| BackgroundPneumococcal disease (PD) has high incidence, high mortality, serious antibiotic resistance and side-effects, and especially the severe impact on infants and the elderly people. So PD has always been a crucial public health problem to the entire world. China is one of the countries with high incidence of pneumonia streptococcal disease, however our residents as well as the society are not aware of these and pay little attention on the prevention of pneumococcal disease hazards and vaccination, and few scholars are involved in health-economics-related researches on PDs and its vaccines. As we all know, the immune prevention is always the basis of prevention and control of infectious diseases and early initiative vaccination is an important way to reduce the incidence of PD. So the health economics research on PD as well as other infectious diseases prevention is a topic worth further study.ObjectivesThis study was designed as the retrospectively analysis the direct medical costs of pneumococcal diseases, systematically collection of PD epidemiology data as well as the efficacy of seven-valent pneumococcal conjugate vaccine (PCV7) and the application of decision analysis model to analyze the cost-effectiveness of the PCV7vaccine. The study took China’s current public health policy into consideration to evaluate the social impact of PCV7vaccination. The results would provide a strong basis for governmental policy planning on infectious diseases prevention and help to optimize the allocation of public health resources and promote society harmony.Contents and MethodsIn this study, the author applied several methods which included the integrated use of literature analysis, site surveys, data analysis and processing, and health economics decision-making model application and the study was divided into three main parts:The first part was a systematic literature review on PDs and its vaccines. In this part, the author summed up China and foreign studies on public health impact of pneumococcal disease, application history of pneumococcal conjugate vaccine and its related health economic evaluation.The second part was the study on medical costs of pneumococcal disease in China and it is divided into the following three sub-studies:(1) Direct medical cost analysis on pneumonia inpatients in China. In this part, systematic sampling was used to collect data on inpatients costs of pneumonia in2008-2010in China. The author analyzed the inpatients direct medical costs of pneumonia and three-year trend among regions, level of cities, and types of the hospitals and insurances was also compared.(2) Direct medical cost analysis of pneumococcal diseases inpatients in Shanghai. In this part, the author collected and analyzed the direct medical cost of all-age inpatients with invasive pneumococcal diseases (meningitis, bacteremia and pneumonia). The cost data is part of the model inputs in the health economics decision-making model on PCV7conjunction.(3) Direct medical cost analysis of children’s IPD diseases. The author selected "Children’s Hospital of Shanghai" as the database of IPD inpatients confirmed by laboratory detection of Streptococcus pneumonia. The direct medical costs in the course of their hospitalization was collected and analyzed with SPSS to explore the children IPD disease burden and related factors.The third part is the cost-effectiveness analysis on PCV7. The author collected demographic, epidemiological, clinical and cost data of Shanghai inpatients and used decision-analysis model to assess the health economics and social impact of PCV7’s inoculation in Shanghai.ResultsIn China, the average hospitalization expense per patient was Y7560Yuan,￥6598Yuan, Y6545Yuan from2008to2010(all costs reported in2010Yuan) and the drug-to-total-cost ratio was46%,56%and58%respectively. The average hospitalization expense slightly declined while drug expense accounted for a rise. There were obvious gaps between patients in different level cities, hospitals and insurance systems:the average hospitalization expense in provincial capitals and municipalities was3.48times the national average. The coverage of medical insurance for urban residents was low when compared with that for urban workers.In Shanghai in2011, the average day of hospitalization was13days among all-age pneumonia inpatients and the average hospitalization expense per patient was￥10,971Yuan. The average day and costs of children under2years of age and elderly people over50years old were significantly higher than other adult populations. The average day of hospitalization was22.63days among all-age meningitis inpatients and the average hospitalization expense per patient was Y23,322Yuan. The length of average day and direct medical costs of all-age meningitis inpatients were significantly higher than pneumonia patients. We could know that meningitis was more severe damage and loss to the patients and society when compared with pneumonia.The study on pediatric patients with IPD in Children’s Hospital of Shanghai showed that the average hospitalization expense per patient was￥18,517Yuan, and￥22,143.88Yuan,￥28899.48Yuan,￥4,295.65Yuan for pneumococcal sepsis, meningitis and pneumonia inpatients respectively. Pneumococcal sepsis and meningitis are serious diseases and easily occurred among children under5years old. In addition, the average day of hospitalization obviously influenced the hospitalization expense.In the PCV7decision-analysis model analysis which assumed that the PCV7vaccine was under widely vaccination, the injection of PCV7vaccine could avoid79,089pneumococcal disease infections and1,123deaths and gained9,835QALYs. The incremental cost-effectiveness ratio (ICER) was only￥72,838Yuan and Shanghai GDP per capita in2011was￥82,560Yuan. According to the WHO recommendations on cost effectiveness analysis, PCV7vaccine was highly cost effective in Shanghai.ConclusionsThe prevention and management of pneumococcal diseases should be based on immune prevention. A wide range of immune prevention and treatment measures can reduce the incidence of pneumococcal disease and reduce mortality, thus contributing to the prevention and management of pneumococcal disease. The government needs to further the pilot on clinical pathway, standardize the process of diagnosis and treatment of pneumonia and control the growth of health expenditure; gradually raise the level of basic medical insurance and rationally distribute and use medical resource for the well-being of the people... |
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