摘要
Background China has a high burden of influenza-associated illness among children.We aimed to evaluate the cost-effectiveness of introducing government-funded influenza vaccination to children in China(fully-funded policy)compared with the status quo(self-paid policy).Methods A decision tree model was developed to calculate the economic and health outcomes,from a societal perspective,using national-and provincial-level data.The incremental cost-effectiveness ratio(ICER)[incremental costs per quality-adjusted life year(QALY)gained]was used to compare the fully-funded policy with the self-paid policy under the willingness-to-pay threshold equivalent to national and provincial GDP per capita.Sensitivity analyses were performed and various scenarios were explored based on real-world conditions,including incorporating indirect effect into the analysis.Results Compared to the self-paid policy,implementation of a fully-funded policy could prevent 1,444,768[95%uncertainty range(UR):1,203,446-1,719,761]symptomatic cases,92,110(95%UR:66,953-122,226)influenza-related hospitalizations,and 6494(95%UR:4590-8962)influenza-related death per season.The fully-funded policy was cost-effective nationally(7964 USD per QALY gained)and provincially for 13 of 31 provincial-level administrative divisions(PLADs).The probability of a funded vaccination policy being cost-effective was 56.5%nationally,and the probability in 9 of 31 PLADs was above 75%.The result was most sensitive to the symptomatic influenza rate among children under 5 years[ICER ranging from−25,612(cost-saving)to 14,532 USD per QALY gained].The ICER of the fully-funded policy was substantially lower(becoming cost-saving)if the indirect effects of vaccination were considered.Conclusions Introducing a government-funded influenza policy for children is cost-effective in China nationally and in many PLADs.PLADs with high symptomatic influenza rate and influenza-associated mortality would benefit the most from a government-funded influenza vaccination program.
