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1 1 醫院全面員工水痘抗體篩檢及疫苗注射之成本效益分析 ,2 2 彰化基督教醫院 1 感染預防暨控制中心 2 內科部感染科 3 檢驗醫學部 4 內科部家庭醫學科 % P = % 2,559,670 2,812, :24:1-9 感控雜誌關鍵詞 :

2 2 醫院員工水痘疫苗成本效益分析前言 chicken pox Herpesvirus 3, Varicella- Zoster virus [1] [7] 2004 [8] 2~3 5 1~2 5 3~9 60% 15 90% [2] 11,000 [3] 1, [4] [5] [6] 材料與方法一研究對象 CDC Hospital Infection Control Practices Advisory Committee, HICPAC engyme-linked fluorescent assay, ELFA kit VIDAS, biomérieux, Marcy l Etoile, France 感染控制雜誌

3 廖湘英張志演鄭敏琳等 3 VZV IgG < ~0.9 > varivax Merck&co., New South Wales, US. 10% 10% 二成本效益分析方法說明三統計方法 t 0.05 結果 P < , % 3.5% 5.4% 62.9% 6% 94% [2] 2003 ~ ~ P = %

4 4 醫院員工水痘疫苗成本效益分析圖一每年感染水痘員工人數 373 1,418, , % 63,800 79, ,559, ,500 表一實施全面性水痘抗體篩檢及疫苗施打政策十年花費估算項目人次費用新台幣元水痘抗體篩檢 200 元 / 人 7,090 人 * 1,418,000 水痘疫苗 1,565 元 / 人 638 人次 ** 998,470 門診掛號 100 元 / 人 638 人次 63,800 水痘抗體覆檢 200 元 / 人 397 人 *** 79,400 總計 2,559,670 元 * 以 2008 年至 2009 年的員工數 3,733 為計算基礎, 每年的員工替換率為 10% 373 人 10 年預估人數 :3, =7,090 ** 施打疫苗人數 : 以 7,090 人作計算, 血清待確認施打 1 劑, 陰性施打 2 劑, 順從性為 62.9% 計算 7, % %=481.6 陰性打 2 劑 7, % 62.9%=156 待確認打 1 劑 =638 *** 抗體複檢人數為施打疫苗人數 : =397 感染控制雜誌

5 廖湘英張志演鄭敏琳等 , acyclovir , % 1, % 24.6% 1, % 7, , ,930 討論 2,812, ,602 2,559,670 acyclovir 24,

6 6 醫院員工水痘疫苗成本效益分析表二推估實施疫苗政策 10 年, 減少員工水痘感染所省下的花費項目人數 / 日數 / 發生率費用新台幣元因處理接觸者所產生的費用事件調查 8 小時感控師薪水支出 1,500 元接觸者的處理包括檢測抗體費用門診檢查等 450 元 / 人平均 50 人 22,500 元因照顧員工感染者所產生的費用平均薪資 2,234 元 / 人 / 天請假 10 天 22,340 元代理人薪資支出代理 10 天 8,590 元醫療支出每人平均 2,304 元門診費用 + 口服抗病毒藥 850 元 / 人 94% 799 元門診費用 + 住院針劑抗病毒藥 25,090/ 人 6% 1,505 元住院費用 3,226 元 / 天, 需住院 7 天 6% 1,355 元平均 1 人 1 人 58,589 元 10 年總計 48 人 2,812,272 元 [10] 31% [9] % [11-13] [14] [15-17] [18] 感染控制雜誌

