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Article(id=1321170102276444584, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321169992024961657, articleNumber=null, orderNo=null, doi=10.11847/zgggws1145567, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1730476800000, receivedDateStr=2024-11-02, revisedDate=1734796800000, revisedDateStr=2024-12-22, acceptedDate=1737907200000, acceptedDateStr=2025-01-27, onlineDate=1792921098536, onlineDateStr=2026-10-25, pubDate=1744214400000, pubDateStr=2025-04-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792921098536, onlineIssueDateStr=2026-10-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792921098536, creator=13701087609, updateTime=1792921098536, updator=13701087609, issue=Issue{id=1321169992024961657, tenantId=1146029695717560320, journalId=1319373219989389464, year='2025', volume='41', issue='4', pageStart='385', pageEnd='512', issueExtLink='null', onlineDate='null', pubDate='1744214400000', pubDateStr='2025-04-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792921072250, creator='13701087609', updateTime=1792921072250, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=489, endPage=493, ext={EN=ArticleExt(id=1321170102465188265, articleId=1321170102276444584, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Cost-effectiveness analysis of influenza vaccination among the elderly in Qingdao city, columnId=1320427686514770171, journalTitle=Chinese Journal of Public Health, columnName=Survey and Report, runingTitle=null, highlight=null, articleAbstract=
Objective

To evaluate the cost-effectiveness of different influenza vaccination rates among the elderly population aged 65 years and above in Qingdao city.

Methods

A Markov model was constructed to evaluate the cost-effectiveness of different influenza vaccination rates for influenza prevention. The per capita gross domestic product (GDP) of Qingdao city in 2021 was used as the willingness-to-pay threshold for one quality-adjusted life year (QALY). The target population was the elderly aged 65 years and above in Qingdao city. The model time horizon was one year. Three influenza vaccination rates were set at 20%, 40%, and 75%, respectively. Univariate and probabilistic sensitivity analyses were performed to assess the impact of different parameters on the results.

Results

Compared with no influenza vaccination, a 20% vaccination rate could reduce the number of influenza infections by 11 942 cases, reduce the total cost by 847 831.97 CNY, and increase the total QALYs by 6 964.09; a 40% vaccination rate could reduce the number of influenza infections by 23 884 cases, reduce the total cost by 1 695 663.95 CNY, and increase the total QALYs by 13 928.19; and a 75% vaccination rate could reduce the number of influenza infections by 44 782 cases, reduce the total cost by 3 179 369.90 CNY, and increase the total QALYs by 26 115.36. Univariate sensitivity analysis showed that the top four parameters affecting the results were the influenza rate in the unvaccinated population, the influenza rate in the vaccinated population, the cost of inpatient treatment, and the cost of outpatient treatment, respectively. Probabilistic sensitivity analysis showed that all three vaccination rates had more than a 90% advantage compared with no vaccination.

Conclusions

Compared with no influenza vaccination, increasing the influenza vaccination rate among the elderly population aged 65 years and above in Qingdao city has a high cost-effectiveness advantage.

, authors=Jinru LI1, Jing JIA1, Chunhui WANG2, Zhaohai MENG3, Xuezhao LU1, Yu GAO1, Kunzheng LYU1, authorsList=Jinru LI, Jing JIA, Chunhui WANG, Zhaohai MENG, Xuezhao LU, Yu GAO, Kunzheng LYU, authorCompany=null, correspAuthors=Kunzheng LYU, authorNote=null, correspAuthorsNote=
LV Kunzheng, 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=1321170103517958578, articleId=1321170102276444584, tenantId=1146029695717560320, journalId=1319373219989389464, language=CN, title=青岛市老年人流感疫苗接种成本效果分析, columnId=1320427686770622717, journalTitle=中国公共卫生, columnName=调查报告与分析, runingTitle=null, highlight=null, articleAbstract=
目的

评估青岛市≥65岁老年人群不同流感疫苗接种率的成本效果。

方法

通过构建马尔科夫模型，评估不同流感疫苗接种率对预防流感的成本效果。以2021年青岛市人均国内生产总值（GDP）作为购买1个质量调整寿命年（QALY）的支付意愿阈值，以青岛市≥65岁老年人群为对象，模型时限为1年，设定3种流感疫苗接种率分别为20%，40%和75%，采用单因素和概率敏感性分析评估不同参数对结果的影响。

