Cost-effectiveness of vaccination against herpes zoster and postherpetic neuralgia: a critical review

Kawai, Kosuke; Préaud, E.; Baron-Papillon, Florence; Largeron, Nathalie; Acosta, Camilo J.

doi:10.1016/j.vaccine.2014.01.058

Cited by 48 publications

(36 citation statements)

References 39 publications

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“…22 Furthermore, the results were in line with the conclusions drawn from 2 recent literature reviews [30][31][32] Methods…”

Section: Resultssupporting

confidence: 87%

“…Nevertheless, it is expected that these uncertainties surrounding the cost inputs were of minor impact on the results as demonstrated by the deterministic sensitivity analysis. Overall, our model which incorporated for the first time the real-life time efficacy waning with age, produced robust results aligned with existing literature 22,30,31 on HZ vaccination costeffectiveness and is highly transferable to the German setting. This study bring useful evidence to document what could be the potential expected efficiency of new vaccination program, benefits difficult to estimate prior vaccination implementation.…”

Section: Discussionsupporting

confidence: 68%

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Cost-effectiveness analysis of a vaccination program for the prevention of herpes zoster and post-herpetic neuralgia in adults aged 50 and over in Germany

Préaud

Uhart²,

Böhm³

et al. 2015

Human Vaccines & Immunotherapeutics

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Herpes zoster (HZ; shingles) is a common viral disease that affects the nerves and surrounding skin causing a painful dermatomal rash and leading to debilitating complications such as, mainly, post-herpetic neuralgia (PHN). Currently, there is no effective treatment for HZ and PHN. The objective of this study was to assess the cost-effectiveness of a HZ vaccination program in Germany. An existing Markov Model was adapted to the German healthcare setting to compare a vaccination policy to no vaccination on a lifetime time-horizon, considering 2 scenarios: vaccinating people starting at the age of 50 or at the age of 60 years, from the perspective of the statutory health insurance (SHI) and the societal perspective. According to the perspective, vaccinating 20% of the 60+ German population resulted in 162,713 to 186,732 HZ and 31,657 to 35,793 PHN cases avoided. Corresponding incremental cost-effectiveness ratios (ICER) were 39,306 €/QALY from the SHI perspective and 37,417 €/QALY from a societal perspective. Results for the 50+ German population ranged from 336,468 to 394,575 HZ and from 48,637 to 56,087 PHN cases avoided from the societal perspective. Corresponding ICER were 39,782 €/QALY from a SHI perspective and 32,848 €/QALY from a societal perspective. Sensitivity analyses showed that results are mainly impacted by discount rates, utility values and use of alternative epidemiological data.The model indicated that a HZ vaccination policy in Germany leads to significant public health benefits and could be a cost-effective intervention. The results were robust and consistent with local and international existing literature.

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“…22 Furthermore, the results were in line with the conclusions drawn from 2 recent literature reviews [30][31][32] Methods…”

Section: Resultssupporting

confidence: 87%

Section: Discussionsupporting

confidence: 68%

Cost-effectiveness analysis of a vaccination program for the prevention of herpes zoster and post-herpetic neuralgia in adults aged 50 and over in Germany

Préaud

Uhart²,

Böhm³

et al. 2015

Human Vaccines & Immunotherapeutics

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“…6,14 Cost effectiveness of Zostavax varies depending on patients' age and is more cost effective for patients aged 60–70 years but is not as cost effective for patients aged >80 years. 15,16 …”

