Cost-Effectiveness Analysis Update of the Adjuvanted Recombinant Zoster Vaccine in Japanese Older Adults

Abstract

Introduction This study aimed to update cost-effectiveness and public health impact estimates of the two-dose recombinant zoster vaccine (RZV) compared with no vaccination against herpes zoster (HZ) in the Japanese population aged 65 years. List price of the vaccine and latest RZV efficacy and waning estimates were incorporated. Methods A multicohort static Markov model with a cycle length of 1 year was used to follow a hypothetical cohort of one million people aged 65 years over their remaining lifetime (base case). Age-stratified vaccine efficacy and waning rates were updated on the basis of the latest clinical trial data (interim ZOE-LTFU; NCT02723773). First-dose coverage was assumed at 40%, and second-dose compliance was assumed at 95%. Costs and outcomes were discounted at 2% annually, and the incremental cost-effectiveness ratio (ICER) was calculated from payer and societal perspectives. The societal perspective considered productivity loss due to suffering HZ, or due to suffering HZ and time required for vaccination. Sensitivity analyses explored the overall uncertainties in the model. Scenario analyses for Japanese adults aged 50, 60, 70, 80, ≥ 50, and ≥ 65 years (main scenario) were conducted. An ICER below ¥5–6 million/quality-adjusted life-year (QALY) was considered cost-effective. Results RZV was estimated to prevent 71,423 HZ cases and 15,858 post-herpetic neuralgia (PHN) cases per million people aged 65 years compared with no vaccine in Japan. The ICER was ¥4,205,515 from a payer perspective and was most sensitive to assumptions regarding vaccine efficacy waning, proportion of patients with HZ developing PHN, and HZ incidence. From societal perspectives, ICERs were ¥3,854,192 (productivity loss from suffering HZ only) and ¥4,622,212 (productivity loss from suffering HZ and time required for vaccination). Overall, the results were considered robust under extensive sensitivity and scenario analyses. Conclusion Vaccination against HZ with RZV is cost-effective compared with no vaccination in Japanese adults aged 65 years. Graphical abstract Supplementary Information The online version contains supplementary material available at 10.1007/s13555-022-00744-8.

Public health impact of herpes zoster vaccination on older adults in Hong Kong

“… 31 While it is challenging to make meaningful comparisons between our NNV values for the overall cohort and the gender-specific NNV trends reported in You et al, 31 there is some congruency between the two sets of results in that the NNV to prevent one HZ case generally increased with age. In a broader context, our NNV result for RZV to prevent one HZ case in the overall cohort is consistent with recent findings in the region, where NNV was reported to be 6 in Japan 55 and 8 in Beijing. 30 As for PHN, the NNV for RZV to prevent one case in the overall cohort was 40 in our study, which was numerically higher than 26 reported in the Japan study 55 but lower than 68 reported in the Beijing study.…”

“…In a broader context, our NNV result for RZV to prevent one HZ case in the overall cohort is consistent with recent findings in the region, where NNV was reported to be 6 in Japan 55 and 8 in Beijing. 30 As for PHN, the NNV for RZV to prevent one case in the overall cohort was 40 in our study, which was numerically higher than 26 reported in the Japan study 55 but lower than 68 reported in the Beijing study. 30 This observed difference may be explained by the differing target age groups (≥50 YOA in our study and the Beijing study; 65 YOA in the Japan study) and local-specific model parameters in the reported studies.…”

“… 30 This observed difference may be explained by the differing target age groups (≥50 YOA in our study and the Beijing study; 65 YOA in the Japan study) and local-specific model parameters in the reported studies. 30 , 55 Therefore, given that existing local data are limited and the above evidence, our study provides useful insight into the PHI and efficiency of HZ vaccination in Hong Kong through RZV.…”

Willingness to Pay for COVID-19 Vaccines in Japan

“…However, it is important for preventive medicine to be cost-effective; incremental quality-adjusted life years (QALYs) gained from COVID-19 vaccination were not sought in this study. The generally acceptable threshold in Japan is less than 5-6 million JPY/QALY [38], and a health economic analysis of where the market price of this COVID-19 vaccine should be set is an important issue to be considered in the future.…”

The potential economic impact of the updated COVID-19 mRNA fall 2023 vaccines in Japan

“…48 All other AE costs were derived from Teng (2022), with the assumptions that 20% of grade 3 systemic AEs would require an outpatient visit, and that 60% of anaphylaxis cases would require hospitalization (and the remaining 40% would require emergency room care). 49 AE QALY losses were obtained from Teng (2022), and the QALY loss associated with infection-induced myocarditis was estimated based on data from Prosser (2019). 49,50 Inputs for vaccine-related AEs are presented in Table 4 below.…”