Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin-Madison, School of Medicine & Public Health, Madison, Wisconsin, USA.
Division of Health Care Delivery Research, Mayo Clinic, Jacksonville, Florida, USA.
Aliment Pharmacol Ther. 2023 Jun;57(11):1326-1334. doi: 10.1111/apt.17454. Epub 2023 Mar 10.
Recombinant zoster vaccine (RZV) is recommended for all adults ≥19 years of age who are at increased risk for HZ, including patients with inflammatory bowel disease (IBD).
A Markov model was constructed to compare the RZV cost-effectiveness with no vaccination in patients with Crohn's Disease (CD) and ulcerative colitis (UC). A simulated cohort of 1 million patients was used for each IBD group at ages 18, 30, 40, and 50. The primary objective of this analysis was to compare RZV cost-effectiveness in patients with CD and UC, comparing vaccination to no vaccination.
Overall, vaccination is cost-effective for both CD and UC, with the incremental cost-effectiveness ratio (ICERs) below $100,000/quality-adjusted life years (QALY) for all age cohorts. For patients with CD, 30 years of age and older, and those with UC 40 years and older, vaccination was both more effective and less expensive than the non-vaccinated strategy (CD ≥30: ICERs $6183-$24,878 and UC ≥40: ICERs $9163-$19,655). However, for CD patients under 30 (CD 18: ICER $2098) and UC patients under 40 (UC = 18: ICER $11,609, and UC = 30: $1343), costs were greater for vaccinated patients, but there was an increase in QALY. One-way sensitivity analysis of age indicates that cost break-even occurs at age 21.8 for the CD group and 31.5 for the UC group. In probabilistic sensitivity analysis, 92% of both CD and UC simulations indicated that vaccination was preferred.
In our model, vaccination with RZV was cost-effective for all adult patients with IBD.
带状疱疹重组疫苗（RZV）推荐用于所有≥19 岁、带状疱疹风险增加的成年人，包括炎症性肠病（IBD）患者。
构建了一个马尔可夫模型，以比较克罗恩病（CD）和溃疡性结肠炎（UC）患者中 RZV 的成本效益。对于每个 IBD 组，在 18、30、40 和 50 岁时，使用 100 万例患者的模拟队列。本分析的主要目的是比较 CD 和 UC 患者中 RZV 的成本效益，比较疫苗接种与不接种疫苗。
总体而言，对于 CD 和 UC 患者，疫苗接种具有成本效益，所有年龄组的增量成本效益比（ICER）均低于 10 万美元/质量调整生命年（QALY）。对于 30 岁及以上的 CD 患者和 40 岁及以上的 UC 患者，疫苗接种既比非疫苗接种策略更有效，也更便宜（CD≥30：ICERs 为 6183-24878 美元，UC≥40：ICERs 为 9163-19655 美元）。然而，对于 30 岁以下的 CD 患者（CD 18：ICER 为 2098 美元）和 40 岁以下的 UC 患者（UC=18：ICER 为 11609 美元，UC=30：ICER 为 1343 美元），接种疫苗的患者成本更高，但 QALY 有所增加。对年龄的单因素敏感性分析表明，CD 组的成本平衡点为 21.8 岁，UC 组为 31.5 岁。在概率敏感性分析中，92%的 CD 和 UC 模拟表明疫苗接种是首选。
在我们的模型中，RZV 疫苗接种对所有成年 IBD 患者具有成本效益。
