Smith K J, Roberts M S
Department of Medicine, Mercy Hospital of Pittsburgh, PA 15219, USA.
J Infect Dis. 1998 Nov;178 Suppl 1:S85-90. doi: 10.1086/514270.
Famciclovir and valaciclovir were approved for use in the treatment of herpes zoster despite controversy over antiviral therapy in zoster due to high costs and uncertain benefits. To explore these issues, a Markov decision model was developed, and the incremental cost effectiveness of antiviral treatment for herpes zoster was estimated using these agents compared with no antiviral therapy. A third-party payer perspective was taken. Sensitivity analyses were performed, modeling differences in antiviral efficacy, postherpetic neuralgia (PHN) risk, and other illness parameters. Treatment of severely symptomatic acute zoster was found reasonable from a cost-effectiveness standpoint in base-case and worst-case scenarios. Treatment of mildly symptomatic acute zoster was more expensive but would likely be considered cost effective in scenarios where PHN risk was higher, PHN duration longer, or antiviral shortening of PHN greater. Further research comparing antiviral efficacy in herpes zoster is needed.
尽管由于成本高昂且益处不确定，带状疱疹的抗病毒治疗存在争议，但泛昔洛韦和伐昔洛韦仍被批准用于治疗带状疱疹。为探讨这些问题，开发了一个马尔可夫决策模型，并与不进行抗病毒治疗相比，使用这些药物估计了带状疱疹抗病毒治疗的增量成本效益。采用了第三方支付方的视角。进行了敏感性分析，模拟了抗病毒疗效、带状疱疹后神经痛（PHN）风险及其他疾病参数的差异。从成本效益的角度来看，在基础病例和最坏情况的场景中，治疗症状严重的急性带状疱疹是合理的。治疗症状轻微急性带状疱疹的成本更高，但在PHN风险更高、PHN持续时间更长或抗病毒治疗缩短PHN时间更多的场景中，可能会被认为具有成本效益。需要进一步研究比较带状疱疹的抗病毒疗效。
