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Article(id=1321169772084052558, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321169668631548508, articleNumber=null, orderNo=null, doi=10.11847/zgggws1146482, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1732204800000, receivedDateStr=2024-11-22, revisedDate=1745337600000, revisedDateStr=2025-04-23, acceptedDate=1751904000000, acceptedDateStr=2025-07-08, onlineDate=1792921019811, onlineDateStr=2026-10-25, pubDate=1757433600000, pubDateStr=2025-09-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792921019811, onlineIssueDateStr=2026-10-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792921019811, creator=13701087609, updateTime=1792921019811, updator=13701087609, issue=Issue{id=1321169668631548508, tenantId=1146029695717560320, journalId=1319373219989389464, year='2025', volume='41', issue='9', pageStart='1025', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='1757433600000', pubDateStr='2025-09-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792920995147, creator='13701087609', updateTime=1792920995147, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1056, endPage=1061, ext={EN=ArticleExt(id=1321169773950517839, articleId=1321169772084052558, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Economic evaluation of influenza vaccination for key populations in keylocations: a systematic review, columnId=1321169680920850568, journalTitle=Chinese Journal of Public Health, columnName=Special Report — Influenza Prevention and Health Protection, runingTitle=null, highlight=null, articleAbstract=
Objective

To understand the current status of economic evaluation research on influenza vaccination in key locations, and to provide scientific evidence for residents and policymakers regarding influenza vaccination economics.

Methods

We searched the China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, Web of Science, and PubMed databases to collect relevant Chinese and English literature published between March 12, 1982, and November 5, 2024, on the economic evaluation of influenza vaccination in key locations. We conducted a systematic literature review to analyze the current research status of economic evaluations of influenza vaccines for populations in key locations.

Results

This study included 21 studies, involving eight countries: the United States, Korea, the Netherlands, Mexico, the United Kingdom, Brazil, Finland, and Thailand. Seven studies focusing on hospitals indicated that influenza vaccination in hospitals is cost-effective. Five studies focusing on childcare facilities and primary/secondary schools showed that influenza vaccination for children in these settings is cost-effective. Three studies focusing on nursing homes demonstrated that influenza vaccination for the elderly in these settings is cost-effective. Of the four studies focusing on workplaces, three indicated that influenza vaccination for healthy employees is cost-effective. Additionally, one study from Thailand focusing on prisons found that influenza vaccination for inmates is cost-effective, while one study from Finland focusing on households found that influenza vaccination for housewives was not cost-effective.

Conclusions

Influenza vaccination in key locations is generally cost-effective. Economic evaluations of influenza vaccination in key locations should be conducted based on national influenza vaccination cost and influenza disease burden data to provide references for relevant decision-making.

, authors=Yingying GAO1, Mengwei WEN2, Shuying YIN3, Hongli JIANG1, authorsList=Yingying GAO, Mengwei WEN, Shuying YIN, Hongli JIANG, authorCompany=null, correspAuthors=Hongli JIANG, authorNote=null, correspAuthorsNote=
JIANG Hongli, E-mail:
, copyrightStatement=Copyright © 2025 Chinese Journal of Public Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1321169774768407122, articleId=1321169772084052558, tenantId=1146029695717560320, journalId=1319373219989389464, language=CN, title=重点场所人群流感疫苗接种经济学评价系统文献综述, columnId=1321169681155731594, journalTitle=中国公共卫生, columnName=专题报道——预防流感，守护健康, runingTitle=null, highlight=null, articleAbstract=
目的

了解重点场所人群流感疫苗接种的经济学评价研究现状，为居民和决策者提供科学的流感疫苗接种经济学证据。

方法

检索中国知网数据库、万方数据知识服务平台、Web of Science数据库和PubMed数据库，收集1982年3月12日—2024年11月5日公开发表的关于重点场所人群流感疫苗接种经济学评价的相关中、英文文献，对重点场所人群流感疫苗经济学评价的研究现状进行系统文献综述法分析。

