Liu Lulu, Zhang Qilin, Shu Yamin, Wang Lei, Shuai Zhenqingyun, Chu Mingming, Zhang Zhe, Zhang Rong
Department of Pharmacy, The Second Affiliated Hospital of Army Medical University, No.83 Xinqiao Central Street, Shapingba District, Chongqing, 400037, China.
Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Pharmacoecon Open. 2025 Sep 9. doi: 10.1007/s41669-025-00604-z.
Two vaccines against herpes zoster (HZ) are currently authorized for use in China: the adjuvanted recombinant zoster vaccine (RZV) and live-attenuated Zoster Vaccine Live (ZVL). The significant disparities in prices and efficacy between the two vaccines necessitate an evaluation of their relative value in order to make an informed choice. This study aimed to evaluate the comparative cost effectiveness of RZV, ZVL, and no vaccination for older adults at different ages from the societal perspective.
The Markov decision model was parameterized using vaccine efficacy data, the latest incidence rates, costs, and health-related quality-of-life data. Participants consisted of a cohort comprising adults aged ≥ 50 years in China. The lifetime health impacts, cost, life-year (LY), quality-adjusted life-year (QALY) gained and the incremental cost-effectiveness ratio (ICER), net monetary benefits (NMB), net health benefits (NHB), and expected value of perfect information (EVPI) were calculated. Sensitivity analyses, scenario analyses, and subgroup analyses were performed.
Compared with no vaccination, RZV and ZVL could avoid 2,009,292 versus 510,192 HZ cases, and 334,637 versus 90,996 post-herpetic neuralgia (PHN) cases in the overall cohort, respectively. RZV and ZVL were more costly by US$1624 million versus US$896 million compared with no vaccination, with an additional 58,180 versus 23,390 QALYs. At threefold gross domestic product per capita, RZV had cost-effectiveness probabilities of 47.37% for ages 50-59 years, 83.24% for ages 60-69 years, 28.28% for ages 70-79 years, and 51.93% for ages ≥ 80 years, while ZVL had 7.07%, 12.79%, 69.55%, 2.82% probability, and no vaccination had 45.56%, 3.97%, 2.17%, 45.25% probability of being cost effective for the corresponding age cohorts.
The strategy utilizing RZV demonstrated superior efficacy in reducing the burden of HZ compared with ZVL. RZV was most cost effective in the 50-59, 60-69 and ≥ 80 years age groups, and ZVL was most cost effective in the 70-79 years group.
目前两种预防带状疱疹（HZ）的疫苗已在中国获批使用：重组带状疱疹疫苗（RZV，含佐剂）和减毒活疫苗重组带状疱疹疫苗（ZVL）。两种疫苗在价格和疗效上存在显著差异，因此有必要评估它们的相对价值，以便做出明智的选择。本研究旨在从社会角度评估RZV、ZVL以及不接种疫苗对不同年龄段老年人的成本效果。
使用疫苗效力数据、最新发病率、成本以及与健康相关的生活质量数据对马尔可夫决策模型进行参数化。研究对象为中国年龄≥50岁的成年人队列。计算了终身健康影响、成本、生命年（LY）、获得的质量调整生命年（QALY）以及增量成本效果比（ICER）、净货币效益（NMB）、净健康效益（NHB）和完美信息期望值（EVPI）。进行了敏感性分析、情景分析和亚组分析。
与不接种疫苗相比，在整个队列中，RZV和ZVL分别可避免2009292例和510192例HZ病例，以及334637例和90996例带状疱疹后神经痛（PHN）病例。与不接种疫苗相比，RZV和ZVL的成本分别高出16.24亿美元和8.96亿美元，额外获得的QALY分别为58180个和23390个。在人均国内生产总值三倍的情况下，RZV在50 - 59岁年龄组的成本效果概率为47.37%，60 - 69岁年龄组为83.24%，70 - 79岁年龄组为28.28%，≥80岁年龄组为51.93%；而ZVL在相应年龄队列中具有成本效果的概率分别为7.07%、12.79%、69.55%、2.82%，不接种疫苗的概率分别为45.56%、3.97%、2.17%、45.25%。
与ZVL相比，使用RZV的策略在减轻HZ负担方面显示出更高的疗效。RZV在50 - 59岁、60 - 69岁和≥80岁年龄组中成本效果最佳，ZVL在70 - 79岁年龄组中成本效果最佳。
