Modeling gonorrhea vaccination to find optimal targeting strategies that balance impact with cost-effectiveness.

IF 6.9 1区 医学 Q1 IMMUNOLOGY
Trystan Leng, Lilith K Whittles, Dariya Nikitin, Peter J White
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引用次数: 0

Abstract

Vaccination for UK men who have sex with men (MSM) at increased gonorrhea risk has been advised, but not yet implemented. Effective targeting is essential for cost-effectiveness, but previously-examined approaches have disadvantages: Vaccination-on-Diagnosis has low coverage (limiting impact), and Vaccination-according-to-Risk requires asking about sexual behavior to identify at-risk individuals, which is not always feasible. We developed a transmission-dynamic model to evaluate novel strategies offering vaccination based on information readily available to clinicians (diagnostic/vaccination history, if the patient is seeking care due to partner notification). Offering vaccination to MSM who are notified partners of gonorrhea cases or were diagnosed themselves in the past 2 years averts 1.6x more cases and is more cost-effective than Vaccination-on-Diagnosis. If vaccination provides 20% protection for 1.5 years after primary vaccination and 3 years after revaccination then at £18/dose administered, all considered strategies have ≥50 and ≥90% probabilities of positive net monetary benefit compared with no vaccination with a quality-adjusted life year valued at £20,000 and £30,000 respectively, thus meeting the UK criteria for cost-effectiveness. All novel strategies considered achieve greater impact than Vaccination-on-Diagnosis without the feasibility issues of Vaccination-according-to-Risk.

建立淋病疫苗模型,寻找平衡影响与成本效益的最佳靶向策略。
建议英国男男性行为者(MSM)接种淋病风险增加的疫苗,但尚未实施。有效的目标定位对于成本效益至关重要,但以前审查过的方法存在缺点:诊断时接种疫苗覆盖率低(影响有限),根据风险接种疫苗需要询问性行为以确定高危个体,这并不总是可行的。我们开发了一个传播动态模型,以评估基于临床医生可获得的信息(诊断/接种史,如果患者因伴侣通知而寻求治疗)提供疫苗接种的新策略。向被告知有淋病病例的伴侣或在过去两年中自己被诊断出淋病的男男性行为者提供疫苗接种可避免1.6倍以上的病例,并且比诊断后接种疫苗更具成本效益。如果接种疫苗在初次接种后1.5年和再次接种后3年提供20%的保护,那么每剂接种18英镑,与不接种疫苗相比,所有考虑的策略具有≥50%和≥90%的正净货币效益概率,质量调整生命年分别为20,000英镑和30,000英镑,因此符合英国的成本效益标准。所考虑的所有新策略都比根据风险接种疫苗的可行性问题获得更大的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
NPJ Vaccines
NPJ Vaccines Immunology and Microbiology-Immunology
CiteScore
11.90
自引率
4.30%
发文量
146
审稿时长
11 weeks
期刊介绍: Online-only and open access, npj Vaccines is dedicated to highlighting the most important scientific advances in vaccine research and development.
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