结果

本研究共纳入21项研究，涉及美国、韩国、荷兰、墨西哥、英国、巴西、芬兰和泰国8个国家。其中，7项针对医院的研究表明在医院为人群接种流感疫苗具有经济性，5项针对托幼机构和中小学校的研究表明在托幼机构和中小学校为儿童接种流感疫苗具有成本效果，3项针对养老机构的研究表明在养老机构为老年人接种流感疫苗具有经济性，针对工作场所的4项研究中3项表明为健康职工接种流感疫苗具有经济性；此外，泰国的1项针对监狱的研究发现为服刑人员接种流感疫苗亦具有经济性，但芬兰的1项针对家庭的研究则发现为家庭中的家庭妇女接种流感疫苗不具有成本效益。

结论

重点场所人群接种流感疫苗具有经济性，应基于本国流感疫苗接种成本和流感疾病负担数据开展重点场所人群流感疫苗经济学评价，以为相关决策提供参考。

, authors=高莹莹1, 温梦薇2, 尹述颖3, 蒋虹丽1, *, *, authorsList=高莹莹, 温梦薇, 尹述颖, 蒋虹丽, authorCompany=null, correspAuthors=蒋虹丽, authorNote=

高莹莹（2001—），硕士在读，研究方向：卫生事业管理

, correspAuthorsNote=
蒋虹丽，E-mail：
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Prevention and control of seasonal influenza with vaccines: recommendations of the advisory committee on immunization practices–United States, 2022-23 influenza season[J]. 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General characteristics of the included literature

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研究国家发表年份场所环境研究人群接种疫苗类型研究视角研究方法质量评价/分
墨西哥[23]2020儿童聚集场所5～11岁儿童流感疫苗社会视角静态1年期模型83
荷兰[24]2020儿童聚集场所2～16岁儿童鼻内给药减毒流感疫苗社会视角随机动态传播模型84
美国[25]2005三级儿童医院6～23月龄婴幼儿流感疫苗社会视角成本效益模型85
美国[26]2018急诊室儿童患者流感疫苗社会视角决策树模型85
美国[27]2008医院哮喘儿童患者流感疫苗社会视角决策树模型80
英国[28]2021幼儿园及中小学2～16岁儿童鼻内给药减毒活疫苗社会视角动态传播模型90
马尔可夫模型
美国[29]2019学校小学生和中学生流感疫苗社会视角随机对照试验83
决策树模型
美国[30]2007托幼机构6～36月龄婴幼儿三价减毒活疫苗社会视角双季随机对照试验86
美国[31]2002老年人健康组织65～74岁老年人流感疫苗社会视角回顾性队列研究86
美国[32]2019养老院养老院常住居民（>100 d）高剂量三价流感疫苗付款人视角集群随机对照试验86
美国[33]2012急诊室>50岁成人静脉注射三价灭活疫苗医疗保险支付方概率决策模型84
马尔可夫模型
韩国[34]2017医院有>20年冠心病史患者流感疫苗社会视角决策树模型84
美国[35]2019医院冠心病患者流感疫苗社会视角决策树模型84
荷兰[36]1998社区慢性肺病成年患者流感疫苗社会视角前瞻性队列研究80
成本效益模型
美国[37]2003工作场所18～64岁健康职工鼻内给药减毒活疫苗社会视角随机对照试验86
美国[38]2005社区及工作场所<50岁成年人流感疫苗社会视角马尔可夫模型84
巴西[39]1999工作场所健康职工流感疫苗工作场所雇主视角分层成本效益模型84
荷兰[40]2018荷兰大学医学中心医护人员流感疫苗社会视角集群随机对照试验84
决策树模型
泰国[41]2020监狱服刑人员流感疫苗卫生疾病控制部视角易感者–感染者–康复者模型85
系统动态模型
美国[42]2000工作场所18～64岁健康职工流感疫苗社会视角随机对照试验83
芬兰[43]1997家庭18～62岁女性流感疫苗社会视角非随机对照试验80
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纳入文献一般特征

