Abstract：
OBJECTIVE: People living with HIV (PLWHIV) are susceptible to opportunistic infections including herpes zoster (HZ) and postherpetic neuralgia (PHN). The recombinant zoster vaccine (RZV) (Shingrix) is available in some countries. However, the cost-effectiveness for PLWHIV remains unknown. This study aimed to analyze the cost-effectiveness of RZV for PLWHIV ≥50 years old.
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.
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.
摘要：
目的：HIV感染者（PLWHIV）容易受到包括带状疱疹（HZ）和带状疱疹后神经痛（PHN）在内的机会性感染。重组带状疱疹疫苗(RZV)(Shingrix)在一些国家是可用的。然而,PLWHIV的成本效益仍然未知.本研究旨在分析RZV对≥50岁PLWHIV患者的成本-效果。
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。
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。
