Cost-Effectiveness of the Adjuvant Recombinant Zoster Vaccine in Japanese Adults Aged 65 Years and Older

Abstract

Introduction The incidence of herpes zoster (HZ) rises steeply after the age of 50 years and the number of HZ cases and complications such as postherpetic neuralgia (PHN) is predicted to increase because of the ageing population. The objective of this study was to estimate the cost-effectiveness of recombinant zoster vaccine (RZV) compared with no vaccine for the Japanese population aged ≥ 65 years. Methods A multi-cohort static Markov model with a cycle length of 1 year was used to follow a hypothetical cohort of 1 million people aged ≥ 65 years over their remaining lifetime. Vaccination at ≥ 65 years was used in alignment with the influenza and pneumococcal vaccines recommended from 65 years. Japan-specific data inputs for the model were obtained from local 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% with a second dose compliance of 95%. Costs and outcomes were discounted at 2% annually and the incremental cost-effectiveness ratio (ICER) was calculated from both a payer’s and the societal perspective. Sensitivity analyses were carried out to explore the overall uncertainty in the model. Results Vaccination with RZV was projected to prevent 48,943 HZ cases and 12,136 PHN cases per million people aged ≥ 65 years compared with no vaccination. The incremental costs and quality-adjusted life years (QALYs) gained were ¥9.99 billion and 2314 QALYs from a payer’s perspective and ¥9.34 billion and 2314 QALYs from a societal perspective. The resulting ICERs were approximately ¥4,320,000 and ¥4,040,000 per QALY gained from a payer’s and the societal perspective, respectively. The ICER remained below a willingness-to-pay threshold of ¥5,000,000 for most sensitivity analyses carried out. Conclusion Vaccination against HZ with RZV would be cost-effective compared with no vaccination for the Japanese population aged ≥ 65 years. Trial Registration GSK study identifier: HO-16-17837. Funding GlaxoSmithKline Biologicals SA. Electronic supplementary material The online version of this article (10.1007/s13555-019-0291-4) 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

“…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 . 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 resource utilization in older adults compared with VVL and would be a cost‐effective strategy . 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 .…”

“…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.…”

Potential public health impact of the adjuvanted recombinant zoster vaccine among people aged 50 years and older in Beijing

“…As HZ-related mortality data were not readily available for Beijing or China, data from Japan were employed. 26 The model assumed no additional mortality specifically attributable to PHN or other complications, on top of that from HZ.…”