应用决策树马尔科夫模型分析江苏省孕妇接种季节性流感疫苗的成本效用

Cost-utility analysis of seasonal influenza vaccination of pregnant women in Jiangsu province:a decision-tree Markov model

目的 评价江苏省孕妇免费接种季节性流感疫苗(Seasonal influenza vaccine, SIV)的成本效用。方法 从社会角度构建决策树马尔科夫模型,估算孕妇免费和自费接种SIV策略的成本和质量调整生命年(Quality-adjusted life years, QALY),以及增量成本效用比(Incremental cost-utility ratio, ICUR)和净货币效益(Net monetary benefit, NMB),对模型参数进行敏感性分析。结果 在假设的江苏省10万名孕妇人群中,孕妇免费接种SIV策略与自费接种策略相比在1年内可减少3 145人次流感感染,节约成本1 412 233.2元,多获得14.7个QALY,人均NMB为35.4元。单因素敏感性分析显示所有模型参数在设定的调整范围内均能获得NMB,其中流感感染率和SIV保护效果的敏感性高。当支付意愿阈值为2022年江苏省人均国内生产总值(144 390元)时,概率敏感性分析显示免费接种策略具有成本效用的概率为100%。结论 从社会角度看江苏省孕妇免费接种SIV具有较高的成本效用。

Objective To evaluate the cost-utility of providing seasonal influenza vaccine(SIV)at no cost to pregnant women in Jiangsu province.Methods We constructed a decision-tree Markov model to estimate costs and quality-adjusted life years(QALYs)of free compared with self-paid SIV vaccination strategies for pregnant women from a societal perspective,and calculated the incremental cost-utility ratios(ICUR)and net monetary benefits(NMB).We conducted sensitivity analyses of model parameters.Results Compared with a self-paid SIV vaccination strategy,a free vaccination strategy would reduce by 3145 times influenza infections in a hypothetical population of 100000 pregnant women within one year,saving 1412233.2 yuan and obtaining 14.7 QALY benefit with an NMB of 35.4 yuan per pregnant woman.Univariate sensitivity analyses showed that all model parameters could obtain NMB within the range of values tested.The most sensitive parameters were the influenza infection rate and the protective effectiveness of SIV in pregnant women.When using the Jiangsu province’s gross domestic product per capita in 2022(144390 yuan)as the willingness to pay threshold,probability sensitivity analyses showed that the probability of favorable cost-utility with the free vaccination strategy would be 100%.Conclusions A free SIV vaccination strategy for Jiangsu pregnant women has a high cost-utility from a societal perspective.