日本老年人中佐剂重组带状疱疹疫苗的成本效益分析更新
Cost-Effectiveness Analysis Update of the Adjuvanted Recombinant Zoster Vaccine in Japanese Older Adults.
作者信息
Teng Lida, Mizukami Akiko, Ng Cheryl, Giannelos Nikolaos, Curran Desmond, Sato Tomohide, Lee Christa, Matsuki Taizo
机构信息
Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan.
GSK, 1-8-1 Akasaka, Minato-ku, Tokyo, 107-0052, Japan.
出版信息
Dermatol Ther (Heidelb). 2022 Jun;12(6):1447-1467. doi: 10.1007/s13555-022-00744-8. Epub 2022 Jun 6.
INTRODUCTION
This study aimed to update cost-effectiveness and public health impact estimates of the two-dose recombinant zoster vaccine (RZV) compared with no vaccination against herpes zoster (HZ) in the Japanese population aged 65 years. List price of the vaccine and latest RZV efficacy and waning estimates were incorporated.
METHODS
A multicohort static Markov model with a cycle length of 1 year was used to follow a hypothetical cohort of one million people aged 65 years over their remaining lifetime (base case). Age-stratified vaccine efficacy and waning rates were updated on the basis of the latest clinical trial data (interim ZOE-LTFU; NCT02723773). First-dose coverage was assumed at 40%, and second-dose compliance was assumed at 95%. Costs and outcomes were discounted at 2% annually, and the incremental cost-effectiveness ratio (ICER) was calculated from payer and societal perspectives. The societal perspective considered productivity loss due to suffering HZ, or due to suffering HZ and time required for vaccination. Sensitivity analyses explored the overall uncertainties in the model. Scenario analyses for Japanese adults aged 50, 60, 70, 80, ≥ 50, and ≥ 65 years (main scenario) were conducted. An ICER below ¥5-6 million/quality-adjusted life-year (QALY) was considered cost-effective.
RESULTS
RZV was estimated to prevent 71,423 HZ cases and 15,858 post-herpetic neuralgia (PHN) cases per million people aged 65 years compared with no vaccine in Japan. The ICER was ¥4,205,515 from a payer perspective and was most sensitive to assumptions regarding vaccine efficacy waning, proportion of patients with HZ developing PHN, and HZ incidence. From societal perspectives, ICERs were ¥3,854,192 (productivity loss from suffering HZ only) and ¥4,622,212 (productivity loss from suffering HZ and time required for vaccination). Overall, the results were considered robust under extensive sensitivity and scenario analyses.
CONCLUSION
Vaccination against HZ with RZV is cost-effective compared with no vaccination in Japanese adults aged 65 years.
引言
本研究旨在更新两剂重组带状疱疹疫苗（RZV）与65岁日本人群不接种带状疱疹（HZ）疫苗相比的成本效益和公共卫生影响估计值。纳入了疫苗标价以及RZV的最新疗效和衰减估计值。
方法
采用周期长度为1年的多队列静态马尔可夫模型，对100万65岁的假设队列人群的余生进行追踪（基础病例）。根据最新临床试验数据（中期ZOE-LTFU；NCT02723773）更新年龄分层的疫苗疗效和衰减率。假设首剂接种率为40%，第二剂依从率为95%。成本和结果按每年2%进行贴现，并从支付方和社会角度计算增量成本效益比（ICER）。社会角度考虑了因患HZ或因患HZ以及接种疫苗所需时间导致的生产力损失。敏感性分析探讨了模型中的总体不确定性。对50、60、70、80、≥50和≥65岁的日本成年人进行了情景分析（主要情景）。ICER低于500 - 600万日元/质量调整生命年（QALY）被认为具有成本效益。
结果
与日本不接种疫苗相比，估计RZV每百万65岁人群可预防71423例HZ病例和15858例带状疱疹后神经痛（PHN）病例。从支付方角度来看，ICER为4205515日元，对疫苗疗效衰减、HZ患者发生PHN的比例以及HZ发病率的假设最为敏感。从社会角度来看，ICER分别为3854192日元（仅因患HZ导致的生产力损失）和4622212日元（因患HZ以及接种疫苗所需时间导致的生产力损失）。总体而言，在广泛的敏感性和情景分析下，结果被认为是稳健的。
结论
在65岁的日本成年人中，与不接种疫苗相比，接种RZV预防HZ具有成本效益。
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