Préaud Emmanuelle, Uhart Mathieu, Böhm Katharina, Aidelsburger Pamela, Anger Delphine, Bianic Florence, Largeron Nathalie
a Sanofi Pasteur MSD ; Lyon , France.
Hum Vaccin Immunother. 2015;11(4):884-96. doi: 10.1080/21645515.2015.1011561.
Herpes zoster (HZ; shingles) is a common viral disease that affects the nerves and surrounding skin causing a painful dermatomal rash and leading to debilitating complications such as, mainly, post-herpetic neuralgia (PHN). Currently, there is no effective treatment for HZ and PHN. The objective of this study was to assess the cost-effectiveness of a HZ vaccination program in Germany. An existing Markov Model was adapted to the German healthcare setting to compare a vaccination policy to no vaccination on a lifetime time-horizon, considering 2 scenarios: vaccinating people starting at the age of 50 or at the age of 60 years, from the perspective of the statutory health insurance (SHI) and the societal perspective. According to the perspective, vaccinating 20% of the 60+ German population resulted in 162,713 to 186,732 HZ and 31,657 to 35,793 PHN cases avoided. Corresponding incremental cost-effectiveness ratios (ICER) were 39,306 €/QALY from the SHI perspective and 37,417 €/QALY from a societal perspective. Results for the 50+ German population ranged from 336,468 to 394,575 HZ and from 48,637 to 56,087 PHN cases avoided from the societal perspective. Corresponding ICER were 39,782 €/QALY from a SHI perspective and 32,848 €/QALY from a societal perspective. Sensitivity analyses showed that results are mainly impacted by discount rates, utility values and use of alternative epidemiological data.The model indicated that a HZ vaccination policy in Germany leads to significant public health benefits and could be a cost-effective intervention. The results were robust and consistent with local and international existing literature.
带状疱疹（HZ；俗称缠腰龙）是一种常见的病毒性疾病，会影响神经及周围皮肤，引发疼痛性的皮节疹，并导致主要如疱疹后神经痛（PHN）等使人衰弱的并发症。目前，对于HZ和PHN尚无有效治疗方法。本研究的目的是评估德国HZ疫苗接种计划的成本效益。将一个现有的马尔可夫模型适用于德国的医疗环境，以在终身时间范围内比较疫苗接种策略与不接种疫苗的情况，考虑两种情形：从法定健康保险（SHI）和社会角度出发，分别对50岁或60岁开始接种疫苗的人群进行分析。根据该角度，对德国60岁及以上人群的20%进行接种，可避免162,713至186,732例HZ病例以及31,657至35,793例PHN病例。从SHI角度来看，相应的增量成本效益比（ICER）为39,306 €/QALY，从社会角度来看为37,417 €/QALY。对于德国50岁及以上人群，从社会角度来看，可避免336,468至394,575例HZ病例以及48,637至56,087例PHN病例。相应的ICER从SHI角度来看为39,782 €/QALY，从社会角度来看为32,848 €/QALY。敏感性分析表明，结果主要受贴现率、效用值和替代流行病学数据的使用影响。该模型表明，德国的HZ疫苗接种政策可带来显著的公共卫生效益，并且可能是一种具有成本效益的干预措施。结果具有稳健性，且与当地和国际现有文献一致。
