白喉百日咳破傷風疫苗第四劑之經濟評估－非細胞性疫苗與傳統疫苗之比較

Acellular vs. Whole Cell Pertussis Vaccine in Taiwan, an Economic Evaluation

蒲若芳(Raho-Fang Pwu) ； 陳建煒(K. Arnold Chan) ； 季瑋珠(Wei-Chu Chie)

《台灣公共衛生雜誌》 20卷2期 (2001/04) Pp. 121-130

https://doi.org/10.6288/TJPH2001-20-02-06

摘要

目標：傳統百日咳疫苗含死菌成份，容易造成嚴重的副作用；新的非細胞性疫苗雖可大幅減少接種後不良反應之發生，成本卻比前者昂貴。本研究希望藉經濟評估來幫助決策者了解問題現況，並比較兩種疫苗之優劣。方法：作者嘗試分別估計非細胞性白喉百日咳破傷風疫苗與傳統白喉百日咳破傷風疫苗之成本與健康效應，以作為兩種疫苗選擇之決策參考之用。本研究採決策樹方式，進行包括成本效性及成本效用分析等經濟評估；並就其中重要變項，進行敏感度分析。結果：以十八個月大的幼兒所施打的第四劑三合一疫苗而言，非細胞性疫苗的成本高，但由於不良反應較少，因此在成本效性分析的結果顯示平均每減少一個不良反應，只約需多花上90~130元。在疫苗相關不良反應中，非細胞性疫苗比傳統疫苗輕微，但反映在生活品質評分上的程度不多，所以在成本效用分析上的結果差異大，成為每增加一單位幼兒生活品質評分，需多花1,500~2,000元左右；每增加一單位家庭品質評分，則需多1,800~2,500元。結論：就醫療總支出而言，對於三合一疫曲之使用，傳統疫苗仍佔優勢。但若以減少不良反應發生所需花費而言，支出並不高，值得衛生決策單位考量。(台灣衛誌2001；20(2):121－130)

關鍵字

決策分析 ； 決策樹 ； 白喉百日咳破傷風疫苗第四劑 ； 經濟評估

並列摘要

Objectives: To perform an economic evaluation for the use of the 4th dose of acellular (OTaP) or whole-cell Diphtheria-Tetanus-Pertussis (DTP) vaccine in Taiwan. Methods: Using decision analytic models, the costs and various health effects of applying whole-cell and acellular DPT vaccines were assessed. Results: Total medical expenses related to the vaccinations were higher in DTaP, but the effectiveness and utility scores were also higher. Since the adverse reaction (ADR) rate is lower in DTaP group, the results for the cost-effectiveness analysis was 90-130 NT dollars (about US$ 3-4) per ADR prevented. However, the ADRs studied here were rather mild, therefore the gains in quality of life were quite small. The cost-utility analysis resulted in a NTD 1,500-2,000 (US$ 45-60) cost per baby's quality of life score gained, as well as a NTD 1, 800-2,500 (US$ 55-76) cost per family's quality of life point gained. Conclusion: The DTaP vaccine program is not financially incentive to be used in Taiwan. However, it might still be under consideration in terms of quality of life improvements.(Taiwan J Public Health. 2001 ;20(2):121-130)

並列關鍵字

Decision analysis ； Decision tree ； DTP vaccine 4th dose ； economic evaluation.