Community and patient values for preventing herpes zoster
Community and patient values for preventing herpes zoster
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DOI：
10.2165/00019053-200826030-00006
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发表时间：
2008-01-01
影响因子：
4.4
通讯作者：
Prosser, Lisa A.
中科院分区：
文献类型：
--
作者：
Lieu, Tracy A.;Ortega-Sanchez, Ismael;Prosser, Lisa A.
目的：美国免疫实践咨询委员会最近推荐了一种新的带状疱疹(带状疱疹)疫苗，供60岁的成年人常规使用。然而，对这种疫苗的成本效益的估计差异很大，部分原因是关于预防带状疱疹的价值的数据存在差距。我们的目标是(I)就预防带状疱疹的一系列后果的价值产生全面的信息；(Ii)在社区成员和带状疱疹和带状疱疹后神经痛(PHN)患者中比较这些值；方法：来自全国代表性调查研究小组的社区成员(n=527)完成了一项基于互联网的调查，使用时间权衡和支付意愿问题来评估一系列情景，这些情景描述了带状疱疹患者的不同疼痛强度(0到10，其中0代表不痛，10代表可以想象到的最严重的疼痛)和持续时间(30天到1年)。来自两个大型医疗保健系统的带状疱疹患者(n=382)或PEN患者(n=137)[定义为90天内有症状]完成了电话采访，回答了与基于互联网的调查类似的问题，并回答了有关他们目前带状疱疹经历的问题。结果：在时间权衡问题上，社区成员提供了89天(95%可信区间24,182)的平均折扣天数来避免最轻的情景(疼痛级别为3的1个月)和162天(95%可信区间88,259)的折扣天数以避免最严重的情景(疼痛级别为8的12个月)。与带状疱疹患者相比，社区成员交换了更多的天数来避免低严重性的情况，但相似的天数来避免高严重性的情况。与PHN患者相比，社区成员交易的天数更少，以避免高度严重的情况。在支付意愿问题中，社区成员提供的平均金额为450美元(95%可信区间203,893)以避免1个月达到3级的疼痛，平均1384美元(95%可信区间873,2050)[2005年的数值]以避免12个月的8级疼痛。社区成员比带状疱疹或PHN患者花更少的钱来避免低度和高度严重的情况(p值
Objectives: The US Advisory Committee on Immunization Practices has recently recommended a new vaccine against herpes zoster (shingles) for routine use in adults aged >= 60 years. However, estimates of the cost effectiveness of this vaccine vary widely, in part because of gaps in the data on the value of preventing herpes zoster. Our aims were to (i) generate comprehensive information on the value of preventing a range of outcomes of herpes zoster; (ii) compare these values among community members and patients with shingles and post-herpetic neuralgia (PHN); and (iii) identify clinical and demographic characteristics that explain the variation in these values.Methods: Community members drawn from a nationally representative survey research panel (n = 527) completed an Internet-based survey using time trade-off and willingness-to-pay questions to value a series of scenarios that described cases of herpes zoster with varying pain intensities (on a scale of 0 to 10, where 0 represents no pain and 10 represents the worst imaginable pain) and duration (30 days to 1 year). Patients with shingles (n = 382) or PEN (n = 137) [defined as having symptoms for >= 90 days] from two large healthcare systems completed telephone interviews with similar questions to the Internet-based survey and also answered questions about their current experience with herpes zoster. We constructed generalized linear mixed models to evaluate the associations between demographic and clinical characteristics, the length and intensity of the health states and time trade-off and willingness-to-pay values.Results: In time trade-off questions, community members offered a mean of 89 (95% CI 24, 182) discounted days to avoid the least severe scenario (pain level of 3 for 1 month) and a mean of 162 (95% CI 88, 259) discounted days to avoid the most severe scenario (pain level of 8 for 12 months). Compared with patients with shingles, community members traded more days to avoid low-severity scenarios but similar numbers of days to avoid high-severity scenarios. Compared with patients with PHN, community members traded fewer days to avoid high-severity scenarios. In multivariate analyses, older age was the only characteristic significantly associated with higher time trade-off values.In willingness-to-pay questions, community members offered a mean of $US450 (95% CI 203, 893) to avoid pain of level 3 for I month and a mean of $US1384 (95% CI 873, 2050) [year 2005 values] to avoid pain of level 8 for 12 months. Community members traded less money than patients with either shingles or PHN to avoid both low- and high-severity scenarios (p-values