结果

与不接种流感疫苗相比，20%疫苗接种率可降低流感感染人数11 942例，总成本降低847 831.97元，总QALY增加6 964.09；40%疫苗接种率可降低流感感染人数23 884例，总成本降低1 695 663.95元，总QALY增加13 928.19；75%疫苗接种率可降低流感感染人数44 782例，总成本降低3 179 369.90元，总QALY增加26 115.36。单因素敏感性分析显示，对结果影响的前4个参数依次为未免疫人群流感率、免疫人群流感率、住院治疗成本和门诊治疗成本。概率敏感性分析结果显示，与不接种流感疫苗比较，3种不同疫苗接种率均有超过90%的优势。

结论

与不接种流感疫苗相比，提高青岛市≥65岁老年人群流感疫苗接种率具有较高的成本效果优势。

, authors=李金儒1, 贾静1, 王春辉2, 孟兆海3, 卢学昭1, 高钰1, 吕坤政1, *, *, authorsList=李金儒, 贾静, 王春辉, 孟兆海, 卢学昭, 高钰, 吕坤政, authorCompany=null, correspAuthors=吕坤政, authorNote=

李金儒（1995—），医师，硕士，研究方向：呼吸道传染病防控

, correspAuthorsNote=
吕坤政，E-mail：
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Vaccine, 2021, 39(16): 2237-2245., articleTitle=null, refAbstract=null), Reference(id=1321170111218700795, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170102276444584, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=11, rfOrder=10, authorNames=null, journalName=null, refType=null, unstructuredReference=Lai X Z, Rong H G, Ma X C, et al. The economic burden of influenza-like illness among children, chronic disease patients, and the elderly in China: a national cross-sectional survey[J]. 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Infectious Diseases of Poverty, 2015, 4: 44., articleTitle=null, refAbstract=null), Reference(id=1321170111352918525, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170102276444584, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=13, rfOrder=12, authorNames=null, journalName=null, refType=null, unstructuredReference=Yao Q, Liu C J, Zhang Y G, et al. Changes in health-related quality of life of Chinese populations measured by the EQ-5D-3 L: a comparison of the 2008 and 2013 National Health Services Surveys[J]. 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BMC Infectious Diseases, 2017, 17(1): 686., articleTitle=null, refAbstract=null), Reference(id=1321170111550050815, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170102276444584, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=15, rfOrder=14, authorNames=null, journalName=null, refType=null, unstructuredReference=青岛市统计局, 国家统计局青岛调查队. 青岛统计年鉴–2021[M]. 北京: 中国统计出版社有限公司, 2021., articleTitle=null, refAbstract=null), Reference(id=1321170111621353984, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170102276444584, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=16, rfOrder=15, authorNames=null, journalName=null, refType=null, unstructuredReference=杜芳, 王蒲生, 黄琇棠, 等. 深圳市65岁以上老年人群接种流感疫苗的成本-效果分析[J]. 中国卫生经济, 2021, 40(10): 74-78., articleTitle=null, refAbstract=null), 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266500)])], figs=[ArticleFig(id=1321170107817120231, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170102276444584, language=EN, label=Fig.1, caption=Markov model structure for cost-effectiveness analysis of different influenza vaccination rates, figureFileSmall=zm784tqVj2D1UEaBT5WKZg==, figureFileBig=olPdyuyoWIZs4os5GaKKrw==, tableContent=null), ArticleFig(id=1321170107880034792, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170102276444584, language=CN, label=图1, caption=不同流感疫苗接种率成本效果分析的马尔科夫模型结构, figureFileSmall=zm784tqVj2D1UEaBT5WKZg==, figureFileBig=olPdyuyoWIZs4os5GaKKrw==, tableContent=null), ArticleFig(id=1321170108052001257, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170102276444584, language=EN, label=Fig.2, caption=Tornado diagram of univariate sensitivity analysis of different influenza vaccination coverage rates, figureFileSmall=0kcInyBTBu2scu1agse0EA==, figureFileBig=XUUsVejXTvU5XSln6glG5A==, tableContent=null), ArticleFig(id=1321170108119110122, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170102276444584, language=CN, label=图2, caption=不同流感疫苗接种率的单因素敏感性分析暴风图

