5岁以下婴幼儿接种5价轮状病毒疫苗的卫生经济学评价(基于决策树-马尔可夫模型)

Health economic evaluation for pentavalent rotavirus vaccine among children under 5 years old based on decision tree Markov model

目的从全社会角度评价5岁以下婴幼儿人群接种5价轮状病毒疫苗相比不接种疫苗的成本收益。方法构建决策树-马尔可夫模型,以接种5价轮状病毒疫苗为研究策略,不接种为对照策略,模拟1000000名5岁以下婴幼儿人群队列,评估接种5价轮状病毒疫苗相较于不接种的成本-效果、成本-效益、成本-效用,使用伤残调整寿命年(disability adjusted life year,DALY)作为效用指标,并通过敏感性分析评价模型拟合结果的稳定性。结果模型拟合结果显示,与不接种5价轮状病毒疫苗相比,接种疫苗5年减少22826例轮状病毒感染病例、14618例门诊病例、5243例住院以及1066例死亡病例,成本-效果比为17329.36;成本-效益比为1∶3.59;接种疫苗的成本-效用比为799.54元/DALY,不接种疫苗的成本-效用比为1018.73元/DALY,增量成本-效用比为23201.05元/DALY。单因素敏感性分析显示,5岁以下婴幼儿轮状病毒感染率、5价疫苗保护率和疫苗价格对模型拟合结果影响较大。概率敏感性分析结果显示,接种疫苗是绝对优势策略。结论在5岁以下婴幼儿人群中开展5价轮状病毒疫苗接种具有较好的成本收益,值得推广。

Objective To assess the cost-effectiveness of vaccinating children under 5 years old with pentavalent rotavirus vaccine compared to non-vaccination from a societal perspective.Methods A decision tree Markov model was constructed using vaccination with pentavalent rotavirus vaccine as the intervention strategy and non-vaccination as the control strategy.A sample of hypothetical 1000000 children under 5 years old was used to evaluate the cost-effectiveness,cost-benefit,and cost-utility of vaccination with pentavalent rotavirus vaccine compared to non-vaccination.Disability-adjusted life year(DALY)was used as the utility measure,and sensitivity analysis was conducted to assess the stability of the model fitting results.Results Model fitting results showed that vaccination with the pentavalent rotavirus vaccine resulted in a reduction of 22826 cases of rotavirus infection,14618 outpatient cases,5243 hospitalizations,and 1066 deaths over 5 years comparing to non-vaccination.The cost-effectiveness ratio was 17329.36,the cost-benefit ratio was 1∶3.59,and the cost-utility ratio for vaccination was 799.54 RMB per DALY,while the cost-utility ratio for non-vaccination was 1018.73 RMB per DALY.The incremental cost-effectiveness ratio was 23201.05 RMB per DALY.Univariate sensitivity analysis indicated that the rate of rotavirus infection among children under 5 years old,the protective efficacy of pentavalent rotavirus vaccine,and vaccine price had a significant impact on the model fitting results.Probabilistic sensitivity analysis showed that vaccination with the pentavalent rotavirus vaccine was an economically dominant strategy.Conclusions Implementing pentavalent rotavirus vaccine vaccination in children under 5 years old demonstrates favorable cost-effectiveness and is worthy of promotion.