Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults.
نویسندگان
چکیده
BACKGROUND A vaccine to prevent herpes zoster was recently approved by the United States Food and Drug Administration. We sought to determine the cost-effectiveness of this vaccine for different age groups. METHODS We constructed a cost-effectiveness model, based on the Shingles Prevention Study, to compare varicella zoster vaccination with usual care for healthy adults aged >60 years. Outcomes included cost in 2005 US dollars and quality-adjusted life expectancy. Costs and natural history data were drawn from the published literature; vaccine efficacy was assumed to persist for 10 years. RESULTS For the base case analysis, compared with usual care, vaccination increased quality-adjusted life expectancy by 0.0007-0.0024 quality-adjusted life years per person, depending on age at vaccination and sex. These increases came almost exclusively as a result of prevention of acute pain associated with herpes zoster and postherpetic neuralgia. Vaccination also increased costs by $94-$135 per person, compared with no vaccination. The incremental cost-effectiveness ranged from $44,000 per quality-adjusted life year saved for a 70-year-old woman to $191,000 per quality-adjusted life year saved for an 80-year-old man. For the sensitivity analysis, the decision was most sensitive to vaccine cost. At a cost of $46 per dose, vaccination cost <$50,000 per quality-adjusted life year saved for all adults >60 years of age. Other variables related to the vaccine (duration, efficacy, and adverse effects), postherpetic neuralgia (incidence, duration, and utility), herpes zoster (incidence and severity), and the discount rate all affected the cost-effectiveness ratio by >20%. CONCLUSIONS The cost-effectiveness of the varicella zoster vaccine varies substantially with patient age and often exceeds $100,000 per quality-adjusted life year saved. Age should be considered in vaccine recommendations.
منابع مشابه
A vaccine to prevent herpes zoster and post-herpetic neuralgia in older adults.
BACKGROUND The incidence and severity of herpes zoster and postherpetic neuralgia increase with age in association with a progressive decline in cell-mediated immunity to varicella-zoster virus (VZV). We tested the hypothesis that vaccination against VZV would decrease the incidence, severity, or both of herpes zoster and postherpetic neuralgia among older adults. METHODS We enrolled 38,546 a...
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Background. Herpes zoster (HZ), or shingles, is a painful disease that results from reactivation of the varicella zoster virus (VZV) which has remained latent in sensory ganglia following primary infection i.e. varicella (VZV), a virus commonly acquired in childhood (chickenpox) [1]. The most common complication is post-herpetic neuralgia (PHN), a severe pain that can persist for months [2]. HZ...
متن کاملA Vaccine to Prevent Herpes Zoster and Postherpetic Neuralgia in Older Adults
The authors’ affiliations are listed in the Appendix. Address reprint requests to Dr. Oxman at the Shingles Prevention Study (Mail code 111F-1), VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, or at mnoxman@ucsd. edu. *Other members of the Shingles Prevention Study Group are listed in the Appendix. N Engl J Med 2005;352:2271-84. Copyright © 2005 Massachusetts Med...
متن کاملA Cost-Effectiveness Analysis of an Adjuvanted Subunit Vaccine for the Prevention of Herpes Zoster and Post-Herpetic Neuralgia
متن کامل
Vaccination against Herpes Zoster and Postherpetic Neuralgia.
BACKGROUND Herpes zoster (HZ) and postherpetic neuralgia (PHN) cause significant morbidity in older adults. The incidence and severity of HZ and PHN increase with age in association with an age-related decline in varicella-zoster virus (VZV)-specific cell-mediated immunity (VZV-CMI). VZV vaccines can boost VZV-CMI. Therefore, we tested the hypothesis that VZV vaccination would protect older adu...
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ورودعنوان ژورنال:
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
دوره 44 10 شماره
صفحات -
تاریخ انتشار 2007