注：图A、B和C分别为20%接种率、40%接种率和75%接种率。

, figureFileSmall=0kcInyBTBu2scu1agse0EA==, figureFileBig=XUUsVejXTvU5XSln6glG5A==, tableContent=null), ArticleFig(id=1321170108194607595, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170102276444584, language=EN, label=Fig.3, caption=Probabilistic sensitivity analysis scatter plot of different influenza vaccination coverage rates, figureFileSmall=ZwslnzNEg7JVan+IttHkcQ==, figureFileBig=yJ8wuR+OqryIfpZHLgBgcw==, tableContent=null), ArticleFig(id=1321170108274299372, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170102276444584, language=CN, label=图3, caption=不同流感疫苗接种率的概率敏感分析散点图

注：图A、B和C分别为20%接种率、40%接种率和75%接种率。

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Model parameter table

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参数名称基线值标准差范围分布
流行病学参数
　未免疫人群流感率0.072[8]0.043～0.120β
　免疫人群流感率0.030 240.018～0.050β
　流感所致门诊病例比例0.62[9]0.027β
　流感所致住院病例比例0.042 1[9]0.014β
成本参数
　疫苗成本（含管理费）51.1[10]40.90～61.30γ
　一般治疗成本106[11]75～138γ
　门诊治疗成本17 644.852 5[12]399.993γ
　住院治疗成本832.243 5[12]11 748.181 5γ
效用参数
　健康老人QALY0.956[13]0.099β
　流感后门诊患者QALY0.573 3[14]0.210 9β
　流感后住院患者QALY0.412 8[14]0.269β
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模型参数表

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参数名称基线值标准差范围分布
流行病学参数
　未免疫人群流感率0.072[8]0.043～0.120β
　免疫人群流感率0.030 240.018～0.050β
　流感所致门诊病例比例0.62[9]0.027β
　流感所致住院病例比例0.042 1[9]0.014β
成本参数
　疫苗成本（含管理费）51.1[10]40.90～61.30γ
　一般治疗成本106[11]75～138γ
　门诊治疗成本17 644.852 5[12]399.993γ
　住院治疗成本832.243 5[12]11 748.181 5γ
效用参数
　健康老人QALY0.956[13]0.099β
　流感后门诊患者QALY0.573 3[14]0.210 9β
　流感后住院患者QALY0.412 8[14]0.269β
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Cost-effectiveness analysis results of different influenza vaccination coverage rates

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主要健康效果不接种流感疫苗20%接种率40%接种率75%接种率
流感感染人数102 94691 00479 06258 164
降低流感感染人数11 94223 88444 782
总成本（元）133 279 206.68132 431 374.71131 583 542.73130 099 836.78
增加的成本（元）–847 831.97–1 695 663.95–3 179 369.90
总QALY1 306 853.491 313 817.581 320 781.681 332 968.85
增加的QALY6 964.0913 928.1926 115.36
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不同流感疫苗接种率的成本效果分析结果

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主要健康效果不接种流感疫苗20%接种率40%接种率75%接种率
流感感染人数102 94691 00479 06258 164
降低流感感染人数11 94223 88444 782
总成本（元）133 279 206.68132 431 374.71131 583 542.73130 099 836.78
增加的成本（元）–847 831.97–1 695 663.95–3 179 369.90
总QALY1 306 853.491 313 817.581 320 781.681 332 968.85
增加的QALY6 964.0913 928.1926 115.36
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青岛市老年人流感疫苗接种成本效果分析
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李金儒 1 , 贾静 1 , 王春辉 2 , 孟兆海 3 , 卢学昭 1 , 高钰 1 , 吕坤政 1, *, *
中国公共卫生 | 调查报告与分析 2025,41(4): 489-493
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中国公共卫生 |调查报告与分析 2025 , 41 (4) : 489 -493
青岛市老年人流感疫苗接种成本效果分析
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李金儒1, 贾静1, 王春辉2, 孟兆海3, 卢学昭1, 高钰1, 吕坤政1, *, *
作者信息
  • 1青岛市疾病预防控制中心（青岛市预防医学研究院）传染病防制所，青岛 266033
  • 2青岛市市北区疾病预防控制中心卫生应急办公室，青岛 266000
  • 3青岛市西海岸新区疾病预防控制中心，青岛 266500
通讯作者:
吕坤政，E-mail：
作者简介:

