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

王睿; 孙芯蕊; 杨帆; 王齐; 王雷; 魏晟

doi:10.16462/j.cnki.zhjbkz.2024.08.017

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

doi: 10.16462/j.cnki.zhjbkz.2024.08.017

王睿¹,
孙芯蕊¹,
杨帆¹,
王齐¹,
王雷²,
魏晟^{1, 3, ,}

1.
华中科技大学同济医学院公共卫生学院流行病与卫生统计学系, 武汉 430030
2.
湖北省疾病预防控制中心, 武汉 430079
3.
南方科技大学公共卫生及应急管理学院, 深圳 518055

基金项目:

国家重点研发计划 2022YFC2305103

详细信息

通讯作者:
魏晟，E-mail：weisheng@mails.tjmu.edu.cn

中图分类号: R186
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- 文章访问数: 24
- HTML全文浏览量: 13
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- 被引次数: 0
出版历程
- 收稿日期: 2024-01-11
- 修回日期: 2024-05-15
- 网络出版日期: 2024-09-29
- 刊出日期: 2024-08-10

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

WANG Rui¹,
SUN Xinrui¹,
YANG Fan¹,
WANG Qi¹,
WANG Lei²,
WEI Sheng^{1, 3
, ,}

1.
Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
2.
Hubei Center for Disease Control and Prevention, Wuhan 430079, China
3.
School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen 518055, China

Funds:

National Key Research and Development Program of China 2022YFC2305103

More Information

Corresponding author: WEI Sheng, E-mail: weisheng@mails.tjmu.edu.cn

摘要

摘要: 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。
- 国产口服轮状病毒疫苗 /
- 同时接种 /
- 决策树-马尔可夫模型 /
- 成本效果 /
- 成本效用
Abstract: 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 100 000 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 1 856.4 yuan, 3.395 million yuan and 6 401.7 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 1 398.2 yuan, 2.559 million yuan, and 5 044.6 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.
- Oral rotavirus vaccine /
- Co-administration /
- Decision tree-Markov model /
- Cost-effectiveness /
- Cost-utility

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图 1 儿童ORV疫苗接种策略成本效用决策树-马尔可夫模型的敏感性分析旋风图

ORV，国产口服轮状病毒疫苗；RVGE，轮状病毒胃肠炎；QALY，质量调整寿命年；“―”，无法获取。

Figure 1. Sensitivity analysis tornado chart of the cost-utility decision tree-Markov model for the ORV vaccination strategy for children

ORV: domestically produced oral rotavirus vaccine; RVGE: rotavirus gastroenteritis; QALY: quality-adjusted life year.

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表 1 ORV疫苗同时接种卫生经济学评价的决策树-马尔可夫模型参数

Table 1. Decision tree-Markov model parameters for health economic evaluation of co-administration ORV vaccination

