results are presented in M(P25,P75).Results In the scenario of 40%vaccination coverage in the population with diabetes,government fully-funded vaccination programme was estimated to cost 1.71(1.67,1.75)billions CNY,and expected to prevent 110000(81000,143000)influenza-related ILI consultations,36000(28000,44000)influenza-related SARI hospitalizations and 12000(9000,16000)influenza-related deaths due to respiratory and cardiovascular diseases.A total of 108000(82000,142000)QALY were estimated to be gained.The ICER was 10088(7365,14046)CNY per QALY gained.The probability of cost-effectiveness of the fully-funded vaccination programme was 99.1%at a threshold of 53680 CNY per QALY gained(GDP per capita in 2016).Conclusion Government fully-funded influenza vaccination in population with diabetes is cost-effective,and thus is recommended as the key strategy of diabetes prevention and control.