School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong; Harvard Medical School, Harvard University, Boston, MA, USA.
Vaccine. 2018 Jul 25;36(31):4610-4620. doi: 10.1016/j.vaccine.2018.06.049. Epub 2018 Jun 27.
Adjuvanted herpes zoster (HZ) subunit vaccine is recommended for adults aged ≥50 years. This study aimed to investigate cost-effectiveness of HZ subunit vaccine for older adults at different age in Hong Kong.
A life-long Markov model was designed to simulate outcomes of four alternatives: Vaccination at model entry (age 50 years); deferring vaccination to 60 years; deferring vaccination to 70 years; and no vaccination. Outcome measures included direct cost, indirect cost, HZ and post-herpetic neuralgia incidences, quality-adjusted life years (QALYs) loss, and incremental cost per QALY saved (ICER). Model clinical inputs were derived from literature. HZ treatment costs were collected from a cohort of HZ patients (n = 218). One-way and probabilistic sensitivity analyses were performed.
In base-case analysis, vaccination at 50 years showed highest QALYs saved and increment cost (0.00258; USD166), followed by deferring to 60 years (0.00215 QALYs saved; USD102) and deferring to 70 years (0.00134 QALYs; USD62) when comparing to no vaccination. ICERs of vaccination arms versus no vaccine (46,267-64,341 USD/QALY) were between 1-3 × gross domestic product (GPD) per capita in Hong Kong (USD43,530-USD130,590). One-way sensitivity analyses found vaccine cost to be the common and most influential parameter for ICER of each vaccination strategy to become <1 × GDP per capita. In probabilistic sensitivity analysis, vaccination at 50 years, deferring to 60 years and 70 years were accepted as cost-effective in 90% of time at willingness-to-pay (WTP) of 78,400 USD/QALY, 57,680 USD/QALY and 53,760 USD/QALY, respectively.
Cost-effectiveness of each strategy is highly subject to the vaccine cost and WTP threshold per QALY saved.
带状疱疹（HZ）亚单位佐剂疫苗推荐用于 50 岁以上的成年人。本研究旨在探讨 HZ 亚单位疫苗在香港不同年龄段老年人中的成本效益。
设计了一个终生的 Markov 模型，以模拟四种方案的结果：在模型进入时（50 岁）接种疫苗；推迟至 60 岁接种疫苗；推迟至 70 岁接种疫苗；不接种疫苗。结果测量包括直接成本、间接成本、HZ 和带状疱疹后神经痛的发生率、质量调整生命年（QALYs）的损失，以及每节省一个 QALY 的增量成本（ICER）。模型的临床输入来自文献。HZ 治疗费用来自 HZ 患者队列（n=218）。进行了单因素和概率敏感性分析。
在基准分析中，与不接种疫苗相比，50 岁时接种疫苗显示出最高的 QALY 节省和增量成本（0.00258；166 美元），其次是推迟至 60 岁（0.00215 QALYs 节省；102 美元）和推迟至 70 岁（0.00134 QALYs；62 美元）。与不接种疫苗相比，疫苗接种组的 ICER（46267-64341 美元/QALY）在香港人均国内生产总值（GDP）的 1-3 倍之间（43530-130590 美元）。单因素敏感性分析发现，疫苗成本是每种疫苗接种策略的 ICER 成为人均 GDP 的 1 倍以下的常见和最具影响力的参数。在概率敏感性分析中，在支付意愿（WTP）为 78400 美元/QALY、57680 美元/QALY 和 53760 美元/QALY 时，50 岁时接种疫苗、推迟至 60 岁和 70 岁分别在 90%的时间内被认为是具有成本效益的。
每种策略的成本效益高度取决于疫苗成本和每节省一个 QALY 的 WTP 阈值。
