建模 M72/AS01 疫苗和 BCG 复种的健康和经济影响：南非的估计。

Modelling the health and economic impacts ofM72/AS01 vaccination and BCG-revaccination: Estimates for South Africa.

机构信息

TB Modelling Group and TB Centre, London School of Hygiene and Tropical Medicine, United Kingdom; Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, United Kingdom; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, United Kingdom.

出版信息

Vaccine. 2024 Feb 27;42(6):1311-1318. doi: 10.1016/j.vaccine.2024.01.072. Epub 2024 Feb 2.

DOI:10.1016/j.vaccine.2024.01.072

PMID:38307747

Abstract

BACKGROUND

Tuberculosis remains a major public health problem in South Africa, with an estimated 300,000 cases and 55,000 deaths in 2021. New tuberculosis vaccines could play an important role in reducing this burden. Phase IIb trials have suggested efficacy of the M72/AS01 vaccine candidate and BCG-revaccination. The potential population impact of these vaccines is unknown.

METHODS

We used an age-stratified transmission model of tuberculosis, calibrated to epidemiological data from South Africa, to estimate the potential health and economic impact of M72/AS01 vaccination and BCG-revaccination. We simulated M72/AS01 vaccination scenarios over the period 2030-2050 and BCG-revaccination scenarios over the period 2025-2050. We explored a range of product characteristics and delivery strategies. We calculated reductions in tuberculosis cases and deaths and costs and cost-effectiveness from health-system and societal perspectives.

FINDINGS

M72/AS01 vaccination may have a larger impact than BCG-revaccination, averting approximately 80% more cases and deaths by 2050. Both vaccines were found to be cost-effective or cost saving (compared to no new vaccine) across a range of vaccine characteristics and delivery strategies from both the health system and societal perspective. The impact of M72/AS01 is dependent on the assumed efficacy of the vaccine in uninfected individuals. Extending BCG-revaccination to HIV-infected individuals on ART increased health impact by approximately 15%, but increased health system costs by approximately 70%.

INTERPRETATION

Our results show that M72/AS01 vaccination or BCG-revaccination could be cost-effective in South Africa. However, there is considerable uncertainty in the estimated impact and costs due to uncertainty in vaccine characteristics and the choice of delivery strategy.

FUNDING

This work was funded by the Bill & Melinda Gates Foundation (INV-001754). This work used the Cirrus UK National Tier-2 HPC Service at EPCC (https://www.cirrus.ac.uk) funded by the University of Edinburgh and EPSRC (EP/P020267/1).

摘要

背景

结核病仍然是南非的一个主要公共卫生问题，2021 年估计有 30 万例病例和 5.5 万例死亡。新的结核病疫苗可能在减轻这一负担方面发挥重要作用。IIb 期试验表明 M72/AS01 候选疫苗和 BCG 再接种的有效性。这些疫苗的潜在人群影响尚不清楚。

方法

我们使用结核病的年龄分层传播模型，根据南非的流行病学数据进行校准，以估计 M72/AS01 疫苗接种和 BCG 再接种的潜在健康和经济影响。我们模拟了 2030 年至 2050 年期间的 M72/AS01 疫苗接种方案和 2025 年至 2050 年期间的 BCG 再接种方案。我们探索了一系列产品特性和交付策略。我们从卫生系统和社会角度计算了结核病病例和死亡人数的减少以及成本和成本效益。

发现

M72/AS01 疫苗接种的影响可能大于 BCG 再接种，到 2050 年可避免约 80%的病例和死亡。从卫生系统和社会角度来看，在一系列疫苗特性和交付策略下，两种疫苗均具有成本效益或成本节约（与没有新疫苗相比）。M72/AS01 的影响取决于假设疫苗对未感染者的疗效。将 BCG 再接种扩大到接受抗逆转录病毒治疗的 HIV 感染者，将健康影响增加了约 15%，但增加了约 70%的卫生系统成本。