Cost-effectiveness of candidate adjuvanted subunit vaccine for vaccinating U.S. adults not previously vaccinated against herpes zoster
BACKGROUND: Herpes Zoster (HZ) affects one in three adults in the
United States (U.S.) over the course of their lifetimes. HZ is characterized
by a highly painful rash and is associated with a substantial cost burden.
One vaccine is currently marketed in the U.S. to prevent HZ, Zoster
Vaccine Live (ZVL). A non-live adjuvanted subunit vaccine (HZ/su)
for prevention of HZ is under regulatory review in the U.S.
OBJECTIVE: To determine the cost-effectiveness of HZ/su versus no
vaccine and versus ZVL for U.S. adults not previously vaccinated
against HZ aged 60+.
METHODS: The ZOster ecoNomic Analysis (ZONA) model is a deterministic
Markov model. A hypothetical 1 million(M)-person cohort of
U.S. adults not previously vaccinated against HZ aged 60+ was modeled
over their remaining lifetimes from the year of vaccination with
annual cycle lengths. Three different HZ vaccination strategies were
compared: no vaccination, vaccination with HZ/su, and vaccination
with ZVL. The primary perspective was societal, including both direct
medical costs and indirect costs. Model inputs included: demographics,
incidence and disease burden, vaccine characteristics, utilities,
and vaccine costs. Costs and quality-adjusted life-years (QALYs) were
presented over the lifetime of the cohort, with both discounted 3% per
year. Deterministic and probabilistic sensitivity analyses, along with
scenario and threshold analyses were carried out to explore the robustness
of our findings considering uncertainty about model inputs.
RESULTS: The ZONA model estimated that in the 1M-person cohort,
HZ/su vaccination would reduce disease burden resulting in a gain of
2,291 QALYs at a total societal cost of $27M compared to no vaccination.
This produced an incremental cost-effectiveness ratio of $11,863
per QALY saved. Compared to ZVL, the ZONA model estimated that
vaccination of the cohort with HZ/su would reduce disease burden
and result in a gain of 1,261 discounted QALYs and societal cost savings
of almost $96M. Sensitivity, scenario, and threshold analyses
demonstrated robustness of these findings.
CONCLUSIONS: For vaccinating U.S. adults aged 60+ who have not
been previously vaccinated against HZ, HZ/su is cost-effective relative
to a no vaccination choice and cost saving relative to a vaccination
with ZVL choice. These findings were robust as demonstrated by sensitivity,
scenario, and threshold analyses.
Patterson, B., Curran, D., Buck, P., Varghese, L., Oorschot, D., Carrico, J. D., ... Yawn, B. (2018). Cost-effectiveness of candidate adjuvanted subunit vaccine for vaccinating U.S. adults not previously vaccinated against herpes zoster. Journal of Managed Care and Specialty Pharmacy, 24(4-a), S20. [B2]. DOI: 10.18553/jmcp.2018.24.4-a.s1