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Cost-Effectiveness Analysis of Herpes Zoster Vaccination in 50- to 85-Year-Old Immunocompetent Belgian Cohorts: A Comparison between No Vaccination, the Adjuvanted Subunit Vaccine, and Live-Attenuated Vaccine

Author

Listed:
  • Zoë Pieters

    (Hasselt University)

  • Benson Ogunjimi

    (University of Antwerp
    Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS)
    Antwerp University Hospital
    University of Antwerp)

  • Philippe Beutels

    (University of Antwerp)

  • Joke Bilcke

    (University of Antwerp)

Abstract

Background A new adjuvanted subunit vaccine (HZ/su), with higher vaccine efficacy than live-attenuated vaccine (ZVL), has been licensed in Europe since March 2018. Therefore, Belgian decision-makers might need to re-assess their recommendations for vaccination against herpes zoster (HZ). Methods We conducted a cost-effectiveness analysis, using a Markov decision tree, of vaccinating 50- to 85-year-old immunocompetent Belgian cohorts with no vaccination, HZ/su, ZVL, and ZVL with booster after 10 years. Due to the uncertainty in vaccine waning of HZ/su vaccine beyond 4 years, we used a logarithmic and 1-minus-exponential function to model respectively a long and short duration of protection. We used a lifetime time horizon and implemented the health care payer perspective throughout the analysis. Results HZ/su had the greatest impact in avoiding health and economic burden. However, it would never become cost-effective at a willingness-to-pay threshold of €40,000 per quality-adjusted life year (QALY) gained at its market price set by the manufacturer in the USA. Depending on the waning function assumed for HZ/su, the price per dose needs to drop 60% or 83% such that vaccination with HZ/su, assuming respectively a long or short duration of protection, would become cost-effective in 50- and 80-year-old individuals. At €40,000 per QALY gained, ZVL or ZVL with booster was never found cost-effective compared with HZ/su, even if only administration cost was considered. Conclusion HZ/su is cost-effective in the 50-year-old age cohort at the unofficial Belgian threshold of €40,000 per QALY gained, if its price drops to €55.40 per dose. This result is, however, very sensitive to the assumed duration of protection of the vaccine, and the assumed severity and QALY loss associated with HZ and post-herpetic neuralgia (PHN).

Suggested Citation

  • Zoë Pieters & Benson Ogunjimi & Philippe Beutels & Joke Bilcke, 2022. "Cost-Effectiveness Analysis of Herpes Zoster Vaccination in 50- to 85-Year-Old Immunocompetent Belgian Cohorts: A Comparison between No Vaccination, the Adjuvanted Subunit Vaccine, and Live-Attenuated," PharmacoEconomics, Springer, vol. 40(4), pages 461-476, April.
    • Handle: RePEc:spr:pharme:v:40:y:2022:i:4:d:10.1007_s40273-021-01099-2
    DOI: 10.1007/s40273-021-01099-2
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