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首页> 外文期刊>Vaccine >Cost-effectiveness of vaccination of the elderly against herpes zoster in The Netherlands
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Cost-effectiveness of vaccination of the elderly against herpes zoster in The Netherlands

机译：荷兰老年人接种带状疱疹疫苗的成本效益

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Background: Each year a substantial number of Dutch elderly suffers from herpes zoster (HZ), caused by the reactivation of the varicella zoster virus (VZV). A potential complication of HZ is postherpetic neuralgia (PHN) which results in a prolonged loss of quality of life. A large randomized clinical trial, labelled the Shingles Prevention study (SPS), demonstrated that a live attenuated VZV vaccine can reduce the incidence of HZ and PHN. Objective: We aimed to estimate the incremental cost-effectiveness ratio (ICER) of vaccination of the elderly against HZ versus no such vaccination in The Netherlands. Methods: A cohort model was developed to compare the costs and effects in a vaccinated and a non-vaccinated age- and gender-stratified cohort of immune-competent elderly. Vaccination age was varied from 60 to 75 years. Data from published literature such as the SPS were used for transition probabilities. The study was performed from the societal as well as the health care payer's perspective and results were expressed in euros per quality-adjusted life year (QALY) gained. Results: In the base case, we estimated that vaccination of a cohort of 100,000 60-year-olds would prevent 4136 cases of HZ, 305 cases of PHN resulting in a QALY-gain of 209. From the societal perspective, a total of (sic)1.9 million was saved and the ICER was (sic)35,555 per QALY gained when a vaccine price of (sic)87 was used. Vaccination of women resulted in a lower ICER than vaccination of men ((sic)33,258 vs. (sic)40,984 per QALY gained). The vaccination age with the most favourable ICER was 70 years ((sic)29,664 per QALY gained). Parameters with a major impact on the ICER were the vaccine price and HZ incidence rates. In addition, the model was sensitive to utility of mild pain, vaccine efficacy at the moment of uptake and the duration of protection induced by the vaccine. Conclusion: Vaccination against HZ might be cost-effective for ages ranging from 60 to 75 when a threshold of (sic)50,000 per QALY gained would be used, at (sic)20,000 per QALY this might not be the case. Additional information on the duration of vaccine-protection is needed to further optimize cost-effectiveness estimations
机译：背景：每年，由于水痘带状疱疹病毒（VZV）的重新激活，许多荷兰老人患有带状疱疹（HZ）。 HZ的潜在并发症是带状疱疹后神经痛（PHN），导致生命质量延长。一项名为带状疱疹预防研究（SPS）的大型随机临床试验证明，减毒活VZV疫苗可以减少HZ和PHN的发生。目的：我们的目的是估计老年人接种HZ疫苗的成本效益比（ICER）与荷兰没有接种这种疫苗的成本效益比之比。方法：建立了队列模型，比较了有免疫能力的老年人的接种疫苗和未接种年龄和性别分层疫苗接种的成本和效果。疫苗接种年龄从60岁到75岁不等。来自出版文献（例如SPS）的数据用于过渡概率。这项研究是从社会以及医疗保健支付者的角度进行的，结果以获得的每质量调整生命年（QALY）的欧元表示。结果：在基本病例中，我们估计对100,000个60岁人群进行疫苗接种将预防4136例HZ和305例PHN，从而使QALY增至209。从社会角度来看，总共（使用sic的疫苗价格节省了190万，每QALY节省了ICIC 35,555。妇女接种疫苗后的ICER低于男性接种疫苗（每获得QALY 33,258 vs.40,984）。最佳ICER的疫苗接种年龄为70岁（每获得QALY 29,664）。对ICER影响最大的参数是疫苗价格和HZ发生率。另外，该模型对轻度疼痛的效用，摄取时的疫苗效力以及疫苗诱导的保护期敏感。结论：当使用每个QALY 50,000（sic）的阈值，每个QALY 20,000（sic）的阈值时，针对HZ的疫苗接种对于60至75岁的年龄段可能是具有成本效益的。需要更多有关疫苗保护期的信息，以进一步优化成本效益估算

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