A health economic model for evaluating a vaccine for the prevention of herpes zoster and post-herpetic neuralgia in the UK

Abstract

BackgroundA live-attenuated vaccine aimed at preventing herpes zoster (HZ) and its main complication, post-herpetic neuralgia (PHN) is available in Europe for immunocompetent adults aged 50 years and more. The study objective is to assess the cost effectiveness of a vaccination program for this population in the UK.MethodsA state-transition Markov model has been developed to simulate the natural history of HZ and PHN and to estimate the lifetime effects of vaccination in the UK. Several health states are defined including good health, HZ, PHN, and death. HZ and PHN health states are further divided to reflect pain severity.ResultsThe model predicts that a vaccination strategy for those aged over 50 years would lead to an incremental cost-effectiveness ratio of £13,077 per QALY gained from the NHS perspective, when compared to the current strategy of no vaccination. Age-group analyses show that the lowest ICERs (£10,984 and £10,275 for NHS) are observed when vaccinating people between 60-64 and 65-69 years of age. Sensitivity analyses showed that results are sensitive to the duration of vaccine protection, discount rate, utility decrements and pain severity split used.ConclusionsUsing the commonly accepted threshold of £30,000 per QALY gained in the UK, most scenarios of vaccination programmes preventing HZ and PHN, including the potential use of a repeat dose, may be considered cost-effective by the NHS, especially within the 60 to 69 age-groups.

Cost-effectiveness of vaccination against herpes zoster

“…32,33 Finally 14 cost-effectiveness studies of HZ vaccination remained and were systematically reviewed. [34][35][36][37][38][39][40][41][42][43][44][45][46][47] Main study characteristics Table 1 summarizes the main characteristics of the included studies ordered by publication date. Several studies did not mention all the main features reported in Table 1, such as time horizon, costing year, sensitivity analysis and funding.…”

“…Country and funding Of the 14 studies included, 9 were conducted in European countries (UK, Belgium, The Netherlands, Switzerland and France) [34][35][36][37][38][39][40][41][42][43][44][45][46][47] and 5 in non-European countries (US and Canada). [35][36][37][38][39] Six studies were funded by the pharmaceutical industry, 36,38,41,42,44,46 five studies by public resources 34,37,39,40,43,45 and two studies were performed without external funding.…”

“…[35][36][37][38][39] Six studies were funded by the pharmaceutical industry, 36,38,41,42,44,46 five studies by public resources 34,37,39,40,43,45 and two studies were performed without external funding. 35,47 Type of analysis All 14 studies used the incremental cost-effectiveness ratio (ICER) as primary outcome, in which costs are expressed as monetary units and effects as quality-adjusted life years (QALY) gained.…”

“…35,47 Type of analysis All 14 studies used the incremental cost-effectiveness ratio (ICER) as primary outcome, in which costs are expressed as monetary units and effects as quality-adjusted life years (QALY) gained. Several studies also performed a cost-effectiveness analysis, presenting results as costs per averted HZ case, 36,41,42,44,46 per averted PHN case, 36,41,42,44,46 or per life year gained. 34 Model design and alternatives A total of 13 studies used a "traditional" decision analytic model to calculate the cost-effectiveness of vaccination against HZ.…”

“…34 Model design and alternatives A total of 13 studies used a "traditional" decision analytic model to calculate the cost-effectiveness of vaccination against HZ. [34][35][36][37][38][39][40][41][42][43][44][45][46][47] Decision models which were predominantly used concern Cohort models and Markov models. One study used discrete event simulation (DES) modeling.…”