, figureFileSmall=null, figureFileBig=null, tableContent=
研究国家发表年份场所环境研究人群接种疫苗类型研究视角研究方法质量评价/分
墨西哥[23]2020儿童聚集场所5～11岁儿童流感疫苗社会视角静态1年期模型83
荷兰[24]2020儿童聚集场所2～16岁儿童鼻内给药减毒流感疫苗社会视角随机动态传播模型84
美国[25]2005三级儿童医院6～23月龄婴幼儿流感疫苗社会视角成本效益模型85
美国[26]2018急诊室儿童患者流感疫苗社会视角决策树模型85
美国[27]2008医院哮喘儿童患者流感疫苗社会视角决策树模型80
英国[28]2021幼儿园及中小学2～16岁儿童鼻内给药减毒活疫苗社会视角动态传播模型90
马尔可夫模型
美国[29]2019学校小学生和中学生流感疫苗社会视角随机对照试验83
决策树模型
美国[30]2007托幼机构6～36月龄婴幼儿三价减毒活疫苗社会视角双季随机对照试验86
美国[31]2002老年人健康组织65～74岁老年人流感疫苗社会视角回顾性队列研究86
美国[32]2019养老院养老院常住居民（>100 d）高剂量三价流感疫苗付款人视角集群随机对照试验86
美国[33]2012急诊室>50岁成人静脉注射三价灭活疫苗医疗保险支付方概率决策模型84
马尔可夫模型
韩国[34]2017医院有>20年冠心病史患者流感疫苗社会视角决策树模型84
美国[35]2019医院冠心病患者流感疫苗社会视角决策树模型84
荷兰[36]1998社区慢性肺病成年患者流感疫苗社会视角前瞻性队列研究80
成本效益模型
美国[37]2003工作场所18～64岁健康职工鼻内给药减毒活疫苗社会视角随机对照试验86
美国[38]2005社区及工作场所<50岁成年人流感疫苗社会视角马尔可夫模型84
巴西[39]1999工作场所健康职工流感疫苗工作场所雇主视角分层成本效益模型84
荷兰[40]2018荷兰大学医学中心医护人员流感疫苗社会视角集群随机对照试验84
决策树模型
泰国[41]2020监狱服刑人员流感疫苗卫生疾病控制部视角易感者–感染者–康复者模型85
系统动态模型
美国[42]2000工作场所18～64岁健康职工流感疫苗社会视角随机对照试验83
芬兰[43]1997家庭18～62岁女性流感疫苗社会视角非随机对照试验80
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重点场所人群流感疫苗接种经济学评价系统文献综述
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高莹莹 1 , 温梦薇 2 , 尹述颖 3 , 蒋虹丽 1, *, *
中国公共卫生 | 专题报道——预防流感，守护健康 2025,41(9): 1056-1061
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中国公共卫生 |专题报道——预防流感，守护健康 2025 , 41 (9) : 1056 -1061
重点场所人群流感疫苗接种经济学评价系统文献综述
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高莹莹1, 温梦薇2, 尹述颖3, 蒋虹丽1, *, *
作者信息
  • 1复旦大学公共卫生学院，上海 200032
  • 2上海市同仁医院科研科，上海 200335
  • 3深圳市卫生健康发展研究和数据管理中心，深圳 518028
通讯作者:
蒋虹丽，E-mail：
作者简介:

高莹莹（2001—），硕士在读，研究方向：卫生事业管理

Economic evaluation of influenza vaccination for key populations in keylocations: a systematic review
Yingying GAO1, Mengwei WEN2, Shuying YIN3, Hongli JIANG1
Affiliations
  • 1School of Public Health, Fudan University, Shanghai 200032, China
  • 2Scientific Research Department, Shanghai Tongren Hospital Shanghai 200335, China
  • 3Shenzhen Health Development Research and Data Management Center, Shenzhen 518028, China
    • Corresponding Author:
    JIANG Hongli, E-mail:
出版时间: 2025-09-10 doi: 10.11847/zgggws1146482
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摘要
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目的

了解重点场所人群流感疫苗接种的经济学评价研究现状，为居民和决策者提供科学的流感疫苗接种经济学证据。

方法

检索中国知网数据库、万方数据知识服务平台、Web of Science数据库和PubMed数据库，收集1982年3月12日—2024年11月5日公开发表的关于重点场所人群流感疫苗接种经济学评价的相关中、英文文献，对重点场所人群流感疫苗经济学评价的研究现状进行系统文献综述法分析。

