A cost-effectiveness analysis of revaccination and catch-up strategies with the 23-valent pneumococcal polysaccharide vaccine (PPV23) in older adults in Japan

Objective: In Japan, the National Immunization Program (NIP) includes PPV23 as the primary vaccination for adults and catch-up cohorts. The Japanese Association for Infectious Diseases recommends revaccination for older adults who received primary vaccination ≥5 years earlier. The cost-effectiveness of adding revaccination and/or continuing catch-up vaccination in the NIP was evaluated from the public payer perspective in Japan.

Methods: The Markov model included five health states: no pneumococcal disease, invasive pneumococcal diseases (IPD), non-bacteremic pneumococcal pneumonia (NBPP), post-meningitis sequelae, and death. Cohorts of adults aged 65–95 were followed until age 100 or death: 2014 cohort (aged 65–95, vaccinated: 2014); 2019 cohort (aged 65: 2019); and 2019 catch-up cohort (aged 70–100: 2019, unvaccinated: 2014). Strategies included: (1) vaccinate 2014 and 2019 cohorts; (2) vaccinate 2014 and 2019 cohorts and revaccinate both; (3) strategy 1 and vaccinate 2019 catch-up cohort; (4) strategy 2 and vaccinate 2019 catch-up cohort; and (5) strategy 4 and revaccinate 2019 catch-up cohort. Parameters were retrieved from global and Japanese sources, costs and QALYs discounted at 2%, and incremental cost-effectiveness ratios (ICERs) estimated.

Results: Strategy 1 had the highest number of IPD and NBPP cases, and strategy 5 the lowest. Strategies 3–5 dominated strategy 1 and strategy 2 was cost-effective compared to strategy 1 (ICER: ¥1,622,153 per QALY gained). At a willingness-to-pay threshold of ¥5 million per QALY gained, strategy 2 was cost-effective and strategies 3–5 were cost-saving compared to strategy 1.

Conclusions: Strategies including revaccination, catch-up, or both were cost-effective or cost-saving in comparison to no revaccination and no catch-up. Results can inform future vaccine policies and programs in Japan.     

疫苗药物经济学评价中有关成本和效果的测算方法探讨

与一般药物相比,疫苗具有外部性、保护率和作用时间不确定等特性,因此疫苗的经济学评价应当有其特殊性.本文回顾了近十几年世界有关疫苗经济学评价的研究报道,综合概括了疫苗经济学评价方法的最新进展.本文讨论的主要内容包括间接成本法、边际成本法、选择合适流行病学模型测量健康结果、成本和效果的贴现等.     

北京疫苗领域产业技术路线图研究

疫苗产业是北京未来高精尖产业体系的重要部分。为预判疫苗产业未来发展趋势,厘清北京疫苗产业未来发展的重要影响因素,论文构建了纵向包括关键技术、重点产品、市场环境、政策环境、交叉科学与技术共5个层面,横向面向未来10年的分析框架,研判北京疫苗产业未来发展趋势与发展路径,并绘制出北京疫苗领域产业技术路线图。研究发现北京疫苗领域总体技术水平基础较好,部分子领域与国际比肩,但仍面临部分关键核心技术与国际水平差距较大、原材料及高端设备“卡脖子”等问题。论文从加强基础研究、推进关键核心技术攻关、加强政策扶持与优惠政策落实、优化创新生态环境、推进国际化发展战略等方面,为北京未来疫苗产业高质量创新发展提出政策建议。     

评价疫苗产品对成本-效果的长期影响的必要性探讨——基于儿童七价肺炎结合疫苗的经济性评价

目的从长期研究视角出发,对将七价肺炎链球菌结合疫苗纳入免疫规划方案开展经济学分析,探讨对疫苗产品开展成本-效果分析时进行长期评价的重要性。方法从支付方的研究角度,构建Markov模型,结合北京市的成本数据和我国台湾地区健保局的流行病学数据,模拟在北京市将PCV7纳入免疫规划方案,实施10年后的成本效果进行研究。结果经过成本-效果分析得出,免疫规划方案实施10年期间,在北京市共避免6390人死亡、获得6393个QALYs,其中以2岁以下儿童和65岁以上老人受到的保护效果最显著。而且从长远来看,对全人群而言,方案实施10年使得总成本可节约7.14元/人。结论在进行疫苗类产品成本-效果分析时,关注其对成本、效果长期影响至关重要。     

Health and economic impact of PHiD-CV in Canada and the UK: a Markov modelling exercise

Abstract

Objective:

The spectrum of diseases caused by Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) represents a large burden on healthcare systems around the world. Meningitis, bacteraemia, community-acquired pneumonia (CAP), and acute otitis media (AOM) are vaccine-preventable infectious diseases that can have severe consequences. The health economic model presented here is intended to estimate the clinical and economic impact of vaccinating birth cohorts in Canada and the UK with the 10-valent, pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) compared with the newly licensed 13-valent pneumococcal conjugate vaccine (PCV-13).

