Abstract：
OBJECTIVE: Cost-effectiveness analysis (CEA) is the standard framework for informing the efficient allocation of scarce healthcare resources. The importance of considering all relevant intervention strategies and appropriate incremental comparisons have both long been recognized in CEA. Failure to apply methods correctly can lead to suboptimal policies. Our objective is to assess if CEAs of infant pneumococcal vaccination apply appropriate methods with respect to the completeness of strategies assessed and incremental comparisons between them.
METHODS: We conducted a systematic search of the PubMed, Scopus, Embase, and Web of Science databases and performed a comparative analysis of the retrieved pneumococcal vaccination CEAs. We checked the appropriateness of the incremental analyses by attempting to replicate the published incremental cost-effectiveness (CE) ratios from the reported costs and health effects.
RESULTS: Our search returned twenty-nine eligible articles. Most studies failed to recognize one or more intervention strategies (n = 21). Incremental comparisons were questionable in four CEAs and insufficient reporting of cost and health effect estimates was identified in three studies. Overall, we only found four studies that made appropriate comparisons between all strategies. Lastly, study findings appear to be strongly associated with manufacturer sponsorship.
CONCLUSIONS: We found considerable scope for improvement regarding strategy comparison in the infant pneumococcal vaccination literature. To prevent overestimation of the CE of new vaccines, we urge greater adherence to existing guidelines recommending that all available strategies are evaluated to capture relevant comparators for CE evaluation. Closer adherence to existing guidelines will generate better evidence, leading to more effective vaccination policies.
METHODS: We conducted a systematic search of the PubMed, Scopus, Embase, and Web of Science databases and performed a comparative analysis of the retrieved pneumococcal vaccination CEAs. We checked the appropriateness of the incremental analyses by attempting to replicate the published incremental cost-effectiveness (CE) ratios from the reported costs and health effects.
RESULTS: Our search returned twenty-nine eligible articles. Most studies failed to recognize one or more intervention strategies (n = 21). Incremental comparisons were questionable in four CEAs and insufficient reporting of cost and health effect estimates was identified in three studies. Overall, we only found four studies that made appropriate comparisons between all strategies. Lastly, study findings appear to be strongly associated with manufacturer sponsorship.
CONCLUSIONS: We found considerable scope for improvement regarding strategy comparison in the infant pneumococcal vaccination literature. To prevent overestimation of the CE of new vaccines, we urge greater adherence to existing guidelines recommending that all available strategies are evaluated to capture relevant comparators for CE evaluation. Closer adherence to existing guidelines will generate better evidence, leading to more effective vaccination policies.
摘要：
目的：成本效益分析（CEA）是为有效分配稀缺医疗资源提供信息的标准框架。考虑所有相关干预策略和适当的增量比较的重要性在CEA中早已得到认可。未能正确应用方法可能导致次优策略。我们的目标是评估婴儿肺炎球菌疫苗接种的CEA是否在评估策略的完整性和它们之间的增量比较方面应用了适当的方法。
方法：我们对PubMed进行了系统的搜索，Scopus,Embase,和WebofScience数据库，并对检索到的肺炎球菌疫苗接种CEA进行了比较分析。我们通过尝试从报告的成本和健康影响中复制已发布的增量成本效益（CE）比率来检查增量分析的适当性。
结果：我们的搜索返回了29篇符合条件的文章。大多数研究未能识别一种或多种干预策略（n=21）。在四个CEA中，增量比较值得怀疑，并且在三项研究中发现了对成本和健康影响估计的报告不足。总的来说,我们仅发现四项研究对所有策略进行了适当的比较.最后,研究结果似乎与制造商赞助密切相关.
结论：在婴儿肺炎球菌疫苗接种文献中，我们发现策略比较有相当大的改进余地。为了防止高估新疫苗的CE，我们敦促更多遵守现有指南,建议对所有可用策略进行评估,以获取CE评估的相关比较指标.更严格地遵守现有指南将产生更好的证据，导致更有效的疫苗接种政策。
方法：我们对PubMed进行了系统的搜索，Scopus,Embase,和WebofScience数据库，并对检索到的肺炎球菌疫苗接种CEA进行了比较分析。我们通过尝试从报告的成本和健康影响中复制已发布的增量成本效益（CE）比率来检查增量分析的适当性。
结果：我们的搜索返回了29篇符合条件的文章。大多数研究未能识别一种或多种干预策略（n=21）。在四个CEA中，增量比较值得怀疑，并且在三项研究中发现了对成本和健康影响估计的报告不足。总的来说,我们仅发现四项研究对所有策略进行了适当的比较.最后,研究结果似乎与制造商赞助密切相关.
结论：在婴儿肺炎球菌疫苗接种文献中，我们发现策略比较有相当大的改进余地。为了防止高估新疫苗的CE，我们敦促更多遵守现有指南,建议对所有可用策略进行评估,以获取CE评估的相关比较指标.更严格地遵守现有指南将产生更好的证据，导致更有效的疫苗接种政策。