结果

本研究共纳入21项研究，涉及美国、韩国、荷兰、墨西哥、英国、巴西、芬兰和泰国8个国家。其中，7项针对医院的研究表明在医院为人群接种流感疫苗具有经济性，5项针对托幼机构和中小学校的研究表明在托幼机构和中小学校为儿童接种流感疫苗具有成本效果，3项针对养老机构的研究表明在养老机构为老年人接种流感疫苗具有经济性，针对工作场所的4项研究中3项表明为健康职工接种流感疫苗具有经济性；此外，泰国的1项针对监狱的研究发现为服刑人员接种流感疫苗亦具有经济性，但芬兰的1项针对家庭的研究则发现为家庭中的家庭妇女接种流感疫苗不具有成本效益。

结论

重点场所人群接种流感疫苗具有经济性，应基于本国流感疫苗接种成本和流感疾病负担数据开展重点场所人群流感疫苗经济学评价，以为相关决策提供参考。

流感  /  疫苗接种  /  重点场所  /  经济学评价  /  系统文献综述
Objective

To understand the current status of economic evaluation research on influenza vaccination in key locations, and to provide scientific evidence for residents and policymakers regarding influenza vaccination economics.

Methods

We searched the China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, Web of Science, and PubMed databases to collect relevant Chinese and English literature published between March 12, 1982, and November 5, 2024, on the economic evaluation of influenza vaccination in key locations. We conducted a systematic literature review to analyze the current research status of economic evaluations of influenza vaccines for populations in key locations.

Results

This study included 21 studies, involving eight countries: the United States, Korea, the Netherlands, Mexico, the United Kingdom, Brazil, Finland, and Thailand. Seven studies focusing on hospitals indicated that influenza vaccination in hospitals is cost-effective. Five studies focusing on childcare facilities and primary/secondary schools showed that influenza vaccination for children in these settings is cost-effective. Three studies focusing on nursing homes demonstrated that influenza vaccination for the elderly in these settings is cost-effective. Of the four studies focusing on workplaces, three indicated that influenza vaccination for healthy employees is cost-effective. Additionally, one study from Thailand focusing on prisons found that influenza vaccination for inmates is cost-effective, while one study from Finland focusing on households found that influenza vaccination for housewives was not cost-effective.

Conclusions

Influenza vaccination in key locations is generally cost-effective. Economic evaluations of influenza vaccination in key locations should be conducted based on national influenza vaccination cost and influenza disease burden data to provide references for relevant decision-making.

