背景:目前,预防带状疱疹的重组亚单位疫苗和减毒活疫苗已在中国批准上市。本研究旨在评估重组亚单位疫苗和减毒活疫苗在中国人群中的成本-效果。
方法:使用决策树-马尔可夫分析模型来估计预期成本和质量调整寿命年(QALYs),比较疫苗接种与重组亚单位疫苗的终生成本效益(伦敦,英国,Shingrix,GSK)对减毒活疫苗(长春,中国,干威,长春Bcht)在中国人口中,主要结果指标是增量成本效益比(ICER)。
结果:在基本案例分析中,重组亚单位疫苗的ICER按年龄划分,从每QALY3428美元到5743美元不等,而减毒活疫苗的ICER在每QALY4017美元至18,254美元之间,与没有接种疫苗相比。在所有年龄组中,60至69岁是最佳接种年龄.结果对带状疱疹发病率的变化最敏感,疫苗功效,和贴现率。即使重组亚单位疫苗的两剂依从率达到20%,疫苗接种仍然具有成本效益。与RZV相比,ZVL需要将成本降低至少12.2%才能具有成本效益优势。
结论:重组亚单位疫苗和减毒活疫苗在中国人群中都具有成本效益,但是,相对而言,在50岁以上的所有年龄组中,重组亚单位疫苗在疾病预防和成本效益方面具有更大的优势.
BACKGROUND: Currently, the recombinant subunit vaccine and live attenuated vaccine in the prevention of herpes zoster are approved for marketing in China. This study aims to evaluate the cost-effectiveness of the recombinant subunit vaccine and the live attenuated vaccine in the Chinese population.
METHODS: A decision tree-Markov analysis model was utilized to estimate expected costs and quality-adjusted life years (QALYs), comparing the lifetime cost-effectiveness of vaccination with the recombinant subunit vaccine (London, United Kingdom, Shingrix, GSK) to that of the live attenuated vaccine (Changchun, China, Ganwei, Changchun Bcht) in the Chinese population, with the primary outcome measure being the incremental cost-effectiveness ratio (ICER).
RESULTS: In the base-case analysis, the ICERs for the recombinant subunit vaccine ranged by age from USD 3428 to USD 5743 per QALY, while the ICERs for the live attenuated vaccine ranged from USD 4017 to USD 18,254 per QALY, compared with no vaccination. Among all age groups, the category of 60 to 69 years was the optimal age for vaccination. The results were most sensitive to changes in herpes zoster incidence, vaccine efficacy, and discount rate. Even with a two-dose compliance rate of 20% for the recombinant subunit vaccine, vaccination remained cost-effective. ZVL would need to reduce costs by at least 12.2% compared to RZV to have a cost-effectiveness advantage.
CONCLUSIONS: The recombinant subunit vaccine and the live attenuated vaccine were both cost-effective in the Chinese population, but, relatively, the recombinant subunit vaccine had a greater advantage in disease prevention and cost-effectiveness in all age groups above 50 years.