« iepriekšējāTurpināt »
Vaccines also have provided imunity against infectious diseases
such as measles, diphtheria, whooping cough, tetanus, rubella, umpe,
pneumoccal pneumonia, hepatitis B and rabies.
Aspirin-introduced just after the tum of the century
first safe and effective non-narcotic analgesic, but its potency was
limited. Although analgesics do not cure or appreciably alter the course
of a disease, they can relieve pain and bring a sense of well-being in
the presence of disease.
The first non opiate drug to match the opium
alkaloids in analgesic potency was neperidine, synthesized in 1939. Some of the recently discovered non-steroidal anti-inflammatory drugs
also have excellent analgesic properties.
During the last 25 years, new medicines helped produce a
substantial reduction in the death rate for what had become the leading
killer in the United States and throughout the industrialized
In just the last 10 years, deaths from
strokes declined by 43 percent, while deaths from heart attacks decreased by 25 percent. New medicines, including the thiazide class of diuretic hypotensives, beta blockers and calcium antagonists, were
partly responsible for the improvement.
than 50 other anti-cancer drugs have been developed. In late 1983, the National Cancer Institute reported that more than 50 percent of all
cancer patients are surviving for at least five years--up from 33 percent in the mid 1950s--and that most of this group are cured of the
Medicines have helped treat a wide range of other
diseases-- including mental Illnesses, epilepsy, diabetes, glaucoma and
Parkinson's disease--and, in all, have helped prolong and greatly
improve the quality of life for millions of people throughout the world.
REVIEW OF LITERATURE ON COST-EFFECTIVENESS OF VACCINES
(Reports 2 and 3)
Reviews of the literature on vaccines and vaccination programs both in developed and developing countries result in the same conclusion: their benefits generally exceed their costs, despite differences in evaluative approaches and in the data used.
Vaccines in Developed countries
In Report 2, Burton A. Weisbrod and John H. Huston of the
University of Wisconsin reviewed cost-effectiveness studies of 10
even though the studies were conducted over many years--from 1963 to
1975-and in many regions of several countries Austria, Finland and the
of the two studies reporting results that can be
expressed in benefit-cost ratios, one found that benefits were more than
10 times costs over a nine-year period (a benefit-cost ratio of 10.4:1),
the other that benefits were almost five times costs over a six-year period (a benefit-cost ratio of 4.9:1). And in another study, benefits
were shown to exceed costs by $1.3 billion from 1963 to 1972.
Mimps: Four evaluations of mumps vaccine found benefit-cost ratios
ranging from 3.6:1 to 7.4:1 as well as significant net benefits.
study, for example, calculated a net benefit of $5 million for each
cohort of 1 million children, while another found a net benefit of about
$50 per immunization.
Three studies found that benefits greatly exceeded costs
when rubella vaccine was routinely given to children.
For females from
2 to 12 years old, benefits ranged from eight to 27 times costs (that
is, benefit-cost ratios ranged from 8:1 to 27:1).
Pneumococcal Pneumonia: Four studies of pneumococcal vaccine concluded that benefits exceeded costs for persons in high-risk groups,
such as the elderly and chronically ill.
This conclusion was reached
even though no attenpt was made to include the value of lives saved by the vaccine. The benefits from imunizing low-risk groups were less
There is only one evaluation of pertussis vaccine, and
it found that benefits exceeded costs by more than 150 percent.
The vaccine is given as part of the DPT (diphtheria, pertussis and
tetanus) trivalent vaccine, so the costs of patient and physician time
for administering the vaccine are minimal.
The major costs arise from
the infrequent side effects of the vaccine, which can include
convulsions and encephalitis.
Adenovirus: A study of military recruits found that the benefits
of adenovirus vaccine exceeded costs by 1.56:1.
The results of the studies of the BCG (bacille
Calmette Guerin) vaccination for tuberculosis are contradictory.
study, using Austrian data, found that the benefits of the vaccine
substantially exceeded costs regardless of the age of those vaccinated.
Another study, using British data, found that costs exceeded benefits
using a wide range of vaccine costs and many methods of treating
More than anything, the different findings of the two
studies probably reflect disparities in methodology.
Two studies of polio vaccine found it cost-beneficial by a
ratio as great as 10:1, with net benefits estimated to be about $1
billion a year in the United States.
As with most vaccine studies (and,
in fact, all evaluations of medical technology), however, the social
benefits were understated because the better health of people for whom
the disease was prevented was not taken into account.
especially significant in the case of polio because of the crippling
effects of the disease and the youth of its victims.
The evaluations of flu vaccine have focused on the
benefits and costs of vaccinating people in various age groups.
because the consequences of contracting influenza appear to be related to age and to a person's health immediately before infection.