应用决策树-Markov模型分析b型流感嗜血杆菌疫苗纳入国家免疫规划的成本效益

Cost-benefit analysis of introducing Haemophilus influenzae type b vaccine into the National Immunization Program in China using a decision tree-Markov cohort model

目的分析b型流感嗜血杆菌(Hib)疫苗纳入国家免疫规划(NIP)的成本效益。方法从文献和相关部门收集模型参数,从全社会角度构建决策树-Markov模型,计算Hib疫苗未纳入和纳入NIP中国2017年出生儿童的Hib疫苗接种成本、Hib相关疾病经济负担,分析Hib疫苗纳入NIP的效益成本比(BCR),并进行模型的单因素敏感性分析。结果Hib疫苗未纳入和纳入NIP中国2017年出生儿童的Hib疫苗接种成本分别为281925万元和989836万元,Hib相关疾病的经济负担分别为93993万元、10559万元;Hib疫苗纳入NIP产生的净效益为-445788万元,BCR为0.59。当纳入NIP的每剂次Hib疫苗价格从当前的平均价格79元降至<53元时,BCR>1。结论Hib疫苗按当前平均价格纳入NIP不节约社会成本;Hib疫苗纳入NIP需降低疫苗成本。

Objective To analyze costs and benefits of introducing Haemophilus influenzae type b(Hib) vaccine into the National Immunization Program(NIP).Methods We obtained model parameters from the scientific literature and relevant departments and built a decision tree-Markov model that used the perspective of the whole society.We calculated vaccination costs and the economic burden of Hib-related diseases among children born in 2017 in China for introducing and for not introducing Hib vaccine into NIP.We determined the benefit-cost ratio(BCR) and conducted one-way sensitivity analyses.Results Vaccination costs for the 2017 birth cohort were 2 819.25 and 9 898.36 million yuan for not introducing and for introducing Hib vaccine into NIP,with economic burdens of Hib-related diseases being 939.93 and 105.59 million yuan,respectively.The net benefit for introducing Hib vaccine into NIP was-4 457.88 million yuan,yielding a BCR of 0.59.The BCR would be greater than 1 if the average Hib vaccine price per dose for introduction decreased from the current 79 yuan to less than 53 yuan.Conclusion The introduction of Hib vaccine into NIP was not cost saving for society at the current average vaccine price.We should reduce the Hib vaccine costs if introducing the vaccine into NIP.