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J Zhejiang Univ (Med Sci)  2018, Vol. 47 Issue (4): 374-380    DOI: 10.3785/j.issn.1008-9292.2018.08.08
    
Economic evaluation of different chickenpox vaccination strategies
DENG Xuan(),HE Hanqing*(),ZHOU Yang,PAN Jinren,YAN Rui,TANG Xuewen,FU Jian
Department of Immunization Program, Zhejiang Provincial Center for Diseases Control and Prevention, Hangzhou 310051, China
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Abstract  

Objective: To evaluate the cost/benefit of different vaccination strategies related to chickenpox vaccine. Methods: The direct economic cost and indirect economic cost caused by chickenpox were obtained through questionnaire survey. The epidemic characteristics of chickenpox in Zhejiang province were studied by literature review. Dynamic model was set up by Matlab software based on the parameters of chickenpox, to predict the incidence trends of chickenpox with different immunization strategies (no vaccination, 1-dose vaccination, 2-dose vaccination) in future 40 years (2017-2056). A cost-benefit analysis was conducted, and the sensitivities of the main parameters were analyzed. Results: Through the questionnaire survey of 105 cases, the direct and indirect economic cost per case was 506.84 Yuan and 1045.39 Yuan respectively, with the total of 1552.23 Yuan. During the prediction period (40 years), there would be 7.0908 million cases in strategy 2, which was 59.71% less than strategy 1 (17.5989 million cases). Total vaccination costs in strategy 2 were 2.366 billion Yuan, with a total economic gain of 33.741 billion Yuan and benefit/cost ratio (BCR) of 14.26:1. If strategy 3 was adopted, 2.7249 million chickenpox cases would occur, with a decrease of 84.52% compared with strategy 1. Total vaccination costs in strategy 3 was 4.495 billion Yuan, with a total economic gain of 44.309 billion Yuan and BCR of 9.86:1. Analysis showed that the vaccine price was the most sensitive variable, followed by the incidence of chickenpox in the absence of vaccine. Conclusions: In Zhejiang province, one-dose strategy and two-dose strategy were both cost effective. It is suggested that the chickenpox vaccination should be included in the immunization program in Zhejiang province.



Key wordsCommunicable diseases      Kinetics      Chickenpox vaccine      Vaccination/economics      Sensitivity and specificity      Treatment outcome      Cost-benefit analysis      Immunization programs     
Received: 25 February 2018      Published: 04 December 2018
CLC:  R186  
  F06  
Corresponding Authors: HE Hanqing     E-mail: xdeng@cdc.zj.cn;hanqinghe@cdc.zj.cn
Cite this article:

DENG Xuan,HE Hanqing,ZHOU Yang,PAN Jinren,YAN Rui,TANG Xuewen,FU Jian. Economic evaluation of different chickenpox vaccination strategies. J Zhejiang Univ (Med Sci), 2018, 47(4): 374-380.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2018.08.08     OR     http://www.zjujournals.com/med/Y2018/V47/I4/374


水痘疫苗不同免疫策略的卫生经济学评价

目的: 比较水痘疫苗不同免疫策略的成本和效益。方法: 通过问卷调查的形式获取浙江省因罹患水痘导致的直接和间接经济负担;结合浙江省水痘流行特征数据,应用Matlab软件建立浙江省水痘传播动力学模型,预测从2017年开始后续40年(2017-2056年)采用水痘疫苗不同免疫策略(不接种疫苗、接种一剂、接种两剂)时水痘病例发生情况;以不接种疫苗策略为对照,计算效益-成本比,并对设定的主要参数进行敏感性分析。结果: 完成浙江省105例水痘病例调查,人均直接和间接经济负担分别为506.84元和1045.39元,合计1552.23元。40年间,接种一剂疫苗累计发生709.08万例水痘病例,比不接种疫苗(1759.89万例)减少了59.71%;疫苗接种费用总投入为23.66亿元,所获得的总收益为337.41亿元,效益-成本比为14.26:1。若接种两剂疫苗,40年累计发生272.49万例水痘病例,比不接种疫苗减少了84.52%;总投入和总收益分别为44.95亿元和443.09亿元,效益-成本比为9.86:1。敏感性分析结果显示,无论接种一剂还是接种两剂,疫苗价格均最为敏感,其次为无疫苗状态下的水痘发病率。结论: 浙江省将水痘疫苗纳入免疫规划符合经济性原则,建议将接种一剂甚至两剂全程纳入免疫规划。


