New herpes zoster vaccine predicted to be more cost effective than predecessor  

1. In a computational model, the new “recombinant zoster vaccine” (RZV) was predicted to be most cost-effective than the previous gold standard, the zoster vaccine live (ZVL).

2. The RZV vaccine was predicted to perform better even if only half of patients received the second dose.

Evidence Rating Level: 4 (Below Average)

Study Rundown: A new Herpes zoster (HZ) vaccine called the “recombinant zoster vaccine” (RZV) was approved by the FDA in 2017.  In clinical trials, the RSV was shown to have a higher efficacy than the former gold standard, the “zoster vaccine live” (ZVL).  In this study, a computational model was used to compare the RZV to the ZVLvaccine  using data from a number of published studies.  For all age groups from 50-99, RZV cost less and prevented more cases of HZ, resulting in a favorable incremental cost-effectiveness ratio (ICER).  Notably, their data showed that vaccination with RZV was cheaper than non-vaccination for patients aged 50-59, an age group that did not routinely receive the ZVL vaccine.  As with any simulation, these results were reliant upon a number of assumptions about disease prevalence, symptom severity, and patient and physician compliance with recommendations.  The authors demonstrated that their conclusions were robust to variation in most of these parameters, but duration of vaccine efficacy remained a significant concern.  The ZVL vaccine has been shown to wane significantly over 11 years, and there are not yet sufficient data to determine if the RZV will have similar limitations.

Click to read the study in Annals of Internal Medicine

Click to read the accompanying editorial in Annals of Internal Medicine

Relevant Reading: Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines

In-Depth [simulation]:  This study constructed a computational model to predict the societal cost-effectiveness of different vaccination regimes.  Using published data for the RZV and ZVL vaccines, the authors determined that the RZV vaccine was cheaper and had more health benefits for each age group between 50 and 99.  The primary outcome was the incremental cost-effectiveness ratio (ICER), which is measured in dollars per quality-adjusted life year (QALY).  On a decade by decade basis, the predicted ICER score ranged from $1,000/QALY to $4,700/QALY.  Though the incremental cost was highest for patients aged 50-59, the vaccine was still considered to be economically favorable.  Since it can be difficult to predict adherence for a multiple-injection vaccine series, the authors also confirmed that ICER remains cost effective even if only 50% of patients receive the second dose.  The results were similarly robust to a number of other variables, including incidence of HZ, incidence of post-herpetic neuralgia, and severity of post-vaccination symptoms.  However, their conclusions relied upon sustained vaccine efficacy, which has been a major limitation of the ZVL vaccine.

Image: PD

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