PDF(Pubmed)
Abstract：
Despite widespread use of pneumococcal vaccines throughout Europe, the burden of pneumococcal disease (PD) in adults is considerable. To mitigate this burden, National Immunization Technical Advisory Groups (NITAGs) and Health Technology Assessment (HTA) agencies assess the value of different vaccine schedules for protecting against PD. The aim of this review was to assess the evidence and rationales used by NITAGs/HTA agencies, when considering recent changes to National Immunization Programs (NIPs) for adults, and how identified changes affected vaccine coverage rates (VCRs). A systematic review was conducted of published literature from PubMed® and Embase®, and gray literature from HTA/NITAG websites from the last 5 y, covering 31 European countries. Evidence related to NIP recommendations, epidemiology (invasive PD, pneumonia), health economic assessments and VCRs were collected and synthesized. Eighty-four records providing data for 26 countries were identified. Of these, eight described explicit changes to NIPs for adults in seven countries. Despite data gaps, some trends were observed; first, there appears to be a convergence of NIP recommendations in many countries toward sequential vaccination, with a pneumococcal conjugate vaccine (PCV), followed by pneumococcal polysaccharide vaccine 23. Second, reducing economic or healthcare burden were common rationales for implementing changes. Third, most health economic analyses assessing higher-valency PCVs for adults found its inclusion in NIPs cost-effective. Finally, higher coverage rates were seen in most cases where countries had expanded their NIPs to cover at-risk populations. The findings can encourage agencies to improve surveillance systems and work to reach the NIP\'s target populations more effectively.
摘要：
尽管肺炎球菌疫苗在欧洲广泛使用，成人肺炎球菌病(PD)的负担相当大.为了减轻这种负担，国家免疫技术咨询组（NITAG）和卫生技术评估（HTA）机构评估不同疫苗计划对预防PD的价值。本次审查的目的是评估NITAG/HTA机构使用的证据和理由，当考虑到成人国家免疫计划(NIP)的最新变化时，以及确定的变化如何影响疫苗覆盖率(VCR)。对PubMed®和Embase®的已发表文献进行了系统综述，和来自HTA/NITAG网站的灰色文献，覆盖31个欧洲国家。与NIP建议有关的证据，流行病学（侵袭性PD，肺炎)，收集并综合了卫生经济评估和VCR。确定了为26个国家提供数据的84个记录。其中,八位描述了七个国家成人NIP的明确变化。尽管数据存在差距,观察到一些趋势；首先，在许多国家，NIP建议似乎都在向序贯疫苗接种，与肺炎球菌结合疫苗（PCV），其次是肺炎球菌多糖疫苗23.第二,减少经济或医疗负担是实施变革的常见理由。第三，大多数评估成人高价PCV的健康经济分析发现，将其纳入NIP具有成本效益。最后,在大多数国家扩大其国家实施计划以覆盖高危人群的情况下，覆盖率更高。这些发现可以鼓励机构改善监测系统，并努力更有效地接触NIP的目标人群。
