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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

王睿, 孙芯蕊, 杨帆, 王齐, 王雷, 魏晟. 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[J]. 中华疾病控制杂志, 2024, 28(8): 976-981. doi: 10.16462/j.cnki.zhjbkz.2024.08.017
引用本文: 王睿, 孙芯蕊, 杨帆, 王齐, 王雷, 魏晟. 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[J]. 中华疾病控制杂志, 2024, 28(8): 976-981. doi: 10.16462/j.cnki.zhjbkz.2024.08.017
WANG Rui, SUN Xinrui, YANG Fan, WANG Qi, WANG Lei, WEI Sheng. Health economics evaluation of co-administration of oral rotavirus vaccine in children under 5 years old in China[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2024, 28(8): 976-981. doi: 10.16462/j.cnki.zhjbkz.2024.08.017
Citation: WANG Rui, SUN Xinrui, YANG Fan, WANG Qi, WANG Lei, WEI Sheng. Health economics evaluation of co-administration of oral rotavirus vaccine in children under 5 years old in China[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2024, 28(8): 976-981. 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
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

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

Funds: 

National Key Research and Development Program of China 2022YFC2305103

More Information
  • 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。
  • 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.

    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.
    下载: 导出CSV

    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.
    下载: 导出CSV
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  • 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

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