METHODS: A Markov model was developed to compare the cost-effectiveness of the 2-dose RZV immunization program with no RZV immunization for PLWHIV aged ≥50 years. We built the model with a yearly cycle over a 30-year period and 6 health conditions: HZ free, HZ, PHN, HZ/PHN recovery, HZ recurrence, and death. The parameters in the model were based on previous studies and a nationwide administrative claims database in Japan. The incremental cost-effectiveness ratio (ICER), expressed as Japanese yen (JPY) per the quality-adjusted life-years (QALYs), was estimated from a societal perspective. We conducted a one-way deterministic sensitivity analysis, probabilistic sensitivity analysis with Monte Carlo simulations of 10 000 samples, and scenario analyses.
RESULTS: The ICER of the 2-dose RZV immunization program over no RZV immunization was 78 777 774 JPY (approximately 600 000 US dollars)/QALY. The one-way deterministic sensitivity analysis showed that HZ-related utility was the most significant for ICER. All estimates in the probabilistic sensitivity analysis were located above the willingness-to-pay threshold of 5 million JPY/QALY.
CONCLUSIONS: Our study revealed that no RZV immunization was more cost-effective than the 2-dose RZV immunization program for PLWHIV aged ≥50 years. This may be useful in evidence-based policy making.
方法:开发了马尔可夫模型,以比较2剂量RZV免疫程序与未进行RZV免疫的PLWHIV≥50岁的成本-效果。我们建立了一个30年周期和6种健康状况的模型:HZ免费,HZ,PHN,HZ/PHN恢复,HZ复发,和死亡。模型中的参数基于先前的研究和日本的全国行政索赔数据库。增量成本效益比(ICER),表示为每质量调整生命年(QALYs)的日元(JPY),是从社会角度估计的。我们进行了单向确定性敏感性分析,10000个样本的蒙特卡罗模拟概率灵敏度分析,和情景分析。
结果:2剂量RZV免疫计划的ICER超过无RZV免疫计划的ICER为78777774JPY(约60万美元)/QALY。单向确定性敏感性分析表明,与HZ相关的效用对ICER最为显著。概率敏感性分析中的所有估计值均高于500万日元/QALY的支付意愿阈值。
结论:我们的研究表明,对于≥50岁的PLWHIV,没有RZV免疫比2剂量RZV免疫计划更具成本效益。这在基于证据的政策制定中可能很有用。