李金儒（1995—），医师，硕士，研究方向：呼吸道传染病防控

Cost-effectiveness analysis of influenza vaccination among the elderly in Qingdao city
Jinru LI1, Jing JIA1, Chunhui WANG2, Zhaohai MENG3, Xuezhao LU1, Yu GAO1, Kunzheng LYU1
Affiliations
  • 1Department of Acute Infectious Diseases, Qingdao City Centre for Disease Control and Prevention (Qingdao Institute of Prevention Medicine), Qingdao 266033, China
  • 2Health Emergency Office, Shibei Center for Disease Control and Prevention, Qingdao 266000, China
  • 3West Coast New Area Center for Disease Control and Prevention, Qingdao 266500, China
    • Corresponding Author:
    LV Kunzheng, E-mail:
出版时间: 2025-04-10 doi: 10.11847/zgggws1145567
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摘要
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目的

评估青岛市≥65岁老年人群不同流感疫苗接种率的成本效果。

方法

通过构建马尔科夫模型，评估不同流感疫苗接种率对预防流感的成本效果。以2021年青岛市人均国内生产总值（GDP）作为购买1个质量调整寿命年（QALY）的支付意愿阈值，以青岛市≥65岁老年人群为对象，模型时限为1年，设定3种流感疫苗接种率分别为20%，40%和75%，采用单因素和概率敏感性分析评估不同参数对结果的影响。

结果

与不接种流感疫苗相比，20%疫苗接种率可降低流感感染人数11 942例，总成本降低847 831.97元，总QALY增加6 964.09；40%疫苗接种率可降低流感感染人数23 884例，总成本降低1 695 663.95元，总QALY增加13 928.19；75%疫苗接种率可降低流感感染人数44 782例，总成本降低3 179 369.90元，总QALY增加26 115.36。单因素敏感性分析显示，对结果影响的前4个参数依次为未免疫人群流感率、免疫人群流感率、住院治疗成本和门诊治疗成本。概率敏感性分析结果显示，与不接种流感疫苗比较，3种不同疫苗接种率均有超过90%的优势。

结论

与不接种流感疫苗相比，提高青岛市≥65岁老年人群流感疫苗接种率具有较高的成本效果优势。

流感疫苗  /  成本效果分析  /  马尔科夫模型  /  青岛市
Objective

To evaluate the cost-effectiveness of different influenza vaccination rates among the elderly population aged 65 years and above in Qingdao city.

Methods

A Markov model was constructed to evaluate the cost-effectiveness of different influenza vaccination rates for influenza prevention. The per capita gross domestic product (GDP) of Qingdao city in 2021 was used as the willingness-to-pay threshold for one quality-adjusted life year (QALY). The target population was the elderly aged 65 years and above in Qingdao city. The model time horizon was one year. Three influenza vaccination rates were set at 20%, 40%, and 75%, respectively. Univariate and probabilistic sensitivity analyses were performed to assess the impact of different parameters on the results.

Results

Compared with no influenza vaccination, a 20% vaccination rate could reduce the number of influenza infections by 11 942 cases, reduce the total cost by 847 831.97 CNY, and increase the total QALYs by 6 964.09; a 40% vaccination rate could reduce the number of influenza infections by 23 884 cases, reduce the total cost by 1 695 663.95 CNY, and increase the total QALYs by 13 928.19; and a 75% vaccination rate could reduce the number of influenza infections by 44 782 cases, reduce the total cost by 3 179 369.90 CNY, and increase the total QALYs by 26 115.36. Univariate sensitivity analysis showed that the top four parameters affecting the results were the influenza rate in the unvaccinated population, the influenza rate in the vaccinated population, the cost of inpatient treatment, and the cost of outpatient treatment, respectively. Probabilistic sensitivity analysis showed that all three vaccination rates had more than a 90% advantage compared with no vaccination.