influenza  /  vaccination  /  key locations  /  economic evaluation  /  systematic literature review
高莹莹, 温梦薇, 尹述颖, 蒋虹丽. 重点场所人群流感疫苗接种经济学评价系统文献综述. 中国公共卫生, 2025 , 41 (9) : 1056 -1061 . DOI: 10.11847/zgggws1146482
Yingying GAO, Mengwei WEN, Shuying YIN, Hongli JIANG. Economic evaluation of influenza vaccination for key populations in keylocations: a systematic review[J]. Chinese Journal of Public Health, 2025 , 41 (9) : 1056 -1061 . DOI: 10.11847/zgggws1146482
正文
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流感是由流感病毒引起的急性呼吸道传染性疾病，传播迅速，严重危害人群健康[1]。世界卫生组织（World Health Organization, WHO）报告显示，每年季节性流感在全球可致300万～500万重症病例和29万～65万呼吸道疾病相关死亡病例，而接种疫苗是预防流感的有效措施，建议每年为孕妇、6个月～5岁的儿童、≥65岁老年人、慢性病患者和卫生工作者接种1次流感疫苗[2]。2023年9月，中国疾病预防控制中心发布《中国流感疫苗预防接种技术指南（2023—2024）》（以下简称“《技术指南》”），基于一定的证据[3–19]提出了“建议优先接种人群”，包括医务人员、≥60岁老年人和重点场所人群等，其中重点场所指人群聚集、容易发生流感等呼吸道传染病的场所[20]。然而，目前中国居民的流感疫苗接种率较低，据统计，2021—2022年我国的流感疫苗接种率仅为2.47%[21]，明显低于美国2021—2022年度流感接种率的51.4%[2]。近年来，随着《技术指南》引用经济学评价文献的增加，我国逐渐重视疫苗接种的经济学证据，但现有文献质量参差不齐，且缺乏对重点场所人群接种疫苗的经济学评价研究。为了解重点场所人群流感疫苗接种的经济学评价研究现状，为居民和决策者提供科学的流感疫苗接种经济学证据，本研究通过检索中国知网数据库、万方数据知识服务平台、Web of Science数据库和PubMed数据库，收集1982年3月12日—2024年11月5日公开发表的关于重点场所人群流感疫苗接种经济学评价的相关中、英文文献，对重点场所人群流感疫苗经济学评价的研究现状进行系统文献综述法分析。结果报告如下。
1　资料与方法
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1.1　文献检索策略
在中国知网数据库、万方数据知识服务平台、Web of Science数据库和PubMed数据库中检索1982年3月12日—2024年11月5日公开发表的关于重点场所人群流感疫苗接种经济学评价的相关中、英文文献，末次检索日期为2024年11月10日。中文和英文检索词分别为“流感疫苗”“经济学评价”“成本效果”“成本效用”“成本效益”和“influenza vaccine/flu vaccine”“economic evaluation”“cost-effective*”“cost-utility*”和“cost-benefit*”。
1.2　纳入与排除标准
纳入标准：（1）文献内容与流感疫苗直接相关；（2）文献围绕经济学评价，应用成本效果分析、成本效用分析和成本效益分析方法中的1种或几种，并有完整的评价过程；（3）研究内容基于特定场所环境的重点人群，重点人群指医务人员、≥60岁老年人和儿童等，重点场所指人群聚集、容易发生流感等呼吸道传染病的场所；（4）文献语种为中文或英文。排除标准：（1）文献全文不可获得；（2）文献内容为中文或英文之外的其他语言；（3）综述、摘要和会议文章等。
1.3　数据提取和质量评价
收集文献资料，内容包括研究国家、发表年份、场所环境、研究人群、接种疫苗类型、研究视角和研究方法等。文献筛选与数据提取由2名研究者独立完成，采用标准化表格进行记录,若出现纳入标准争议或数据记录分歧，则由第3名研究者参与讨论并仲裁，确保流程客观性。本研究文献质量评价采用国际通用的卫生经济学研究质量评价工具（Quality of Health Economic Studies, QHES）。QHES工具是基于Chiou C F等[22]开发的标准化框架，其结构化设计可有效减少主观偏倚，适用于系统评价中证据强度的分层与整合，最终在结果中报告各研究评分等级，该工具通过16项结构化条目，涵盖研究目标明确性、数据来源可靠性、模型假设合理性、不确定性分析完整性等方面对研究质量进行量化评分。每条目按符合程度赋分，0分=未提及、1分=部分符合、2分=完全符合，总分换算为0～100分，2名研究者先独立评分，若差异>15分则引入第3名研究者重新评估并达成共识；总分≥75分为高质量研究，50～74分为中等质量，<50分为低质量。
