Benefits and Effectiveness of Pneumococcal Immunization Policies for Young Children in Taiwan

• Main Authors: Ding-Ping Liu, 劉定萍
• Other Authors: 鄭守夏
• Format: Others
• Language: zh-TW
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/22007870796701445820

博士 === 國立臺灣大學 === 健康政策與管理研究所 === 104 === Background: Invasive pneumococcal disease (IPD) is one of the leading causes for hospitalization and deaths among children and the elderly. Pneumococcal conjugate vaccine (PCV) has been introduced by Taiwan government for different target groups of children under 5 years of age since 2009. The effectiveness of the programs has not yet been evaluated. Objectives: 1. To evaluate the PCV coverage and effectiveness for children under 5 years of age; 2. To assess the effectiveness of one dose regimen of PCV for 2-5 years of age; 3. To evaluate the synergy effects for co-administration of PCV and influenza vaccine. Methods: 1. We analyzed long term trend of PCV coverage, IPD prevalence and medical utilization among children under 5 years of age in Taiwan by using CDC registration data and National Health Insurance claim data. 2. For children aged 2-5 years old in 2011-2012, we evaluated the one-dose regimen by comparing medical utilization between vaccinated and non-vaccinated groups. Propensity score matching (1:2) was used to increase the comparability of the two groups; the statistics methods used were generalized linear model with negative binomial regression and logarithmic link and gamma distribution. 3. For children under 5 years of age during 4 influenza seasons from 2009-2013, we classified the subjects into 4 groups: influenza vaccinated, 4-dose PCV vaccinated, both, or none, and compared the all-cause death and medical utilization. In addition, a cost-effectiveness analysis (CEA) was also conducted in this study. Results: 1. The number of IPD cases among children 2-5 years of age have decreased significantly since 2012 (p<.0001); the number of cases under 2 (p<.01) and 5-64 (p<.05) years old have also decreased since 2013. Compared with previous 8 years, pneumococcal infection related costs claimed for National Health Insurance among children 2-5 years of age in 2012 and 2013 decreased 17.5% and 30.3%, respectively. 2. OPD visits related to IPD in vaccinated group is 33% less than that of unvaccinated group (p<.001). Hospitalization related to IPD and pneumonia in vaccinated group is 70% and 31% less than that of unvaccinated group, respectively (p<.001); the cost related to IPD and pneumonia in vaccinated group is 32% and 17% (p<.001) less than unvaccinated group, respectively. 3. Compared with none-vaccinated groups, the three vaccinated groups were all with lower risks for hospitalization caused by pneumonia & flu, respiratory disease and acute otitis media (AOM). The risks of all-cause death of PCV and PCV+FLU groups during flu season were only 18% and 21% of the none vaccinated group, respectively (p<.0001). Nevertheless, there is no synergy effect for those receiving both PCV and flu vaccines. The three vaccination strategies were considered cost-effective with 1.74-1.91 Gross Domestic Product (GDP) per capita needed per life-year gained. The cost of PCV vaccination strategy was higher than influenza vaccination; yet it was still cost-effective with an incremental cost-effectiveness ratio (ICER) per life-year gained reached the WHO criterion. Conclusion: PCV vaccination programs for children were not only effective but also cost-effective; it’s worthy to be included in the national programs.