Conclusions

Compared with no influenza vaccination, increasing the influenza vaccination rate among the elderly population aged 65 years and above in Qingdao city has a high cost-effectiveness advantage.

influenza vaccine  /  cost-effectiveness analysis  /  Markov model  /  Qingdao city
李金儒, 贾静, 王春辉, 孟兆海, 卢学昭, 高钰, 吕坤政. 青岛市老年人流感疫苗接种成本效果分析. 中国公共卫生, 2025 , 41 (4) : 489 -493 . DOI: 10.11847/zgggws1145567
Jinru LI, Jing JIA, Chunhui WANG, Zhaohai MENG, Xuezhao LU, Yu GAO, Kunzheng LYU. Cost-effectiveness analysis of influenza vaccination among the elderly in Qingdao city[J]. Chinese Journal of Public Health, 2025 , 41 (4) : 489 -493 . DOI: 10.11847/zgggws1145567
正文
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流行性感冒（简称“流感”），是由流感病毒引起的一种严重威胁人群健康的急性呼吸道传染病。研究表明，老年人是流感的高危人群，感染流感后出现严重并发症、重症和死亡的风险都将会增加[1]。目前接种流感疫苗是预防流感的最有效办法之一，我国每年都建议将老年人作为流感疫苗优先接种人群[2]。世界卫生组织建议≥65岁老年人群的流感疫苗接种率应达到75%[3]，OECD网站显示2022年全球仅有英国、韩国、丹麦和爱尔兰4个国家的≥65岁老年人群达到75%以上，疫苗接种率分别为80.9%，80.1%，78.0%和75.8%[4]。目前，流感疫苗在我国为非免疫规划疫苗，居民自费自愿接种，有研究表明2014—2015年流感季我国≥60岁老年人群流感疫苗接种率仅为3.8%[5]。目前青岛市尚未对老年人群提供免费的流感疫苗，流感疫苗的成本效果分析测算可以为政府卫生行政部门制定疫苗接种策略提供卫生经济学结果支持，但目前国内相关分析较少。本研究以青岛市≥65岁老年人群作为分析对象，从社会角度分析不同流感疫苗接种率的成本效果，为政府制定和实施相关政策提供参考依据。
1　资料与方法
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1.1　模型设定（图1）
本研究以青岛市≥65岁人口数据为分析对象，通过Excel 2019 软件构建静态马尔可夫模型（图1），通过与不接种流感疫苗进行比较，评价3种不同流感疫苗接种率的成本和健康效用。根据一项我国老年人流感疫苗接种率的meta分析研究，我国≥60岁老年人群流感疫苗合并接种率为21.7%，但收费流感疫苗的合并接种率为12.4%[6]。由于不同地区、疫苗收费政策等存在差异，本研究将20%的流感疫苗接种率作为基础提高策略，将40%流感疫苗接种率作为中间提高策略，将WHO推荐的75%流感疫苗接种率作为目标策略。由于老年人群身体较为虚弱，患流感后不进行治疗的概率较低，因而本研究假设老年人罹患流感后均会采取治疗手段，结局为一般治疗、门诊治疗或住院治疗。基于流感为季节性暴发，且疾病发病期短，本次模型时限以1年为评估，不考虑贴现。
1.2　资料来源
1.2.1　流行病学资料
本研究以2021年青岛市≥65岁老年人群为分析对象，人口数据来源于中国疾病预防控制综合管理系统，为142.98万人。通过查阅文献获知老年人接种流感疫苗的保护效果为0.58[7]，未接种流感疫苗者的流感感染率为0.072[8]，利用公式：接种流感疫苗者发病率=未接种流感疫苗者发病率×（1–疫苗保护效果），可计算出接种流感疫苗者的流感发病率为0.030 24。流感患者的门诊比例和住院比例来自美国的一项调查研究，分别为0.62和0.042 1[9]。未寻求就医行为而采取一般治疗的流感患者比例为100%减去门诊患者和住院患者比例。本研究经青岛市疾病预防控制中心医学伦理委员会审批（项目号：2023YFC3041500）
1.2.2　成本参数和效用参数（表1）