2　结　果
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2.1　文献基本情况（图1、表1）
共检索出相关文献2 286篇（英文文献2 166篇、中文文献120篇），根据纳入和排除标准进行剔除，最终纳入21篇英文文献进行分析。共涉及美国、荷兰、韩国、墨西哥、英国、巴西、芬兰和泰国8个国家，包括医疗机构、托幼机构及中小学校等儿童聚集场所、养老院、老年人健康组织、社区、家庭、工作场所和监狱等研究场所，涉及多个年龄段人群及患者、医护人员、服刑人员等特殊人群，接种疫苗以流感疫苗为主，研究视角多为社会视角，研究方法大多为模型分析和干预对照试验，文献质量为80～90分，整体文献报告较为规范。
2.2　不同重点场所人群流感疫苗接种经济学评价
2.2.1　医院
7项研究表明在医院为人群接种流感疫苗具有经济性。例如针对特定疾病患者的研究，韩国一项研究使用决策树模型测算出为急性冠状综合征患者接种流感疫苗每年可为全国减少8620万美元的医疗费用[34]；美国一项研究则基于决策树模型从医疗保健支付者的角度进行分析，发现在冠心病患者流感疫苗接种率达75%时较不接种疫苗更具有成本效果，其中，18～64岁成年患者接种疫苗的增量成本效果为12 680美元/质量调整生命年，>18岁所有成年患者接种疫苗的增量成本效果为2 432美元/质量调整生命年[35]。3项研究针对儿童患者进行，例如美国一项研究对35例流感住院患儿按是否合并基础疾病分为高风险组和低风险组，并通过成本效果分析发现若为6月龄以上高风险儿童普遍接种流感疫苗，可避免约35万美元的住院费用[25]；另一项研究结果显示，59%的儿童通过常规门诊接种流感疫苗，而急诊科接种可额外覆盖41%未接种儿童，所以该研究通过决策树模型比较了儿科急诊科流感疫苗接种的4种策略，分别为所有患儿接种疫苗、<5岁患儿接种疫苗、高危患儿接种疫苗和患儿不接种疫苗，发现为所有患儿接种疫苗最具成本效果，相较于不接种疫苗的策略，可为每个流感患儿节省33.51美元[26]；美国还有一项研究通过构建决策树模型评估出与不接种疫苗相比，在医院为哮喘儿童患者接种疫苗可为每个哮喘儿童节省9.19美元[27]。此外，有研究分析了老年人和医务人员在医疗机构内的接种策略，例如美国的一项研究应用马尔可夫模型比较了对急诊科老年人的3种流感疫苗接种策略，分别为对>50岁患者接种疫苗、>65岁患者接种疫苗和患者不接种疫苗，结果显示，与患者不接种疫苗的策略相比，对>50岁患者和>65岁患者接种流感疫苗可为每位患者节省34 610美元和13 084美元[33]；荷兰的研究则以某医院医护人员为研究人群，应用决策树模型测算出当医护人员流感疫苗接种率为15.47%时，可为该院节省约2 861欧元的社会成本[40]。
2.2.2　托幼机构和中小学校
5项研究表明在托幼机构和中小学校为儿童接种流感疫苗具有成本效果。例如墨西哥的研究反映当儿童流感疫苗接种率为50%时，全国将减少1.119亿美元的医疗费用[23]；荷兰的一项研究基于随机动态传播模型进行测算，当流感疫苗接种率提高到50%时的增量成本效果为3944欧元/质量调整生命年，远低于该国20 000欧元/质量调整生命年的阈值[24]；美国的一项双季随机对照临床试验以托幼机构儿童为研究人群，认为接种流感疫苗后，在甲型H1N1流感病毒占主导的季节，每100 000名儿童将多获得82个质量调整生命年，在甲型H3N2流感病毒占主导的季节，每100 000名儿童将多获得200个质量调整生命年[30]；此外，美国还进行了一项为期2年的干预研究，将儿童在学校接种流感疫苗与在医院接种进行比较，发现在学校接种可提高学龄儿童的疫苗接种率，减少监护人陪同去医院接种的成本，更具有成本效果，其中小学生的增量成本效果为85.71美元/质量调整生命年，中学生的增量成本效果为86.51美元/质量调整生命年[29]；英国则在幼儿园及中小学中以2～16岁儿童为研究人群进行研究，发现为5～11岁儿童接种流感疫苗最具成本效果，增量成本效果为639英镑/质量调整生命年，低于20 000英镑/质量调整生命年的阈值[28]。
2.2.3　养老机构
3项研究表明在养老机构为老年人接种流感疫苗具有经济性。例如美国一项在老年人聚集的健康组织中以65～74岁健康老年人为研究人群进行的研究发现，与不接种流感疫苗相比，接种3种不同疫苗的策略均具有成本效果，而预防1例死亡病例最低可节省5000美元[31]；在美国疗养院进行的另一项集群随机试验中发现，>65岁老年人接种高剂量三价流感疫苗可较接种标准剂量流感疫苗使每例老年患者多获得526美元的净收益[32]。此外，荷兰的一项前瞻性队列研究还发现，在老年人较聚集的社区接种流感疫苗可为每位>65岁慢性肺病患者带来50英镑收益，但无法确定接种疫苗对18～64岁慢性肺病患者是否具有经济性[36]。
