1. The new adjuvanted herpes zoster subunit vaccine was more efficacious and less expensive for all ages at the price of $280 per series as compared to the single-dose herpes zoster vaccine.
2. It is unclear if a booster of the live attenuated herpes zoster vaccine would be cost-effective, as this was not investigated in this study.
Evidence Rating Level: 2 (Good)
Study Rundown: It is recommended that immunocompetent adults 60 years or older get the live attenuated herpes zoster vaccine (ZVL), however its efficacy decreases over time. A new adjuvanted herpes zoster subunit vaccine (HZ/su) may have higher efficacy over time but may be more expensive. This study aimed to assess the cost-effectiveness of the HZ/su vaccine as compared to the ZVL vaccine.
The HZ/Su vaccine was more effective and less expensive than ZVL vaccine for all ages at a price of $280 ($140 per dose for two doses). The HZ/su vaccine had a 73% probability of being cost-effective for 60-year-olds at $50,000 per quality-adjusted life-year (QALY). Limitations of this study include unknown adherence to the second dose of HZ/su. This study did not look at the possibility of a ZVL booster and thus this could be subject for further study.
In-Depth [decision model]: This Markov decision modeling study was conducted in July 2017 using randomized clinical trial data from medical literature search and aimed to compare the cost-effectiveness of no vaccination, vaccination with ZVL (1 dose) and vaccination with HZ/su (2 doses). Analyses were conducted separately for people aged 60-69, 70-79 and 80 years old and onwards. This was done because the cost-effectiveness of ZVL vaccines varies by vaccination age. Data was derived from participant groups ranging in number from less than 100 to more than 30,000 depending on the variable assessed. The main outcome of interest was total costs and estimated QALYs. Deterministic and probabilistic sensitivity analyses were conducted.
A price of $280 per two-dose series ($140 per dose) of the HZ/su vaccine was more effective and less expensive than the ZVL vaccine at all ages. At all ages no vaccination was the least expensive and least effective. The HZ/su was highly cost-effective compared with no vaccination with an incremental cost-effectiveness ratio below $50,000 per QALY at all ages. The finding was insensitive to variations in most model inputs other than vaccine price and adherence rate. In probabilistic sensitivity analysis HZ/su had 73% probability of being cost-effective for 60-year-olds at $50,000 per QALY.
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