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首页> 美国卫生研究院文献>Human Vaccines Immunotherapeutics >An intervention to improve pneumococcal vaccination uptake in high risk 50-64 year olds vs. expanded age-based recommendations: an exploratory cost-effectiveness analysis
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An intervention to improve pneumococcal vaccination uptake in high risk 50-64 year olds vs. expanded age-based recommendations: an exploratory cost-effectiveness analysis

机译：一项针对50-64岁高危人群提高肺炎球菌疫苗接种率的干预措施与基于年龄的扩大建议相比：一项探索性成本-效果分析

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In the U.S., pneumococcal polysaccharide vaccine (PPSV23) uptake among high-risk adults aged <65 years is consistently low and improvement is needed. One barrier to improved vaccine coverage is the complexity of the adult vaccination schedule. This exploratory analysis compared the cost-effectiveness of strategies to increase pneumococcal vaccine uptake in high-risk adults aged 50–64 years. We used a Markov model to compare strategies for non-immunocompromised 50–64 year olds: 1) current pneumococcal polysaccharide vaccine (PPSV23) recommendations; 2) current recommendations enhanced by an intervention; 3) PPSV23 plus pneumococcal conjugate vaccine (PCV13) for high-risk patients with no intervention; or 4) both vaccines for all 50-year-olds with no intervention. Parameters included CDC data and other US data, varied extensively in sensitivity analyses. In the analysis, vaccinating high-risk individuals with PPSV23/PCV13 was the least costly strategy, with total costs of $424/person. Vaccinating all 50 year olds with PPSV23/PCV13 cost $40 more and gained 0.00068 quality-adjusted life years (QALY), or $57,786/QALY gained. Current recommendations with or without an intervention program were more expensive and less effective than other strategies. In multi-way sensitivity analyses, the current recommendations/intervention program strategy was favored at a $100,000/QALY threshold only if non-bacteremic pneumococcal pneumonia rate or PCV13 serotype coverage were substantially lower than base case values. Thus, an intervention program to improve pneumococcal vaccine uptake among high-risk 50–64 year-olds was not cost-effective in most scenarios. High-risk individuals receiving both PCV13 and PPSV23 could be economically favorable, and vaccinating all 50-year-olds with both vaccines could be considered.
机译：在美国，<65岁的高危成年人的肺炎球菌多糖疫苗（PPSV23）摄入率一直很低，需要改进。提高疫苗覆盖率的一个障碍是成人疫苗接种计划的复杂性。这项探索性分析比较了在50-64岁的高风险成年人中增加肺炎球菌疫苗摄入量的策略的成本效益。我们使用马尔可夫模型比较了50-64岁非免疫功能低下人群的策略：1）当前的肺炎球菌多糖疫苗（PPSV23）建议； 2）通过干预加强当前的建议； 3）PPSV23加肺炎球菌结合疫苗（PCV13）用于高危患者，无需干预；或4）两种疫苗均适用于所有50岁的儿童，无需干预。参数包括CDC数据和其他美国数据，敏感性分析差异很大。在分析中，为高风险个体接种PPSV23 / PCV13是成本最低的策略，总成本为424美元/人。使用PPSV23 / PCV13为所有50岁的儿童接种疫苗的费用增加了40美元，并获得了0.00068质量调整的生命年（QALY），即获得了57,786美元/ QALY。与其他策略相比，当前建议的有或没有干预计划的建议均较昂贵且效果较差。在多向敏感性分析中，仅当非细菌性肺炎球菌性肺炎发生率或PCV13血清型覆盖率显着低于基本病例值时，当前建议/干预计划策略才被推荐在$ 100,000 / QALY阈值。因此，在大多数情况下，一项旨在提高50-64岁高危人群肺炎球菌疫苗摄入量的干预计划并不划算。同时接种PCV13和PPSV23的高危人群在经济上可能是有利的，可以考虑为所有50岁的儿童接种两种疫苗。

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