关键词: 传染病,  动力学,  水痘疫苗,  接种/经济学,  敏感性与特异性,  治疗结果,  费用效益分析,  免疫接种规划 
Fig 1 The infection process by vaccine or naturally
参数 赋值 数据来源
浙江省2007—2016年每年总人口数(N) 按实际数据取值 人口基本信息系统
浙江省2016年人均年收入(元) 48 145 浙江省统计年鉴
浙江省2016年疫苗接种成本(含人力,元) 19.55 文献[12]
自然死亡率(d) 0.0065 浙江人口数据拟合
自然出生率(b) 0.01 浙江人口数据拟合
第一剂水痘疫苗接种率(p1, %) 90 文献[15]
第二剂水痘疫苗接种率(p2, %) 90 假设,敏感性分析
疫苗保护率(%) 80 文献[5-7]
水痘自然发病率(基准值) 800/105 文献[5, 7, 9]
疫苗价格(基准值,元) 50.00 考虑纳入扩大免疫规划,假设
疫苗损耗系数 1.02 根据实际工作经验
水痘基本再生病例数(R0,基准值) 15.6 数据拟合估算
自然感染病例潜伏期(d) 14 文献[10]
自然感染病例传染期(d) 7 文献[10]
突破病例潜伏期(d) 14 文献[10]
突破病例传染期(d) 4.5 文献[10]
感染率(β) 73 数据拟合估算
因水痘死亡率(α) 0.0001 文献[10]
进入潜伏期的速率(ε) 30/14 文献[10]
未接种疫苗的恢复速率(γ) 30/7 文献[10]
接种疫苗后的恢复速率(γV) 30/4.5 文献[10]
抗体衰减速率(k) 30/7300 文献[10]
贴现率(%) 3 文献[10]
Tab 1 Parameter assignment and the source in model construction
(元)
病例分类 n 直接经济负担 间接经济负担 总经济负担
*总病例数.
一剂突破
  门诊病例 43 249.59 919.55 1169.14
  住院病例 2 2450.00 400.00 2850.00
二剂突破
  门诊病例 12 239.88 691.80 931.68
  住院病例 0 0.00 0.00 0.00
自然感染病例
  门诊病例 40 199.09 1173.05 1372.14
  住院病例 8 2794.12 1482.44 4276.56
均值 105* 506.84 1045.39 1552.23
Tab 2 Per capita disease burden of break-through cases and natural infected cases of chickenpox in Zhejiang province
病例分类 2016年人均疾病负担(元)不接种疫苗接种一剂疫苗接种两剂疫苗
总病例数
(万例)
总疾病负担
(亿元)
总病例数
(万例)
总疾病负担
(亿元)
总干预成本
(亿元)
总病例数(万例) 总疾病负担(亿元) 总干预成本(亿元)
“—”无相关数据.
突破病例
  门诊病例 1169.14 616.16 141.43 233.15 50.59
  住院病例 2850.00 6.77 3.79
自然感染病例
  门诊病例 1372.14 1690.42 450.13 82.75 22.29 37.79 12.50
  住院病例 4276.56 69.47 57.65 3.40 2.86 1.55 1.60
合计 1759.89 507.78 709.08 170.37 23.66 272.49 64.69 44.95
Tab 3 Costs and burden of different vaccination strategies against chickenpox
指标 直接经济负担的BCR 总经济负担的BCR
一剂 两剂 一剂 两剂
“—”无相关数据;*基准值.BCR:效益-成本比.
无疫苗状态下水痘发病率
  400/10万 1.78 0.94 8.75 4.62
  600/10万 3.18 1.67 15.67 8.25
  800/10万* 2.72 1.94 14.26 9.86
  1000/10万 1.86 1.44 10.90 8.27
第二剂接种率
  99% 2.12 10.60
  90%* 1.94 9.86
  80% 1.95 9.92
  70% 1.96 9.96
疫苗价格(元)
  50.0 3.84 2.73 20.12 13.91
  70.5* 2.72 1.94 14.26 9.86
  100.0 1.92 1.37 10.06 6.95
  120.0 1.60 1.14 8.38 5.80
  150.0 1.28 0.91 6.71 4.64
  180.0 1.07 0.76 5.59 3.86
贴现率
  0% 2.78 2.02 14.53 10.24
  3%* 2.72 1.94 14.26 9.86
  5% 2.69 1.88 14.12 9.59
  8% 2.67 1.79 13.97 9.21
Tab 4 Sensitivity analysis of main parameters in the model
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