本研究的成本参数以人民币为结算单位，美元以2021年的汇率均值转换为人民币（1美元=6.451 5元人民币）。成本参数包括疫苗成本（包括接种成本和管理成本）、流感一般治疗成本、流感门诊治疗成本和流感住院成本。本研究使用质量调整寿命年（quality adjusted life year, QALY）作为衡量人群健康效用的指标，具体为某健康状态下生活的年数与该状态下健康效用值的乘积。由于本研究模型时限为1年，因而使用老年人群不同健康状态下的健康效用值作为QALY值。本研究使用的效用参数包括健康老人的健康效用值、流感后门诊病人的健康效用值和流感后住院病人的健康效用值。
1.3　成本效果分析
本研究将增量成本效果比（incremental cost-effectiveness ratio, ICER）作为成本效果评价指标，计算公式如下：
${\rm{ICER}}=\dfrac{\Delta\mathrm{C}\mathrm{o}\mathrm{s}\mathrm{t}}{\Delta \mathrm{Q}\mathrm{A}\mathrm{L}\mathrm{Y}} = \dfrac{{ \mathrm{C}\mathrm{o}\mathrm{s}\mathrm{t}}_{1}-{\mathrm{C}\mathrm{o}\mathrm{s}\mathrm{t}}_{2}}{{\mathrm{Q}\mathrm{A}\mathrm{L}\mathrm{Y}}_{1}-{\mathrm{Q}\mathrm{A}\mathrm{L}\mathrm{Y}}_{2}}$
使用Excel 2019软件对数据进行计算和分析，计算ICER值，其中Cost1，Cost2分别表示3种流感疫苗接种率和不接种流感疫苗的总成本，QALY1，QALY2分别表示3种流感疫苗接种率和不接种流感疫苗的总健康效用值。本研究以2021年青岛市人均GDP（138 849元）作为支付意愿阈值（threshold value, WTP）[15]。
1.4　敏感性分析
本研究采用Excel 2019软件进行单因素和概率敏感性分析，从而评估参数不确定性对结果的影响。在单因素敏感性分析中，使用一个参数的不同参数值进行计算，而其他参数则保持不变，使用暴风图展示各参数对结果的影响。在概率敏感性分析中，使用1 000次蒙特卡洛模拟评估参数整体不确定性对结果的影响，从模型中各参数的特定分布中采样，计算不同疫苗接种率的成本效用，结果通过平面散点图展示。
2　结　果
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2.1　成本效果分析结果（表2）
青岛市≥65岁老年人群中，流感疫苗接种率越高，流感感染人数越少，总成本越低，总QALY越高。与不接种流感疫苗相比，20%疫苗接种率可降低流感感染人数11 942例，总成本降低847 831.97元，总QALY增加6 964.09；40%疫苗接种率可降低流感感染人数23 884例，总成本降低1 695 663.95元，总QALY增加13 928.19；75%疫苗接种率可降低流感感染人数44 782例，总成本降低3 179 369.90元，总QALY增加26 115.36。
2.2　单因素敏感性分析（图2）
与不接种流感疫苗相比，20%疫苗接种率、40%疫苗接种率和75%疫苗接种率的单因素敏感性分析结果显示，3种疫苗接种率增量成本效果比（ICER）变化基本一致，对模型结果影响由大到小的前4个参数依次为未免疫人群流感率、免疫人群流感率、住院治疗成本和门诊治疗成本。在所有参数的变化范围内，ICER均处于支付意愿之内。
2.3　概率敏感性分析（图3）
与不接种流感疫苗相比，20%疫苗接种率、40%疫苗接种率和75%疫苗接种率的概率敏感性分析结果显示，在以1倍2021年青岛市人均GDP为支付意愿阈值的情况下，与不接种流感疫苗相比，其他3种流感疫苗接种策略均有超过99%的散点落在阈值以下，其中有超过50%的散点落在绝对优势区域（第四象限）。与不接种流感疫苗比较，20%疫苗接种率的人均增量成本和人均增量效用平均值（标准差）分别为−0.64元（2.29）和0.005（0.001）；40%疫苗接种率的人均增量成本和人均增量效用平均值（标准差）分别为−1.42元（4.86）和0.010（0.003）；75%疫苗接种率的人均增量成本人均增量效用平均值（标准差）分别为−2.41元（9.05）和0.018（0.005）。75%疫苗接种率可以在节省更多成本的同时产生更好的效果，证实75%疫苗接种率为较优策略。
3　讨　论
