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Cost-effectiveness of vaccination of immunocompetent older adults against herpes zoster in the Netherlands: a comparison between the adjuvanted subunit and live-attenuated vaccines
Authors:Pieter T. de Boer  Alies van Lier  Hester de Melker  Albert J. M. van Wijck  Jan C. Wilschut  Albert Jan van Hoek  Maarten J. Postma
Affiliation:1.Centre for Infectious Disease Control,National Institute for Public Health and the Environment,Bilthoven,The Netherlands;2.Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2),University of Groningen, Groningen Research Institute of Pharmacy,Groningen,The Netherlands;3.Pain Clinic,University Medical Centre Utrecht,Utrecht,The Netherlands;4.Department of Medical Microbiology, University Medical Center Groningen,University of Groningen,Groningen,The Netherlands;5.Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health,London School of Hygiene & Tropical Medicine,London,UK;6.Department of Health Sciences,University of Groningen, University Medical Center Groningen,Groningen,The Netherlands;7.Department of Economics, Econometrics & Finance,University of Groningen, Faculty of Economics & Business,Groningen,The Netherlands
Abstract:

Background

The newly registered adjuvanted herpes zoster subunit vaccine (HZ/su) has a higher efficacy than the available live-attenuated vaccine (ZVL). National decision-makers soon need to decide whether to introduce HZ/su or to prefer HZ/su above ZVL.

Methods

Using a Markov model with a decision tree, we conducted a cost-effectiveness analysis of vaccination with HZ/su (two doses within 2?months) or zoster vaccine live (ZVL) (single dose, or single dose with a booster after 10?years) for cohorts of 50-, 60-, 70- or 80-year-olds in the Netherlands. The model was parameterized using vaccine efficacy data from randomized clinical trials and up-to-date incidence, costs and health-related quality of life data from national datasets. We used a time horizon of 15?years, and the analysis was conducted from the societal perspective.

Results

At a coverage of 50%, vaccination with two doses of HZ/su was estimated to prevent 4335 to 10,896 HZ cases, depending on the cohort age. In comparison, this reduction was estimated at 400–4877 for ZVL and 427–6466 for ZVL with a booster. The maximum vaccine cost per series of HZ/su to remain cost-effective to a willingness-to-pay threshold of €20,000 per quality-adjusted life year (QALY) gained ranged from €109.09 for 70-year-olds to €63.68 for 50-year-olds. The cost-effectiveness of ZVL changed considerably by age, with corresponding maximum vaccine cost per dose ranging from €51.37 for 60-year-olds to €0.73 for 80-year-olds. Adding a ZVL booster after 10?years would require a substantial reduction of the maximum cost per dose to remain cost-effective as compared to ZVL single dose. Sensitivity analyses on the vaccine cost demonstrated that there were scenarios in which vaccination with either HZ/su (two doses), ZVL single dose or ZVL + booster could be the most cost-effective strategy.

Conclusions

A strategy with two doses of HZ/su was superior in reducing the burden of HZ as compared to a single dose or single dose + booster of ZVL. Both vaccines could potentially be cost-effective to a conventional Dutch willingness-to-pay threshold for preventive interventions. However, whether HZ/su or ZVL would be the most cost-effective alternative depends largely on the vaccine cost.
Keywords:
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