The new adjuvanted herpes zoster subunit vaccine (HZ/su) would cost less and offer good value compared with the current live attenuated herpes zoster vaccine (ZVL), according to a cost-effectiveness study published in JAMA Internal Medicine.1

Vaccination against herpes zoster is recommended for immunocompetent adults aged 60 years and older. Efficacy rates of 90% have been confirmed for the HZ/su vaccine that persisted across all age groups, with a 3.7-year mean follow-up.2 In addition, unlike ZVL, the HZ/su vaccine can be used in immunocompromised patients. For these reasons, the US Food and Drug Administration Advisory Committee has unanimously voted in favor of HZ/su in adults older than 50 years.3 And in the current JAMA Internal Medicine study, researchers evaluated its economic value.

To test the cost-effectiveness of HZ/su, Markov decision models of the cost-effectiveness of ZVL, HZ/su, and no vaccine strategies were designed and compared using existing randomized controlled trial data. Results from these simulations indicated the HZ/su vaccine is more effective and less expensive than current ZVL at all ages. Sensitivity analysis confirmed this finding across a range of scenarios including efficacy duration, vaccine price, and probability of having postherpetic neuralgia for 12 months or longer.

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These results are based on several assumptions, using current available data; mainly, an assumed price of $280 per series ($140 per dose), high adherence to receiving the complete series, and estimates of single-dose efficacy.

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The researchers note that a decision by the Advisory Committee on Immunization Practices to recommend HZ/su could lead to price increases, and therefore any recommendations should come with a periodic assessment of cost-effectiveness based on vaccine price.


  1. Le P, Rothberg MB. Cost-effectiveness of the adjuvanted herpes zoster subunit vaccine in older adults [published online January 2, 2018]. JAMA Intern Med. doi: 10.1001/jamainternmed.2017.7431
  2. Cunningham AL, Lal H, Kovac M, et al; ZOE-70 Study Group. Efficacy of the herpes zoster subunit vaccine in adults 70 years of age or older. N Engl J Med. 2016;375:1019-1032.
  3. Najafzadeh M. Evolution of herpes zoster vaccines and their economic value [published online January 2, 2018]. JAMA Intern Med. doi: 10.1001/jamainternmed.2017.7442