Methods:

The model described herein is a Markov cohort model built to simulate the epidemiological burden of pneumococcal- and NTHi-related diseases within birth cohorts in the UK and Canada. Base-case assumptions include estimates of vaccine efficacy and NTHi infection rates that are based on published literature.

Results:

The model predicts that the two vaccines will provide a broadly similar impact on all-cause invasive disease and CAP under base-case assumptions. However, PHiD-CV is expected to provide a substantially greater reduction in AOM compared with PCV-13, offering additional savings of Canadian $9.0 million and £4.9 million in discounted direct medical costs in Canada and the UK, respectively.

Limitations:

The main limitations of the study are the difficulties in modelling indirect vaccine effects (herd effect and serotype replacement), the absence of PHiD-CV- and PCV-13-specific efficacy data and a lack of comprehensive NTHi surveillance data. Additional limitations relate to the fact that the transmission dynamics of pneumococcal serotypes have not been modelled, nor has antibiotic resistance been accounted for in this paper.

Conclusion:

This cost-effectiveness analysis suggests that, in Canada and the UK, PHiD-CV’s potential to protect against NTHi infections could provide a greater impact on overall disease burden than the additional serotypes contained in PCV-13.     

Immunization in Developing Countries: Its Political and Organizational Determinants

The factors that most affect immunization coverage involve the global policy environment and contact with international agencies. Except in very poor countries, democracies have lower coverage rates than autocracies. The quality of a country’s institutions and its level of development are also strongly related to immunization rate coverage and vaccine adoption. There is no evidence that disease outbreaks or polio eradication campaigns affect immunization rates. In the current structure of immunization programs, coverage rates respond more to supply-side than demand effects.     

Trust and affect: how do they impact risk information seeking in a health context?

This study examines college students’ intention to seek information about the H1N1 flu vaccine. We specifically focused on the relationship between trust and affect and whether they work together to influence risk information seeking. Results indicated that positive affect moderated the relationship between trust and information seeking, but negative affect did not. While both positive affect and negative affect influenced risk information seeking, when combined with trust, only positive affect remained as a significant predictor. These results suggest that by understanding the role that trust and affect play, medical professionals and disease control agencies can tailor their communication efforts to increase an individual’s intention to seek information about preventive measures. Specifically, maintaining the public’s trust and positive feelings toward these entities is key to successful communication about prevention measures such as vaccination.     

核酸疫苗在疾病防治中的应用

传统疫苗大多是激发机体的体液免疫，很难启动细胞免疫。而核酸疫苗将外源基因与真核质粒重组后直接导入细胞内，使外源基因在宿主细胞内表达合成保护性抗原蛋白。这与病毒的自然感染十分相似，即能产生细胞免疫，又能产生体液免疫。核酸疫苗具有的优点使其在疾病的预防和治疗方面备受关注。该文就核酸疫苗的免疫机理、优点、存在的问题、以及目前的研究进展状况作一综述。     

The cost effectiveness of a quadrivalent human papillomavirus vaccine (6/11/16/18) in Hungary

Abstract

Objective: A transmission dynamic model was used to assess the epidemiological and economic impact of a quadrivalent human papillomavirus (HPV) (6/11/16/18) vaccine in preventing cervical cancer, cervical intraepithelial neoplasia grades 2 and 3 (CIN 2/3), CIN 1 and genital warts in Hungary.

Methods: The routine vaccination of 12-year-old girls and the routine vaccination of 12-year-old girls plus a temporary catch-up programme for girls and women aged 12–24 years was evaluated.

Results: The model projected that at year 100, both strategies could reduce the incidence of HPV 6/11/16/18-related cervical cancer, CIN 2/3, CIN 1 and genital warts cases among Hungarian women by 90%, 90%, 85% and 93%, respectively. Twenty-five years after the introduction of HPV vaccination in the population, routine vaccination of girls by the age of 12 reduced the cumulative number of cases of cervical cancer, CIN 2/3, CIN 1 and genital warts by 685, 13,473, 3,423 and 163,987, respectively. The incremental cost-effectiveness ratios of the two vaccination strategies were €9,577 and €10,646 per quality-adjusted life-year (QALY) gained over a time horizon of 100 years.

Key limitations: The model did not account for the health and economic impact of other HPV diseases which may result from HPV 16, 18, 6, and 11 infections such as vaginal, vulvar, penile, anal and head-neck cancers, and recurrent respiratory papillomatosis. Epidemiological data from Hungary on these other HPV diseases as well genital warts are needed.

Conclusion: A quadrivalent HPV vaccination programme can reduce the incidence of cervical cancer, CIN and genital warts in Hungary at a cost-per-QALY ratio within the range defined as cost effective.