2.2.4　工作场所
4项研究针对工作场所中的健康职工进行了研究，其中3项研究表明为职工接种流感疫苗具有经济性[37–39]。其中，美国的一项基于三价流感减毒活疫苗临床随机对照试验的研究发现，当疫苗及管理成本<43.07美元时为职工接种疫苗具有成本效益[37]；另一项以<50岁健康职工为研究对象的研究比较了4种措施，发现与不干预相比，金刚烷胺治疗、奥司他韦治疗和流感疫苗接种均具有成本效果，如果疫苗接种费用<16美元或流感耽误工作时间>2.4 d时疫苗接种最具成本效果[38]；巴西的研究利用分层成本效益模型测算出与不接种流感疫苗的公司员工相比，接种疫苗的员工可使公司获得121 441美元的净收益，成本效益比为1:2.47[39]。但美国2000年的一项以18～64岁健康职工为研究人群进行的随机安慰剂对照试验研究则表明，接种流感疫苗可以减少流感类疾病、工作日损失和就医次数，但可能无法带来其他经济效益[42]。
2.2.5　其他重点场所
泰国学者聚焦监狱这一特殊场所，应用系统动态模型测算出所有服刑人员都接种流感疫苗与不接种流感疫苗相比，全国总医疗费用约可减少4680万泰铢[41]；芬兰的1项研究将城市家庭妇女分为干预组和对照组，对干预组接种流感疫苗，对照组不接种疫苗，8个月的随访结果表明接种流感疫苗不具有成本效益[43]。
3　讨　论
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研究表明，流感可严重危害人群健康，造成医疗和经济负担，其中接种流感疫苗是预防流感最有效的方式[44–45]。目前已有许多国家开展了流感疫苗接种的经济学评价，本研究通过系统文献综述分析了目前重点场所人群接种流感疫苗的经济学评价研究现状，发现国外研究已针对重点场所开展了系统性研究，得出在医院中为医护人员接种疫苗可为医院节省约2 861欧元的社会成本、在医院为哮喘儿童患者接种疫苗较不接种疫苗可为每个哮喘儿童节省9.19美元的成本以及中小学校儿童在学校接种流感疫苗较去医院接种疫苗更具成本效果等结论。其中，小学生的增量成本效果为85.71美元/质量调整生命年，中学生的增量成本效果为86.51美元/质量调整生命年，在美国某疗养院>65岁老年人接种高剂量三价流感疫苗可较接种标准剂量流感疫苗使每例老年患者多获得526美元的净收益，接种疫苗的员工可使某公司获得121 441美元的净收益，提示为重点场所人群接种流感疫苗更具有经济性。这些研究结果均与我国相关研究中提议为重点场所人群优先接种流感疫苗的结果一致[3，5，10]，但我国目前相关证据不足。
中国近年来已显著加强流感防控工作并逐步深化相关研究，然而由于疫苗接种率较低，研究开展受到一定限制，目前大多研究主要利用现有数据通过决策树模型分析儿童和老年人接种的经济性[4，8–9]，或通过问卷调查进行经济学评价[10，12]，结论普遍支持疫苗接种具有经济性，但对患病人群的细分研究不足，且未比较社区、养老院、学校等场所与医院接种的成本效果差异。此外，研究方法较为单一，缺乏真实世界数据支撑，结论可靠性有待提高。因此，建议未来重点加强三方面工作：一是深化重点场所人群细分研究，特别是患基础疾病的老年人和儿童；二是探索不同场所接种的成本效果差异；三是借鉴国际经验，采用多样化经济学评价方法，并开展更多真实世界研究，以提升研究质量和实践指导价值。

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2025年第41卷第9期
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doi: 10.11847/zgggws1146482
  • 接收时间：2024-11-22
  • 首发时间：2026-10-25
  • 出版时间：2025-09-10
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  • 收稿日期：2024-11-22
  • 修回日期：2025-04-23
  • 录用日期：2025-07-08
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    1复旦大学公共卫生学院，上海 200032
    2上海市同仁医院科研科，上海 200335
    3深圳市卫生健康发展研究和数据管理中心，深圳 518028

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蒋虹丽，E-mail：
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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