Cost-effectiveness of an adjuvanted recombinant zoster vaccine in older adults in the United States who have been previously vaccinated with zoster vaccine live

Abstract

Zoster Vaccine Live (ZVL) is marketed in the US since 2008, and a non-live adjuvanted Recombinant Zoster Vaccine (RZV) was approved in 2017. Literature suggests that waning of ZVL efficacy may necessitate additional vaccination. The Advisory Committee on Immunization Practices recommended vaccination with RZV in immunocompetent adults aged 50+ years old, including those previously vaccinated with ZVL. The objective of this study was to determine the cost-effectiveness of vaccinating US adults aged 60+ years old, previously vaccinated with ZVL. The ZOster ecoNomic Analysis (ZONA) model, a deterministic Markov model, was adapted to follow a hypothetical 1 million(M)-person cohort of US adults previously vaccinated with ZVL. Model inputs included demographics, epidemiology, vaccine characteristics, utilities and costs. Costs and quality-adjusted life-years (QALYs) were presented over the lifetimes of the cohort from the year of additional vaccination, discounted 3% annually. The model estimated that, vaccination with RZV 5 years after previous vaccination with ZVL, would reduce disease burden compared with no additional vaccination, resulting in a gain of 1,633 QALYs at a total societal cost of $96M (incremental cost-effectiveness ratio: $58,793/QALY saved). Compared with revaccinating with ZVL, vaccination with RZV would result in a gain of 1,187 QALYs and societal cost savings of almost $84M. Sensitivity, scenario, and threshold analyses demonstrated robustness of these findings. Vaccination with RZV is predicted to be cost-effective relative to no additional vaccination, assuming a threshold of $100,000/QALY, and cost-saving relative to ZVL revaccination of US adults aged 60+ years old who have been previously vaccinated with ZVL.

Cost-effectiveness of herpes zoster vaccines in the U.S.: A systematic review

“…1 displays the PRISMA flow diagram describing the article selection process. A total of eleven published studies assessing the cost-effectiveness of herpes zoster vaccines met the inclusion and exclusion criteria ( Wilson et al, 2020 , Carpenter et al, 2019 , Curran et al, 2019 , Prosser et al, 2019 , Curran et al, 2018 , Dooling et al, 2018 , Le and Rothberg, 2018 , Le and Rothberg, 2018 , Le and Rothberg, 2017 , Le and Rothberg, Feb 2017 , Le and Rothberg, 2015 ). Four studies exclusively used ZVL, which has been removed from the U.S. marketplace.…”

Incremental clinical and economic impact of recombinant zoster vaccination: real-world data in a budget impact model

“…15 The annual rates of initial and recurrent cases of HZ and rates of associated PHN and nonpain complications (i.e., ocular, neurological, cutaneous, and other nonpain complications) were considered in the model; the default values and assumptions for these epidemiological inputs have been described previously. 16,17 Vaccine efficacy, waning of efficacy, and adverse event inputs used in this model also have been described previously. 16,18 Efficacy against HZ and PHN was included for those vaccinated with RZV and ZVL, with the baseline efficacy for each vaccine varying by age and with efficacy waning based on the years since vaccination.…”

“…Each replication tracked a cohort of individuals year by year over a period of 1 to 15 years through a number of possible health states, consistent with previous costeffectiveness analyses for RZV. 16,17 The…”

Public Health Impact and Cost-Effectiveness of Non-live Adjuvanted Recombinant Zoster Vaccine in Canadian Adults

“…The US adaptation was also updated to examine the potential cost effectiveness of revaccinating adults who had previously been immunized with ZVL. The results demonstrated that vaccination with RZV is cost effective compared to no vaccination at $100,000 WTP in those previously immunized with ZVL [41]. Finally, two independent models including RZV and ZVL have recently been developed for the US context.…”