Abstract：
This study aimed to evaluate the health and economic impact of diphtheria, tetanus, whole-cell pertussis vaccine (DTwP) and diphtheria-tetanus-acellular pertussis vaccine (DTaP) vaccination on pertussis prevention and control in China during the 40 years from 1978 to 2017.
We conducted cost-benefit analyses with a decision tree model populated with historical vaccination coverage levels and pertussis incidence and mortality data from before 1978 and during 1978 to 2017. We modeled 40 birth cohorts from birth until death. Costs and benefits were estimated from direct cost and societal perspectives (direct and indirect costs). Costs and benefits were adjusted to 2017 US dollars (USD), and future values were discounted at a 3% annual rate. We calculated net benefit values (net savings) and benefit-cost ratios of pertussis vaccination of children younger than 5 years. We conducted sensitivity analyses by varying key parameters within plausible ranges.
Without DTwP and DTaP vaccination, there would be an estimated 115.76 million pertussis cases and 426 650 pertussis deaths in the 40 cohorts. With DTwP/DTaP vaccination, pertussis cases and deaths were decreased by an estimated 92.57% and 97.43%, saving 46 987.81 million USD in direct costs and 82 013.37 million USD from societal perspective. Pertussis vaccination program costs were 2168.76 million USD and 3961.28 million USD from direct cost and societal perspectives. Benefit-cost ratios were 21.67:1 from the direct cost perspective and 20.70:1 from the societal perspective. Sensitivity analyses showed the results to be robust.
Over the lifetime of 40 birth cohorts, China\'s immunization program is preventing 93% of pertussis cases and 97% of pertussis deaths, resulting in substantial savings to the healthcare system and society.
We conducted cost-benefit analyses with a decision tree model populated with historical vaccination coverage levels and pertussis incidence and mortality data from before 1978 and during 1978 to 2017. We modeled 40 birth cohorts from birth until death. Costs and benefits were estimated from direct cost and societal perspectives (direct and indirect costs). Costs and benefits were adjusted to 2017 US dollars (USD), and future values were discounted at a 3% annual rate. We calculated net benefit values (net savings) and benefit-cost ratios of pertussis vaccination of children younger than 5 years. We conducted sensitivity analyses by varying key parameters within plausible ranges.
Without DTwP and DTaP vaccination, there would be an estimated 115.76 million pertussis cases and 426 650 pertussis deaths in the 40 cohorts. With DTwP/DTaP vaccination, pertussis cases and deaths were decreased by an estimated 92.57% and 97.43%, saving 46 987.81 million USD in direct costs and 82 013.37 million USD from societal perspective. Pertussis vaccination program costs were 2168.76 million USD and 3961.28 million USD from direct cost and societal perspectives. Benefit-cost ratios were 21.67:1 from the direct cost perspective and 20.70:1 from the societal perspective. Sensitivity analyses showed the results to be robust.
Over the lifetime of 40 birth cohorts, China\'s immunization program is preventing 93% of pertussis cases and 97% of pertussis deaths, resulting in substantial savings to the healthcare system and society.
摘要：
目的：本研究旨在评估白喉对健康和经济的影响，破伤风,全细胞百日咳疫苗(DTwP)和白喉-破伤风-无细胞百日咳疫苗(DTaP)疫苗接种对我国百日咳防治的作用.
方法：我们使用决策树模型进行了成本效益分析，其中包含1978年之前和1978年至2017年期间的历史疫苗接种覆盖率水平以及百日咳发病率和死亡率数据。我们对从出生到死亡的40个出生队列进行了建模。从直接成本和社会角度（直接和间接成本）估计成本和收益。成本和收益调整为2017年美元（USD），未来价值以3%的年利率贴现。我们计算了5岁以下儿童百日咳疫苗接种的净收益值（净储蓄）和收益成本比。我们通过在合理的范围内改变关键参数进行了敏感性分析。
结果：未接种DTwP和DTaP疫苗，在40个队列中,估计有1.15.76亿例百日咳病例和426650例百日咳死亡.使用DTwP/DTaP疫苗接种，百日咳病例和死亡人数分别下降了92.57%和97.43%,从社会角度来看，节省了46987.81万美元的直接成本和82013.37万美元。从直接成本和社会角度来看，百日咳疫苗接种计划的费用分别为216876万美元和396128万美元。从直接成本的角度来看，效益成本比为21.67：1，从社会角度来看为20.70：1。敏感性分析显示结果是稳健的。
结论：在40个出生队列的一生中，中国的免疫计划是防止93%的百日咳病例和97%的百日咳死亡，从而为医疗保健系统和社会节省了大量资金。
方法：我们使用决策树模型进行了成本效益分析，其中包含1978年之前和1978年至2017年期间的历史疫苗接种覆盖率水平以及百日咳发病率和死亡率数据。我们对从出生到死亡的40个出生队列进行了建模。从直接成本和社会角度（直接和间接成本）估计成本和收益。成本和收益调整为2017年美元（USD），未来价值以3%的年利率贴现。我们计算了5岁以下儿童百日咳疫苗接种的净收益值（净储蓄）和收益成本比。我们通过在合理的范围内改变关键参数进行了敏感性分析。
结果：未接种DTwP和DTaP疫苗，在40个队列中,估计有1.15.76亿例百日咳病例和426650例百日咳死亡.使用DTwP/DTaP疫苗接种，百日咳病例和死亡人数分别下降了92.57%和97.43%,从社会角度来看，节省了46987.81万美元的直接成本和82013.37万美元。从直接成本和社会角度来看，百日咳疫苗接种计划的费用分别为216876万美元和396128万美元。从直接成本的角度来看，效益成本比为21.67：1，从社会角度来看为20.70：1。敏感性分析显示结果是稳健的。
结论：在40个出生队列的一生中，中国的免疫计划是防止93%的百日咳病例和97%的百日咳死亡，从而为医疗保健系统和社会节省了大量资金。