7 廖湘英張志演鄭敏琳等 7 3, , ,610 [13] ,245, [21] [18] ,678,020 [19-20] 607, ~

8 8 醫院員工水痘疫苗成本效益分析參考文獻 1. 衛生福利部疾病管制署. 傳染病介紹. 依主要傳染途徑分類. 空氣或飛沫傳染. 水痘. 摘自 54c504e820735b&nowtreeid=dec84a2f0c6fac5b &tid=3e91a91e565a0daa 2. 衛生福利部疾病管制署. 傳染病介紹. 第四類法定傳染病. 水痘. 摘自 gov. tw/professional/knowdisease.aspx?treeid=beac9 C103DF952C4&nowtreeid=376BD9762CA612F A&id=E5A9D152E7821E01&did= 衛生福利部疾病管制署 2011,11 月.99 年傳染病統計暨監視年報. 摘自 gov. tw/uploads/files/201304/7a39a48b da8-be2a1c89b7d7.pdf 4. Lin YH, Huang LM, Chang IS, et al: Disease burden and epidemiological characteristics of varicella in Taiwan from 2000 to J Microbiol Immunol Infect 2009;42: Boelle PY, Hanslik T: Varicella in non-immune persons: incidence, hospitalization and mortality rates. Epidemiol Infect 2002;129: Richard VS, John TJ, Kenneth J, et al: Should health care workers in the tropics be immunized against varicella? J Hosp Infect 2001;47: Bolyard EA, Tablan OC, Williams WW, et al: Guideline for infection control in health care personnel, Am J Infect Control 1998;26: Wu MF, Yang YW, Lin WY, et al: Varicella zoster virus infection among healthcare workers in Taiwan: seroprevalence and predictive value of history of varicella infection. J Hosp Infect 2012;80: 衛生福利部 2011,1 月 24 日. 醫療照護人員預防接種建議. 防疫專區. 摘自 dengue.nat.gov.tw/ct.asp?xitem=25339&ctnode= 1887&mp=1 10. Bouhour D, Gavazzi G, Gaillat J, et al: Survey of vaccination policies in French healthcare institutions. Med Mal Infect 2012;42: Leung J, Kudish K, Wang C, et al: A 2009 varicella outbreak in a Connecticut residential facility for adults with intellectual disability. J Infect Dis 2010;202: Saidel-Odes L, Borer A, Riesenberg K, et al: An outbreak of varicella in staff nurses exposed to a patient with localized herpes zoster. Scand J Infect Dis 2010;42: Apisarnthanarak A, Kitphati R, Tawatsupha P, et al: Outbreak of varicella-zoster virus infection among Thai healthcare workers. Infect Control Hosp Epidemiol 2007;28: Weber DJ, Rutala WA, Hamilton H: Prevention and control of varicella-zoster infections in healthcare facilities. Infect Control Hosp Epidemiol 1996;17: Chou DW, Lee CH, Chen CW, et al: Varicella pneumonia complicated by acute respiratory distress syndrome in an adult. J Formos Med Assoc 1999;98: Lee S, Ito N, Inagaki T, et al: Fulminant varicella infection complicated with acute respiratory distress syndrome, and disseminated intravascular coagulation in an immunocompetent young adult. Intern Med 2004;43: Chuang FR, Lee CH, Chuang CH, et al: Varicellazoster infection with encephalopathy, pneumonia, and renal failure: a case report. Ren Fail 2007;29: Huang WC, Huang LM, Chang IS, et al: Varicella breakthrough infection and vaccine effectiveness in Taiwan. Vaccine 2011;29: Weber DJ, Rutala WA, Parham C: Impact and costs of varicella prevention in a university hospital. Am J Public Health 1988;78: Wreghitt TG, Whipp J, Redpath C, et al: An analysis of infection control of varicella-zoster virus infections in Addenbrooke s Hospital Cambridge over a 5-year period, Epidemiol Infect 1996;117: Kuter B, Matthews H, Shinefield H, et al: Ten year follow-up of healthy children who received one or two injections of varicella vaccine. Pediatr Infect Dis J 2004;23: 感染控制雜誌

9 廖湘英張志演鄭敏琳等 9 Universal Antibody Screening and Vaccination for Controlling Varicella among Health Care Workers: A Cost-effectiveness Determination Siang-Ying Liao 1, Chin-Yen Chang 2, Min-Lin Cheng 3, Mei-Fong Wu 4, Chun-Eng Liu 1,2, Yu-Lin Lee 2 1 Center of Infection Prevention and Control, 2 Department of Internal Medicine, 3 Laboratory Medicine Department, 4 Department of Family Medicine Varicella is highly transmissible, especially within hospitals, owing to the presence of closed air handling systems and patients with varicella or herpes zoster infections. Health care workers HCWs are at risk for contracting varicella infections, and outbreaks of nosocomial infections among HCWs tend to occur every 2 years in our hospital. In 2008, we began a universal employee-screening program examining varicella antibodies. Active vaccination was recommended to all susceptible employees, with 62.9% receiving the vaccination. The average number of HCWs infected with varicella decreased from 7.8 to 3.0 persons/year. Thus, an average of 4.8 HCWs, per year, avoided contracting varicella infection. The cost of the program was high during the first year, due to the universal screening, but has since remained low because only new employees require testing; the staff turnover rate is 10%. According to a 10-year estimate, the program cost will total 2,559,670 NTD. In contrast, the extra cost associated with managing outbreaks among HCWs was estimated to be 3,406,272 NTD over 10 years. The policy of active antibody screening and vaccination is cost-effective, according to our analysis. Additionally, there are other benefits, such as ensuring HCW occupational safety; protecting the hospital s reputation; reducing nosocomial transmission, especially to immunocompromised patients; and preventing legal challenges. This cost analysis provides valuable information for government offices and hospitals, in Taiwan, seeking to establish their own infection control policies. Key words: Chickenpox, varicella, vaccine, cost-effectiveness, health careassociated infections

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....1-p1.73. 173 健康照護者水痘篩檢調查與成本效益分析比較北部某區域教學醫院之經驗 1 1 1 1,2 3 1,2 臺北醫學大學附設醫院 1 感染管制室 2 內科部成人感染科 3 實驗診斷科 10~20% 746 ) 268 ) 25 9.3% 25/268) 19.5% 8/41) 90.7% 243/268) 7 )- 15,328 6,825 418,750 1,562.5 ) 感控雜誌 2013:23:173-180