ワクチン接種の費用対効果/米国での試算

今回の日本でのはしか流行をみてもその影響は相当甚大である。保健所でいつでもワクチン接種ができるような体制が望まれる。
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こどもへのワクチン接種の費用対効果/米国での試算
DTaP(ジフテリア・破傷風・百日咳 三種混合)およびDT(ジフテリア・破傷風)、Hib(インフルエンザ桿菌タイプBワクチン)、IPV(ポリオ不活化ワクチン)、MMR(麻疹・おたふく・風疹 三種混合)、HepB(B型肝炎)、Varicella (水痘) これら小児への7種のワクチンの費用対効果を試算すると、直接および間接的社会的なコストとしてそれぞれ990万ドル・4330万ドル相当の削減効果がある。 効果/費用比は、それぞれ 5.3と 16.5という大きな値となる。米国の医療費は高いので日本ではここまでの効果はないかもしれないが...
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Economic Evaluation of the 7-Vaccine Routine Childhood Immunization Schedule in the United States, 2001
http://archpedi.ama-assn.org/cgi/content/short/159/12/1136
Fangjun Zhou, PhD; Jeanne Santoli, MD, MPH; Mark L. Messonnier, PhD; Hussain R. Yusuf, MBBS, MPH; Abigail Shefer, MD; Susan Y. Chu, PhD, MSPH; Lance Rodewald, MD; Rafael Harpaz, MD, MPH
Arch Pediatr Adolesc Med. 2005;159:1136-1144.
Objective To evaluate the economic impact of the routine US childhood immunization schedule: diphtheria and tetanus toxoids and acellular pertussis; tetanus and diphtheria toxoids; Haemophilus influenzae type b conjugate; inactivated poliovirus; measles, mumps, and rubella; hepatitis B; and varicella vaccines.
Design Decision tree–based analysis was conducted using population-based vaccination coverage, published vaccine efficacies, historical data on disease incidence before vaccination, and disease incidence reported for 1995-2001. Costs were estimated using the direct cost and societal (direct and indirect costs) perspectives. Program costs included vaccine, administration, vaccine-associated adverse events, and parent travel and time lost. All costs were inflated to 2001 US dollars, and all costs and benefits in the future were discounted at a 3% annual rate.
Participants A hypothetical 2001 US birth cohort of 3 803 295 infants was followed up from birth through death.
Main Outcome Measures Net present value (net savings) and benefit-cost ratios of routine immunization.
Results Routine childhood immunization with the 7 vaccines was cost saving from the direct cost and societal perspectives, with net savings of $9.9 billion and $43.3 billion, respectively. Without routine vaccination, direct and societal costs of diphtheria, tetanus, pertussis, H influenzae type b, poliomyelitis, measles, mumps, rubella, congenital rubella syndrome, hepatitis B, and varicella would be $12.3 billion and $46.6 billion, respectively. Direct and societal costs for the vaccination program were an estimated $2.3 billion and $2.8 billion, respectively. Direct and societal benefit-cost ratios for routine childhood vaccination were 5.3 and 16.5, respectively.
Conclusion Regardless of the perspective, the current routine childhood immunization schedule results in substantial cost savings.
Author Affiliations: National Immunization Program, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, Ga. Dr Yusuf is now with UNICEF, New Delhi, India.

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