Cost-Effectiveness of New Adjuvanted Herpes Zoster Subunit Vaccine

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The new adjuvanted herpes zoster subunit vaccine will soon be approved by the FDA.
The new adjuvanted herpes zoster subunit vaccine will soon be approved by the FDA.

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.

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.

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.

References

  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
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