The Potential Public Health Impact of Herpes Zoster Vaccination of People Aged ≥ 50 Years in Japan: Results of a Markov Model Analysis

Abstract

IntroductionThe aim of this study was to compare the public health impact of introducing two herpes zoster (HZ) vaccines into the vaccination programs for the Japanese population aged ≥ 50 years: a single-dose Varicella Vaccine Live (VVL) or a two-dose adjuvanted Recombinant Zoster Vaccine (RZV).MethodsA multi-cohort static Markov model was developed to follow age cohorts (50–59, 60–69, 70–79 and ≥ 80 years) over their remaining lifetime. Japan-specific data inputs for the model were obtained from Japanese data sources. Age-stratified vaccine efficacy and waning rates were based on published clinical trial data. In the base-case analysis, vaccine coverage was assumed to be 40% for both vaccines, and compliance with second-dose of the RZV vaccine was set to 95%.ResultsVaccination with RZV was projected to prevent approximately 3.3 million HZ cases, 692,000 cases of postherpetic neuralgia (PHN), and 281,000 cases of other complications, compared with the prevention of 0.8 million HZ cases, 216,000 PHN cases, and 57,000 other complications with vaccination with VVL. The number of individuals needed to vaccinate in order to prevent one HZ case ranged from 6 to 14 using RZV (depending on age and assumed second-dose compliance) and from 21 to 138 depending on age using VVL. By preventing a higher number of HZ cases and its complications, RZV vaccination led to fewer outpatient visits and hospitalizations than vaccination with VVL.ConclusionBoth vaccines had a positive public health impact compared to no vaccination, but due to its higher vaccine efficacy, RZV demonstrated a superior public health impact compared with VVL.FundingGlaxoSmithKline Biologicals SA.Electronic supplementary materialThe online version of this article (10.1007/s13555-018-0236-3) contains supplementary material, which is available to authorized users.

Risk of herpes zoster in the Japanese population with immunocompromising and chronic disease conditions: Results from a claims database cohort study, from 2005 to 2014

“…resource utilization in older adults compared with VVL and would be a cost-effective strategy. 20,21 Furthermore, in the context of our findings, as a recombinant vaccine, RZV has the potential for use in immunocompromised subjects in which live attenuated vaccines are contraindicated. 27 The safety and immunogenicity of RZV immunization in immunocompromised subjects has been evaluated in a number of randomized studies (in patients undergoing HSCT, in patients with hematological or solid cancers, and in patients following renal transplantation) with no safety concerns.…”

“…At present, a number of effective vaccines to prevent episodes of primary or recurrent HZ episodes are available. These include a live attenuated HZ vaccine (ZVL, Zostavax [Merck Sharp & Dohme, Kenilworth, NJ, USA], which is globally available, and an alternative live vaccine in Japan, Varicella Vaccine Live [VVL], which contains a similar varicella titer to that used in ZVL) . More recently, an adjuvanted recombinant zoster vaccine (RZV, Shingrix [GSK, Rixensart, Belgium]) has been approved for use in older adults in Japan (≥50 years), and elsewhere including the USA and Canada (≥50 years), and Germany (≥60 years) …”

“…These include a live attenuated HZ vaccine (ZVL, Zostavax [Merck Sharp & Dohme, Kenilworth, NJ, USA], 19 which is globally available, and an alternative live vaccine in Japan, Varicella Vaccine Live [VVL], which contains a similar varicella titer to that used in ZVL). 20,21 More recently, an adjuvanted recombinant zoster vaccine (RZV, Shingrix [GSK, Rixensart, Belgium]) has been approved for use in older adults in Japan (≥50 years), and elsewhere including the USA and Canada (≥50 years), and Germany (≥60 years). 20,[22][23][24] The efficacy of RZV has been demonstrated in two large, global phase III trials (both of which included Japanese subjects) where vaccine efficacy of over 90% for HZ and for PHN was observed.…”

“…20,21 More recently, an adjuvanted recombinant zoster vaccine (RZV, Shingrix [GSK, Rixensart, Belgium]) has been approved for use in older adults in Japan (≥50 years), and elsewhere including the USA and Canada (≥50 years), and Germany (≥60 years). 20,[22][23][24] The efficacy of RZV has been demonstrated in two large, global phase III trials (both of which included Japanese subjects) where vaccine efficacy of over 90% for HZ and for PHN was observed. 25,26 Recent cost-effectiveness analyses for the use of RZV in Japan have estimated that RZV could prevent a substantially greater number of HZ cases and reduce…”

The potential public health impact of Herpes Zoster vaccination in the 65 years of age cohort in Italy

“…26 Furthermore, the National Advisory Committee on Immunization (NACI, Canada) has recently released a strong recommendation for using RZV in adults ≥50 YOA for the prevention of HZ without contraindications. 27 Recent analyses demonstrated the superior public health impact of RZV compared with ZVL in Germany and Japan, 28,29 as well as the cost-effectiveness of RZV in older adults in USA and Germany. 30,31 A previous study has shown that introducing a HZ vaccination program for older adults using ZVL would have a beneficial clinical and health economic impact in Italy, 32 while currently there is no such evidence for RZV in the Italian setting.…”