加拿大免疫功能低下成年特定人群中重组带状疱疹疫苗与不接种带状疱疹疫苗相比的成本效益及对公共卫生的影响
Cost-effectiveness and public health impact of recombinant zoster vaccine versus no herpes zoster vaccination in selected populations of immunocompromised adults in Canada.
作者信息
George Sydney, Carrico Justin, Hicks Katherine A, Loukov Dessi, Ng Cheryl, Curran Desmond
机构信息
GSK, Mississauga, ON, Canada.
RTI-Health Solutions, Research Triangle Park, NC, USA.
出版信息
BMC Health Serv Res. 2025 Apr 25;25(1):604. doi: 10.1186/s12913-025-12550-x.
BACKGROUND
The risk of herpes zoster (HZ) increases with age and in immunocompromised (IC) patients. Recombinant zoster vaccine (RZV) is currently recommended in Canada for people aged ≥ 50 years. The objectives of the current study were to evaluate the cost-effectiveness and public health impact of RZV versus no HZ vaccination in select Canadian IC adult populations.
METHODS
The ZOster ecoNomic Analysis ImmunoCompromised (ZONA IC) model followed a base-case cohort of 1600 patients with hematopoietic stem-cell transplant (HSCT) from a starting age of 55 years, who maintained IC status for 5 years, from a societal perspective. Scenario analyses were conducted for patients with breast cancer, renal transplant, human immunodeficiency virus (HIV), and Hodgkin lymphoma. These probabilistic analyses used a life-long time horizon and discount rates of 1.5% for costs and quality-adjusted life-years (QALYs). First-dose coverage was assumed to be 60% and second-dose completion 100%. Deterministic one-way sensitivity analysis for the base case was performed. Costs are reported in 2022 Canadian dollars, with an assumed cost-effectiveness threshold of $50,000 per QALY gained.
RESULTS
In the base-case analysis (HSCT), it was estimated that RZV would prevent medians of 116 HZ and 27 postherpetic neuralgia (PHN) cases, respectively versus no HZ vaccination. Estimated median numbers needed to vaccinate were 8 and 35 to avoid one HZ and one PHN case, respectively. The median incremental cost-effectiveness ratio (ICER) was $22,648 per QALY gained and was most sensitive to assumptions of HZ incidence, direct medical costs for unvaccinated HZ without PHN, and RZV efficacy against PHN. In other IC populations, estimated median ICERs were $24,328 (breast cancer), $27,237 (renal transplant), $67,207 (HIV), and $81,470 (Hodgkin lymphoma).
CONCLUSIONS
RZV in Canada improves public health outcomes and is likely cost-effective for several IC conditions.
背景
带状疱疹（HZ）的风险随年龄增长以及免疫功能低下（IC）患者群体的增加而升高。加拿大目前建议≥50岁的人群接种重组带状疱疹疫苗（RZV）。本研究的目的是评估在特定加拿大IC成年人群体中，RZV与不接种HZ疫苗相比的成本效益和公共卫生影响。
方法
带状疱疹经济分析免疫功能低下（ZONA IC）模型从社会角度出发，以1600例造血干细胞移植（HSCT）患者为基础队列，起始年龄为55岁，这些患者持续5年处于IC状态。对乳腺癌、肾移植、人类免疫缺陷病毒（HIV）和霍奇金淋巴瘤患者进行了情景分析。这些概率分析采用终身时间范围，成本和质量调整生命年（QALY）的贴现率为1.5%。假设首剂接种覆盖率为60%，第二剂完成率为100%。对基础病例进行了确定性单向敏感性分析。成本以2022年加元报告，假设每获得一个QALY的成本效益阈值为50,000加元。
结果
在基础病例分析（HSCT）中，估计RZV与不接种HZ疫苗相比，分别可预防116例HZ和27例带状疱疹后神经痛（PHN）病例。估计分别需要接种8例和35例才能避免1例HZ和1例PHN病例。获得每QALY的中位增量成本效益比（ICER）为22,648加元，对HZ发病率假设、未接种HZ且无PHN的直接医疗成本以及RZV对PHN的疗效最为敏感。在其他IC人群中，估计中位ICER分别为24,328加元（乳腺癌）、27,237加元（肾移植）、67,207加元（HIV）和81,470加元（霍奇金淋巴瘤）。
结论
在加拿大，RZV可改善公共卫生结果，对于几种IC病症可能具有成本效益。
Zotero 插件