5岁以下儿童国产口服轮状病毒疫苗与免疫规划疫苗同时接种的卫生经济学评价

Health economics evaluation of co-administration of oral rotavirus vaccine in children under 5 years old in China

目的 分析国产口服轮状病毒疫苗(oral rotavirus vaccine, ORV)与免疫规划疫苗同时接种策略的成本效果和成本效用。方法 建立决策树-马尔可夫模型,模拟10万名新生儿出生队列,评估0~<5岁儿童ORV与免疫规划疫苗同时接种以及ORV单独接种策略的成本效果和成本效用,并对模型进行敏感性分析。本研究假设同时接种策略下ORV全剂接种率为46%和91%。由于无细胞百白破联合疫苗(diphtheria, tetanus and acellular pertussis combined vaccine, DTaP)的全剂接种率>90%,随着同时接种策略的实施,ORV的接种率可能会逐渐接近DTaP的接种率,故取中间值和最大值。结果 实施ORV与免疫规划疫苗同时接种策略,全剂接种率达到46%,减少1例轮状病毒胃肠炎(rotavirus gastroenteritis, RVGE)病例所花费的成本、减少1例RVGE死亡花费的成本、增量成本效用比(incremental cost-utility ratio, ICUR)分别为1 856.4元、339.5万元、6 401.7元/质量调整寿命年(quality-adjusted life year, QALY);全剂接种率达到91%,减少1例RVGE病例所花费的成本、减少1例RVGE死亡花费的成本、ICUR分别为1 398.2元、255.9万元、5 044.6元/QALY。敏感性分析显示,ORV同时接种策略对增加QALY有良好的成本效用。结论 实施ORV与免疫规划疫苗同时接种策略在儿童中有良好的成本效果和成本效用。

Objective To analyze the cost-effectiveness and cost-utility of the strategy of co-administration of oral rotavirus vaccine(ORV)and immunizing vaccines.Methods A decision tree-Markov model was developed to evaluate 100000 newborns to assess the cost-effectiveness and cos-utility of co-administration of ORV versus the single administration of ORV at the age of 0-5years.And the sensitivity analysis of the model was carried out.According to the hypothesis of study,the ORV full-dose rate under the strategy of co-administration would be 46%and 91%.Since the full vaccination rate of diphtheria,tetanus and acellular pertussis combined vaccine(DTaP)vaccine was more than 90%,which was much higher than that of ORV,with the implementation of the strategy of co-administration,the vaccination rate of ORV might gradually approach the vaccination rate of DTaP vaccine,so the median and maximum values are taken.Results When the strategy of co-administration of ORV and DTaP combined vaccine was implemented and the coverage rate of full dose reached 46%,the cost of reducing 1 RVGE case,the cost of reducing 1 RVGE death,and the incremental cost-utility ratio(ICUR)were 1856.4 yuan,3.395 million yuan and 6401.7 yuan per quality-adjusted life year(QALY),respectively.When the coverage rate of full dose reached 91%,the cost of reducing 1 RVGE case,the cost of reducing 1 RVGE death,and the ICUR were 1398.2 yuan,2.559 million yuan,and 5044.6 yuan per QALY,respectively.Sensitivity analysis showed that the co-administration vaccine strategy of ORV had good cost-utility in increasing QALY.Conclusions Implementing the strategy of co-administration of ORV and immunizing vaccines have good cost-effectiveness and cost-utility in children.