Buck PO, Curran D, Patterson BJ, Varghese L, van Oorschot D, Carrico J, Hicks K, Lee BY, Yawn BP. Cost-effectiveness of adjuvanted recombinant zoster vaccine (RZV) for vaccinating US adults not previously vaccinated against herpes zoster. Poster presented at the 2018 AMCP Managed Care & Specialty Pharmacy Annual Meeting; April 25, 2018. [abstract] J Manag Care Pharm. 2018 Apr; 24(4-a):S20.

BACKGROUND: Herpes Zoster (HZ) affects one in three adults in the United States (US) 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 US 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 US.

OBJECTIVE: To determine the cost-effectiveness of HZ/su versus no vaccine and versus ZVL for US 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 US 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.

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 US 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.

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