Center for Health Economics Research and Modeling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (Vaxinfectio), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
Vaccine. 2012 Jan 11;30(3):675-84. doi: 10.1016/j.vaccine.2011.10.036. Epub 2011 Nov 24.
To assess the cost-effectiveness of vaccinating all or subgroups of adults aged 60 to 85 years against herpes zoster.
A deterministic compartmental static model was developed (in freeware R), in which cohorts can acquire herpes zoster according to their age in years. Surveys and database analyses were conducted to obtain as much as possible Belgian age-specific estimates for input parameters. Direct costs and Quality-Adjusted Life-Year (QALY) losses were estimated as a function of standardised Severity Of Illness (SOI) scores (i.e. as a function of the duration and severity of herpes zoster disease).
Uncertainty about the average SOI score for a person with herpes zoster, the duration of protection from the vaccine, and the population that can benefit from the vaccine, exerts a major impact on the results: under assumptions least in favour of vaccination, vaccination is not cost-effective (i.e. incremental cost per QALY gained >€48,000 for all ages considered) at the expected vaccine price of €90 per dose. At the same price, but under assumptions most in favour of vaccination, vaccination is found to be cost-effective (i.e. incremental cost per QALY gained <€5500 for all ages considered). Vaccination of age cohort 60 seems more cost-effective than vaccination of any older age cohort in Belgium.
If the vaccine price per dose drops to €45, HZ vaccination of adults aged 60-64 years is likely to be cost-effective in Belgium, even under assumptions least in favour of vaccination. Unlike previous studies, our analysis acknowledged major methodological and model uncertainties simultaneously and presented outcomes for 26 different target ages at which vaccination can be considered (ages 60-85).
评估对 60 至 85 岁成年人进行带状疱疹疫苗接种（或亚组接种）的成本效益。
采用确定性房室静态模型（在免费软件 R 中开发），队列可以根据年龄获得带状疱疹。进行调查和数据库分析，以尽可能获得比利时特定年龄的输入参数估计值。直接成本和健康调整生命年（QALY）损失是根据标准化疾病严重程度（SOI）评分（即根据带状疱疹疾病的持续时间和严重程度）来估计的。
对患有带状疱疹的人平均 SOI 评分、疫苗保护期以及可以从疫苗中受益的人群的不确定性对结果产生重大影响：在对疫苗接种最不利的假设下，疫苗接种在预期疫苗价格为 90 欧元/剂时无成本效益（即每获得一个 QALY 的增量成本超过 48,000 欧元）。在相同价格下，但在对疫苗接种最有利的假设下，疫苗接种被认为是具有成本效益的（即所有年龄组考虑在内，每获得一个 QALY 的增量成本低于 5500 欧元）。在比利时，对 60 岁年龄组进行疫苗接种比对任何更年长的年龄组进行疫苗接种更具成本效益。
如果每剂疫苗价格降至 45 欧元，那么在比利时，对 60-64 岁成年人进行 HZ 疫苗接种可能具有成本效益，即使在对疫苗接种最不利的假设下也是如此。与以前的研究不同，我们的分析同时承认了主要的方法学和模型不确定性，并为 26 个不同的目标年龄（60-85 岁）考虑疫苗接种提供了结果。