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本研究通过构建马尔可夫模型，从社会角度评估青岛市≥65岁老年人群不同流感疫苗接种率的成本—效果，与不接种流感疫苗相比，接种流感疫苗会降低流感感染人数；并且随着流感疫苗接种率的增高，虽然疫苗成本将增加，但老年人群的总医疗成本也将降低，同时老年人群的健康效用也将提高。说明提高青岛市≥65岁老年人群流感疫苗接种率具有较高的成本效果优势。
单因素敏感性分析结果显示，在所有参数的变化范围内，ICER均处于支付意愿之内，说明马尔科夫模型稳定性较好。对模型影响最大的参数为未免疫人群的流感感染率，因而在流感高发季前积极推进老年人群的流感疫苗接种，可带来更高的成本效用。概率性敏感性结果显示，与不接种流感疫苗比较，20%、40%和75%疫苗接种率均有超过90%的优势，且流感疫苗接种率越高，其呈现的经济优势也将越大。
目前尚未有针对青岛地区老年人群流感疫苗的成本效果分析，我国其他地区关于老年人流感疫苗的成本效用评价结论与本研究类似，与不接种流感疫苗相比，接种流感疫苗是具有经济优势的，并且当逐步提高老年人群的流感疫苗接种率后，将会带来更多的成本效果优势[16–18]。目前我国仅有北京市、广东省深圳市、河南省新乡市等部分地区为老年人实施流感疫苗的免费接种政策[19]。湖南省长沙市开福区自2018年推行免费流感疫苗接种政策以来，老年人的流感疫苗接种率从17.37%上升到32.65%；浙江省台州市为老年人免费接种流感疫苗后，流感疫苗接种率呈现稳步上升趋势[20–21]。可见推进流感疫苗免费接种策略，可逐步提高老年人群的流感疫苗接种率，起到保护效果。本研究从社会角度出发，评价青岛地区老年人群不用流感疫苗接种率的成本效用，结果显示青岛市老年人群流感疫苗免费接种政策会产生良好的经济效益，按照20%的疫苗接种率将会减少流感相关的医疗成本近84万元，同时随着流感疫苗接种率的提高，将减少更多的医疗成本。
由于流感疫苗接种策略的调整受政府、社会资源等多方面因素影响，政策的实施和覆盖范围、流感疫苗的供应和接种服务能力以及公众对流感疫苗的接受程度都将影响到人群流感疫苗接种率。因此虽然75%的流感疫苗接种率具有更高的经济优势，但达到如此高的流感疫苗接种率并不是一朝一夕能实现的，需要在政策普及、公众接种意愿、疫苗可及性等多方面进行推进，但是只要逐步提高流感疫苗接种率就会具有成本效果优势。
本研究也存在一定的局限性。首先，模型中所有参数均通过查阅文献获得，尽管本研究通过优先选取我国的参数并进行了敏感性分析，但结果仍可能与实际情况有一定的差距；其次，本次研究未考虑到群体免疫的结果，随着流感疫苗接种率的逐步提高，社区大部分人群会对流感产生免疫，使得流感不易于在人群中传播，未免疫人群的流感感染率也将随之降低。由于在模型中并未考虑到此条件，因而在一定程度上会低估高流感疫苗接种所带来的成本效果；最后，本次研究中模型时限仅为1年，未将老年人感染流感后的残疾和死亡情况纳入分析，进一步的成本效果评价将考虑到老年人群感染流感后的残疾、死亡情况。

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doi: 10.11847/zgggws1145567
  • 接收时间：2024-11-02
  • 首发时间：2026-10-25
  • 出版时间：2025-04-10
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  • 收稿日期：2024-11-02
  • 修回日期：2024-12-22
  • 录用日期：2025-01-27
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    1青岛市疾病预防控制中心（青岛市预防医学研究院）传染病防制所，青岛 266033
    2青岛市市北区疾病预防控制中心卫生应急办公室，青岛 266000
    3青岛市西海岸新区疾病预防控制中心，青岛 266500

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2种不同金属材料的力学参数
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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
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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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