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

Abstract

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.

Sponsorship Bias in Base-Case Values and Uncertainty Bounds of Health Economic Evaluations? A Systematic Review of Herpes Zoster Vaccination

“…Most studies report utility weights and/or utility loss related to experiencing herpes zoster with mild, moderate, or severe pain, using the same definition—that is, mild pain as a score of 1 to 2 on an 11-point scale (Zoster Brief Pain Inventory 50 ), moderate pain as a score of 2 to 6 on an 11-point scale, and severe pain as a score of 7 to 10 on an 11-point scale. 28–30,32–34,43–45 Brisson et al 31 do not distinguish between mild and moderate (i.e., mild/moderate was defined as scores 1–6 on an 11-point scale). Najafzadeh et al 40 report a slightly different score for mild (score 0–3), moderate (score 4–7), and severe (score 8–10).…”

“…Also, for the United Kingdom, Moore et al’s base-case PHN proportion 32 is higher than the one assumed by van Hoek et al, 43 but they used a different definition for PHN and different data sources. The 2 German evaluations used data on PHN proportion from 2 different German studies, leading to a much higher base-case proportion assumed by the IF study 34 : 16% compared to 5%. In sensitivity analysis, Préaud et al 34 used the base-case proportion from Ultsch et al 42 Préaud et al 34 used the 1-month PHN definition, whereas Ultsch et al 42 used the 3-month PHN definition.…”

Economic Analysis of Herpes Zoster in a Hospital Setting in Hong Kong

“…Health economic studies found vaccination for HZ to be cost-effective in older adults in different countries (14,15). The current study provided important health economics parameters to the public healthcare policy decision-makers for estimation of the cost and benefits of zoster vaccination in reducing HZ-related hospitalization in Hong Kong.…”

Clinical and economic impact of herpes zoster vaccination in elderly in Italy

“…[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Although the mathematical models and the assumptions are different, these studies demonstrate clearly that the HZ vaccination in the elderly population has a favorable economic profile. Vaccination could have a significant impact on HZ disease and, above all, results a very good investment for NHS and Society.…”