Section: Introductionmentioning

confidence: 99%

National and State-Specific Shingles Vaccination Among Adults Aged ≥60 Years

Williams

Harpaz

2017

American Journal of Preventive Medicine

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Introduction Shingles (herpes zoster) causes substantial morbidity, especially among older adults. The shingles vaccine has been recommended for people aged ≥60 years since 2006. This study assessed recent shingles vaccination at national and state levels among adults aged ≥60 years. Methods The 2014 Behavioral Risk Factor Surveillance System data were analyzed in 2015 to assess shingles vaccination coverage among adults aged ≥60 years at national and state levels. Multivariable logistic regression and predictive marginal models identified factors independently associated with vaccination. Results Shingles vaccination coverage among adults aged ≥60 years was 31.8% (95% CI=31.4%, 32.2%). Among states, shingles vaccination coverage ranged from 17.8% (95% CI=15.8%, 20.0%) in Mississippi to 46.6% (95% CI=44.3%, 48.8%) in Vermont, with a median of 33.3%. Coverage was <25% in four states and >40% in nine states. For all states, coverage was significantly higher among non-Hispanic whites compared with non-white races except for Oregon, with coverage differences ranging from −33.2% in the District of Columbia to 0.9% in Oregon and a median of −16.0%. Characteristics independently associated with vaccination were age, race/ethnicity, sex, education, employment status, household income, region, perceived health status, health insurance status, personal healthcare provider, routine checkup status, and whether reporting that cost was a barrier to seeing a doctor. Conclusions Coverage varied dramatically by state. State-level comparisons may aid in designing tailored intervention programs through sharing of best practices. Strategies are needed to mitigate financial barriers for both provider and patients, improve awareness, and increase provider recommendation of the vaccine.

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“…In a review of 15 studies from North America and Europe, most concluded the zoster vaccine was cost effective, assuming that protection lasted an average of 10 years following immunization; the main cost benefits were via reducing morbidity associated with PHN, rather than zoster [97]. …”

Section: Development Of a Vaccine Against Zoster Efficacy And Safetymentioning

confidence: 99%

“…The original SPS had a relatively short follow up period (mean 3.4 years) so the duration of vaccine-induced protection was unclear. Most cost-effectiveness studies assumed life-long vaccine protection, some studies modeled a more conservative 7.5–10 years protection and others incorporated a waning effect of the vaccine over time [97]. Longer-term follow up of SPS participants, in the Short and Long Term Persistence Study (STPS and LTPS, respectively), demonstrates a waning of VE over time.…”

Section: Development Of a Vaccine Against Zoster Efficacy And Safetymentioning

confidence: 99%

Varicella and herpes zoster vaccine development: lessons learned

Warren‐Gash

Forbes

Breuer

2017

Expert Review of Vaccines

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Introduction: Before vaccination, varicella zoster virus (VZV), which is endemic worldwide, led to almost universal infection. This neurotropic virus persists lifelong by establishing latency in sensory ganglia, where its reactivation is controlled by VZV-specific T-cell immunity. Lifetime risk of VZV reactivation (zoster) is around 30%. Vaccine development was galvanised by the economic and societal burden of VZV, including debilitating zoster complications that largely affect older individuals. Areas covered: We describe the story of development, licensing and implementation of live attenuated vaccines against varicella and zoster. We consider the complex backdrop of VZV virology, pathogenesis and immune responses in the absence of suitable animal models and examine the changing epidemiology of VZV disease. We review the vaccines’ efficacy, safety, effectiveness and coverage using evidence from trials, observational studies from large routine health datasets and clinical post-marketing surveillance studies and outline newer developments in subunit and inactivated vaccines. Expert commentary: Safe and effective, varicella and zoster vaccines have already made major inroads into reducing the burden of VZV disease globally. As these live vaccines have the potential to reactivate and cause clinical disease, developing alternatives that do not establish latency is an attractive prospect but will require better understanding of latency mechanisms.

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Cost-effectiveness of vaccination against herpes zoster and postherpetic neuralgia: a critical review

Cited by 48 publications

References 39 publications

Cost-effectiveness analysis of a vaccination program for the prevention of herpes zoster and post-herpetic neuralgia in adults aged 50 and over in Germany

Cost-effectiveness analysis of a vaccination program for the prevention of herpes zoster and post-herpetic neuralgia in adults aged 50 and over in Germany

National and State-Specific Shingles Vaccination Among Adults Aged ≥60 Years

Varicella and herpes zoster vaccine development: lessons learned

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