参数 Parameter	基线值 Baseline value	取值范围 Range of value	来源 Source
儿童RVGE发病率Incidence of RVGE in children/%			^[9]
0~＜1岁years	12.102	9.494~15.149
1~＜5岁years	8.214	6.013~10.942
儿童RVGE家庭护理率Home care rate of RVGE in children/%			^[10-11]
0~＜1岁years	0.251 917	0.064917~0.430682
1~＜5岁years	0.251 986	0.064986~0.438986
儿童RVGE就诊率Attendance rate of RVGE in children/%	74.80	56.10~93.50	^[10-11]
门诊/住院比例Ratio of outpatient to hospitalization	10.35		^[12]
儿童RVGE死亡率Mortality rate of RVGE in children/%			^[9]
0~＜1岁years	0.000083	0.000073~0.000096
1~＜5岁years	0.000014	0.000012~0.000016
儿童全因死亡率Child all-cause mortality rate/%			^[13]
0~＜1岁years	0.67589	0.59075~0.77713
1~＜5岁years	0.11493	0.10074~0.13119
RVGE家庭护理QALY QALY for RVGE home care			^[9]
0~4岁years	0.685	0.582~0.788
RVGE门诊QALY QALY for RVGE outpatient			^[9]
0~＜5岁years	0.660	0.561~0.759
RVGE住院QALY QALY for RVGE hospitalization			^[9]
0~＜5岁years	0.591	0.502~0.680
家庭护理费用(元/例) Cost of home care (yuan/case)	74.73	53.62~95.76	^[13]
门诊费用(元/例) Cost of outpatient (yuan/case)			^[13]
直接成本Direct cost	881.01	136.67~1909.28
间接成本Indirect cost	261.72	41.05~482.47
住院费用(元/例) Cost of hospitalization (yuan/case)			^[13]
直接成本Direct cost	3767.71	2205.70~5329.73
间接成本Indirect cost	881.01	600.00~1162.09
过早死亡造成的生产力损失(万元/例) Loss of productivity due to premature mortality (10 000yuan/case)	76.78	57.58~95.98	^[14]
ORV价格(元/剂次) Price of ORV (yuan/dose)	172.00	154.80~189.20	^[15]
疫苗接种间接成本(元/剂次) Indirect cost of vaccination (yuan/dose)	103.42	50.78~186.84	^[16]
疫苗冷链储存费用(元/剂次) Cost of cold chain storage of vaccines (yuan/dose)	25.11	―	^[13]
ORV对RVGE家庭护理的效力Effectiveness of ORV on RVGE home care/%	34.90	5.30~55.30	^[17]
ORV对RVGE门诊就诊的效力Effectiveness of ORV on RVGE outpatient visits/%	34.90	5.30~55.30	^[17]
ORV对RVGE住院的效力Effectiveness of ORV on RVGE hospitalization/%	39.00	5.00~61.00	^[18]
单独接种策略接种1剂ORV的接种率1 dose vaccination rate of ORV in single strategy/%	20.26	18.23~22.29	^[19]
单独接种策略接种2剂ORV的接种率2 dose vaccination rate of ORV in single strategy/%	5.51	4.96~6.06	^[19]
单独接种策略接种3剂ORV的接种率3 dose vaccination rate of ORV in single strategy/%	1.77	1.59~1.95	^[19]
疫苗浪费率Vaccine wastage rate/%	1.00	―	^[13]
同时接种策略接种3剂ORV的接种率3 dose vaccination rate of ORV in co-administration strategy /%	91.05	81.95~91.05	^[20]
同时接种策略接种2剂ORV的接种率2 dose vaccination rate of ORV in co-administration strategy /%	8.39	7.55~8.39	^[20]
同时接种策略接种1剂ORV的接种率1 dose vaccination rate of ORV in co-administration strategy/%	0.13	0.00~0.13	^[20]
注：ORV，国产口服轮状病毒疫苗；RVGE，轮状病毒胃肠炎；QALY，质量调整寿命年；“―”，无法获取。 Note: ORV, domestically produced oral rotavirus vaccine; RVGE, rotavirus gastroenteritis; QALY, quality-adjusted life year；"―"，unavailable.

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表 2 ORV与免疫规划疫苗同时接种相比于单独接种的经济学评价

Table 2. Economic evaluation of co-administration ORV vaccination compared to single administration

项目Item	单独接种 Single strategy	同时接种1 (ORV全剂覆盖率46%) Co-administration 1 (ORV full-dose coverage 46%)		同时接种2 (ORV全剂覆盖率91%) Co-administration 2 (ORV full-dose coverage 91%)
		数值Value	差异Variance	数值Value	差异Variance
效果Effect
总病例数Total cases	35 467	29 980	-5 487	18 993	-16 474
家庭护理病例数Home care cases	8 931	7 561	-1 370	4 816	-4 115
门诊病例数Outpatient cases	24 132	20 431	-3 701	13 013	-11 119
住院病例数Hospitalization cases	2 394	1 981	-413	1 163	-1 231
RVGE死亡例数RVGE deaths	10	7	-3	1	-9
效用Utility
QALY	443 699	445 290	1 591	448 465	4 766
成本Cost/10 000 yuan
总成本Total costs	5 180.3	6 198.9	1 018.6	7 483.7	2 303.4
接种成本Vaccination costs	1 106.0	2 883.9	1 777.9	5 767.8	4 661.8
治疗成本Treatment costs	3 396.4	2 857.2	-539.2	1 780.2	-1 616.2
因RVGE过早死亡的成本Cost of premature deaths due to RVGE	677.8	457.8	-220.0	36.8	-641.0
成本效果Cost-effectiveness
减少1例病例花费的成本Reduction in cost of 1 case /yuan	―	1 856.4	―	1 398.2	―
减少1例RVGE死亡花费的成本Reduction in cost of 1 RVGE death /10 000 yuan	―	339.5	―	255.9	―
成本效用Cost-utility
每增加1 QALY花费的成本Increase in cost of 1 QALY /yuan	―	6 401.7	―	5 044.6	―
注：ORV，国产口服轮状病毒疫苗；RVGE，轮状病毒胃肠炎；QALY，质量调整寿命年；“―”，无法获取。 Note: ORV, domestically produced oral rotavirus vaccine; RVGE, rotavirus gastroenteritis; QALY, quality-adjusted life year; "―"，unavailable.

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