The potential cost-effectiveness of vaccination against herpes zoster and post-herpetic neuralgia

被引:55
作者
Brisson, Marc [1 ,2 ]
Pellissier, James M. [3 ]
Camden, Stephanie [1 ]
Quach, Caroline [4 ,5 ]
De Wals, Philippe [2 ,6 ]
机构
[1] Univ Quebec, Ctr Hosp, Hop St Sacrement, Unite Rech Sante Populat, Quebec City, PQ G1S 4L8, Canada
[2] Univ Laval, Dept Social & Prevent Med, Quebec City, PQ, Canada
[3] Merck Res Labs, Blue Bell, PA 19422 USA
[4] McGill Univ, Ctr Hlth, Div Infect Dis, Montreal, PQ, Canada
[5] McGill Univ, Ctr Hlth, Dept Med Microbiol, Montreal, PQ, Canada
[6] Univ Quebec, Cent Hosp, Unit Rech Sante Publ & Sante Environm, Quebec City, PQ, Canada
来源
HUMAN VACCINES | 2008年 / 4卷 / 03期
关键词
varicella zoster virus (VZV); herpes zoster; post-herpetic neuralgia (PHN); vaccines; mathematical model; economic evaluation; cost-effectiveness;
D O I
10.4161/hv.4.3.5686
中图分类号
Q81 [生物工程学(生物技术)]; Q93 [微生物学];
学科分类号
071005 ; 0836 ; 090102 ; 100705 ;
摘要
A clinical trial has shown that a live-attenuated varicella-zoster virus vaccine is effective against herpes zoster (HZ) and post-herpetic neuralgia (PHN). The aim of this study was to examine the cost-effectiveness of vaccination against HZ and PHN in Canada. A cohort model was developed to estimate the burden of HZ and the cost-effectiveness of HZ vaccination, using Canadian population-based data. Different ages at vaccination were examined and probabilistic sensitivity analysis was performed. The economic evaluation was conducted from the ministry of health perspective and 5% discounting was used for costs and benefits. In Canada (population = 30 million), we estimate that each year there are 130,000 new cases of HZ, 17,000 cases of PHN and 20 deaths. Most of the pain and suffering is borne by adults over the age of 60 years and is due to PHN. Vaccinating 65-year-olds (HZ efficacy = 63%, PHN efficacy = 67%, no waning, cost/course = $ 150) is estimated to cost $ 33,000 per QALY-gained (90% CrI: 19,000 63,000). Assuming the cost per course of HZ vaccination is $ 150, probabilistic sensitivity analysis suggest that vaccinating between 65 and 75 years of age will likely yield cost-effectiveness ratios below $ 40,000 per Quality-Adjusted Life-Year (QALY) gained, while vaccinating adults older than 75 years will yield ratios less than $ 70,000 per QALY-gained. These results are most sensitive to the duration of vaccine protection and the cost of vaccination. In conclusion, results suggest that vaccinating adults between the ages of 65 and 75 years is likely to be cost-effective and thus to be a judicious use of scarce health care resources.
引用
收藏
页码:238 / 245
页数:8
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