New Recombinant Vaccine Most Cost-Effective Alternative for Preventing Herpes Zoster

By Will Boggs MD

February 22, 2019

NEW YORK (Reuters Health) - The new recombinant zoster vaccine (RZV) is more cost-effective than both the zoster vaccine live (ZVL) and no vaccination for preventing herpes zoster and related complications, according to a model study.

"We were interested to learn that the cost-effectiveness results were consistent with a policy to vaccinate individuals older than 60 with RZV, even if they had already received ZVL within the last year," Dr. Lisa A. Prosser of the University of Michigan, in Ann Arbor, told Reuters Health by email.

Using published U.S. epidemiological, clinical and cost data, Dr. Prosser and colleagues estimated the cost-effectiveness of vaccination with RZV compared with ZVL and no vaccine, of vaccination with RZV for people who have previously received ZVL, and of preferential vaccination with RZV over ZVL.

Compared with no vaccination, RZV prevented 30% of cases for persons aged 50 to 59 years and 72% of cases for those aged 80 to 89 years over the lifetime horizon, the team reports in the Annals of Internal Medicine, online February 19.

Vaccination with RZV was associated with lower total costs than vaccination with ZVL for all age groups, and vaccination with either vaccine resulted in higher total costs than no vaccination.

From the societal perspective and assuming 100% completion of the two-dose RZV regimen, incremental cost-effective ratios (ICERs) ranged from $10,000 to $47,000 per quality-adjusted life-year (QALY), depending on age at vaccination, and amounted to $19,000 per QALY compared with no vaccination for the combined population aged 60 years or older.

From the healthcare sector perspective, the ICER for this age group was $29,000 per QALY.

In the model, vaccination with ZVL yielded higher costs and fewer health benefits than RZV across all age groups.

Among people previously vaccinated with ZVL, ICERs were below $60,000 per QALY for all age groups except those aged 60 to 69 years who were vaccinated with RZV immediately after vaccination with ZVL and those younger than 60 years, for whom the ICER was $113,000 per QALY.

Vaccination with ZVL would become the preferred strategy for adults aged 60 to 69 years only if the effectiveness of RZV fell below 95% for the two-dose series and 85% for the single-dose, with waning durations of effectiveness and with only 20% of patients completing the two-dose series.

"Recombinant zoster vaccine represents an important new tool for preventing illness and reducing economic burden due to herpes zoster and its complications," the researchers conclude. "As more data become available, future studies should evaluate the Advisory Committee on Immunization Practices (ACIP) policy under real-world conditions by incorporating information on actual vaccine effectiveness and durability, 2-dose series completion, reactogenicity, and serious adverse events."

"These analyses support the September 2017 ACIP recommendations to favor RZV over ZVL, to actively recommend herpes zoster immunization starting at age 50 years, and to give RZV to persons older than 60 years who previously received ZVL," writes Dr. Stephen D. Shafran of the University of Alberta, in Edmonton, Canada, in a linked editorial.

"A challenge with RZV is the need to administer a second dose," he notes. "Another limitation of the current study is that the efficacy values it used for a single dose of RZV - 90% for persons aged 50 to 69 years and 69% for those aged 70 years or older - were derived from a post hoc analysis of the ZOE trials (whose) mean duration of follow-up was less than 90 days. Thus, the true efficacy beyond 90 days after a single dose of RZV is unknown."

Dr. Phuc Le from Cleveland Clinic's Center for Value-Based Care Research, in Ohio, who was not involved in the study, recently published a systematic review of the cost-effectiveness of herpes zoster vaccination. She told Reuters Health by email, "Because we don't have information about the effectiveness of 1 dose, getting both doses is crucial to receive the full vaccine efficacy, as reported in clinical trials, which drives the vaccine cost-effectiveness. Therefore, the current vaccine shortage is an important issue to consider when physicians prescribe the vaccine. Other things to consider are the vaccine's side effects and price change over time."

Dr. Bruce Y. Lee from Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, who has also done cost-effectiveness studies of zoster vaccines, told Reuters Health by email, "Herpes zoster is not a minor problem. It can have a number of complications that can cause severe pain and discomfort, which may even last for years. Vision loss and skin infections can occur as well."

"These complications can also cost money," added Dr. Lee, who was not involved in the new work. "Getting the vaccine seems to be a small price to pay to reduce the risk of these problems."


Ann Intern Med 2019.