A Cost-effectiveness Analysis of an Adjuvanted Subunit Vaccine for the Prevention of Herpes Zoster and Post-herpetic Neuralgia

Abstract

Background Herpes zoster (HZ) develops in up to 50% of unvaccinated individuals, accounting for >1 million cases annually in the United States. A live attenuated HZ vaccine (LAV) is Food and Drug Administration approved for those age 50 years or older, though Advisory Committee on Immunization Practices recommendations are only for those age 60 years or older. LAV efficacy is ~70% for persons 50–59 years of age, with lower efficacy in older adults. A new 2-dose adjuvanted subunit vaccine (SUV) has >95% efficacy in persons 50–69 years of age and remains ~90% efficacious in persons vaccinated at age 70 years. Methods To estimate the relative cost-effectiveness of SUV, LAV, and no vaccination (NoV) strategies, a Markov model was developed based on published data on vaccine efficacy, durability of protection, quality of life, resource utilization, costs, and disease epidemiology. The perspective was US societal, and the cycle length was 1 year with a lifelong time horizon. SUV efficacy was estimated to wane at the same rate as LAV. Outcomes evaluated included lifetime costs, discounted life expectancy, and incremental cost-effectiveness ratios (ICERs). Results For individuals vaccinated at age 50 years, the ICER for LAV vs NoV was $118 535 per quality-adjusted life-year (QALY); at age 60 years, the ICER dropped to $42 712/QALY. SUV was more expensive but had better ICERs than LAV. At age 50, the ICER was $91 156/QALY, and it dropped to $19 300/QALY at age 60. Conclusions Vaccination with SUV was more cost-effective than LAV in all age groups studied. Vaccination with SUV at age 50 years appears cost-effective, with an ICER <$100 000/QALY.

JAK inhibitors and infections risk: focus on herpes zoster

“…110 This vaccine was shown to induce an effective immune response and appears cost-effective compared with the live attenuated vaccine. 111,112 The recombinant vaccine represents a safe alternative for immunosuppressed patients in whom the previous attenuated vaccine is contraindicated. 113 The recent EULAR guidelines on vaccination include the possibility to use the recently approved non-live recombinant zoster vaccine, when commercially available, as it demonstrated to be equally effective although safer than the live vaccine in immunosuppressed adults.…”

Cost-effectiveness of the recombinant zoster vaccine (RZV) against herpes zoster: An updated critical review

“…Three studies 21 , 23 , 24 examined the CE of RZV on cohorts previously vaccinated with ZVL. Many studies 20 , 24 , 25 , 29 , 30 , 32 additionally performed CE analyses of ZVL vaccination vs no vaccination 13 .…”

“…Eleven studies 19–21 , 24 , 25 , 27 , 29 , 30 , 32 , 34 , 35 were funded independently; six studies 22 , 23 , 26 , 28 , 31 , 33 were funded by the vaccine manufacturer. One study 18 compared the results of two separate CEA analyses on immunocompromised populations <50 YOA (one conducted by the CDC, the other by the vaccine manufacturer).…”

“…Most models 22 , 23 , 25 , 26 , 28 , 29 , 33 were implemented in Excel but a few 24 , 32 , 35 relied on various versions of TreeAge Pro . 37 Two models 19 , 30 were implemented in R .…”

Estimated Public Health Impact of the Recombinant Zoster Vaccine

“…24 Previous economic evaluations have assessed the value and affordability of vaccination with RZV in the United States. 13,[25][26][27][28] These analyses, which were conducted to inform HZ vaccination recommendations and RZV reimbursement decisions, modeled the impact of RZV on hypothetical cohorts of older adults or for specific health plan populations that only represented a portion of the US population. Analyses providing public health stakeholders and other policymakers with broad, population-level estimates of the public health impact of potential RZV coverage levels have not been conducted.…”